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The Division of Pediatric Critical Care Medicine offers a Pediatric Critical Care Fellowship accredited by the Accreditation Council for Graduate Medical Education. Clinical training is received at St. Louis Children's Hospital, a nationally recognized pediatric quaternary referral center on the campus of the Washington University Medical Center. St. Louis Children's Hospital serves eastern and southern Missouri, central and southern Illinois, northwestern Kentucky, western Indiana, as well as the broader national and international communities. Pediatric intensive care services at St. Louis Children's Hospital (a regional and national referral center) are provided in two state-of-the-art ICU's, a 24-bed PICU (general medical and surgical intensive care) and a 12-bed CICU (cardiac and cardiothoracic intensive care). These two intensive care units boast active medical/surgical and cardiac services (~ 8000 patient days/year). The PICU and CICU are supported by all pediatric medical and surgical specialties. In addition, they support an ECMO program, a hemofiltration service and a busy solid organ transplant program (kidney, liver, heart, lung), including the largest pediatric lung transplant program in the world. Interventional radiology, CT and cardiac catheterization suites are located immediately adjacent to both intensive care units. PCCM fellows and faculty assist with all pediatric critical care transports (~ 1500 transports annually, making it one of the busiest pediatric transport services in the country). Fellows also participate as members of the transport team and are exposed to the management of a regional referral system. Finally, St. Louis Children's Hospital has a busy Emergency Department (~ 60,000 visits/year), including a Level 1 trauma center and the only pediatric burn center in the region. The Pediatric Critical Care faculty consists of ten physicians. All faculty have academic appointments through the Washington University School of Medicine. Faculty are all board certified in Pediatrics and in Pediatric Critical Care Medicine. In addition, some faculty are also board certified in Anesthesia or Pediatric Cardiology. Pediatric Critical Care faculty have diverse scholarly interests encompassing both the clinical and basic sciences, in addition to their responsibilities for patient care and education. Clinical research interests include pulmonary hypertension, traumatic brain injury, quality/medical error reduction and the epidemiology of critical illness in children. We have a vibrant clinical research program. At present, the Division of Pediatric Critical Care Medicine is supporting 11 clinical trials, with 6 more trials beginning within the next year. These trials include (but are not limited to) studies in: - Traumatic brain injury
- RBC biology and vasoregulation
- Surfactant use in pediatric respiratory failure
- Pulmonary hypertension
- Reperfusion injury
- Nosocomial infection
- Glycemic control in the ICU setting
- Therapeutic hypothermia (traumatic brain injury and cardiac arrest)
In addition, pediatric critical care faculty are carrying out fundamental basic research, investigating the genetics of growth control and tissue regeneration, cardiomyocyte metabolomics, the pathobiology of invasive streptococcal infections and fundamental red blood cell physiology and vasoregulation. Faculty are heavily involved in the field at the national level, with leadership roles in the Pediatric Cardiac Critical Care Society, the American Board of Pediatrics Sub-board of Pediatric Critical Care Medicine, the Society for Critical Care Medicine, the Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI), the Society for Pediatric Research (SPR) and the NACHRI/Virtual PICU consortium. The primary objective of the Pediatric Critical Care Medicine fellowship is to prepare individuals for an academic career in Pediatric Critical Care Medicine. Accordingly, the program's specific goal is to provide trainees with the knowledge and basic experience to become: - Accomplished clinicians, through:
- Guided study of the pathophysiology of medical and surgical critical illness in infants and children
- Learning of skills in diagnostic and therapeutic procedures used in the management of these patients
- Development of the attitudes and communication skills appropriate to facilitate interaction with patients, families, physicians, nurses, and other health professionals
- Effective medical educators, through:
- Contact with appropriate role models at the bedside and during didactic presentations
- Critical commentary by faculty on didactic presentations and participation in conferences organized or led by the trainee
- Carefully monitored supervision of residents and medical students
- Promising researchers in basic science and clinical investigation, through:
- Supervised progression toward formulation of testable research hypothesis
- Learning of proper experimental design and methodology
- Efficient administrators, through supervised acquisition of experience in management and problem solving in a multidisciplinary pediatric intensive care unit
To fulfill its objectives, as outlined above, the Critical Care Program's curriculum is designed to allow a gradual acquisition of both cognitive knowledge and practical skills. Initially, the focus is on the basic assessment and therapy of organ system dysfunction. Thereafter, fellows are encouraged to develop increasing sophistication in their understanding of disease processes and management, leading to independent decision-making and the ability to supervise others. Based on this progression, fellows receive increasing levels of responsibility in patient care, teaching, and supervision of junior fellows, house staff and medical students, and clinical administration during the three years of fellowship. The first year is fully structured, almost entirely clinical, and designed to provide the fellow with the necessary experience to become an excellent clinician. Clinical rotations include: - Eight months of Pediatric Intensive Care Medicine (including multiple rotations in both the PICU and the CICU). Fellows are primarily responsible for all medical patients and co-manage all surgical patients. Beginning July 2009, we will move to a system wherein fellows on clinical service will cover the PICU and CICU either as part of the daytime team or as a night float.
- One month of Pediatric Anesthesiology early in the year, designed to teach airway management, invasive monitoring and the pharmacology of sedation and anesthesia.
- One month of Cardiac Catheterization, designed to teach hemodynamics and vascular access.
- One month of elective.
- The remaining month is available for vacation and to begin the process of selecting a scholarly project that will commence during the second year.
Clinical rotations during the second and third years are generally limited to 3-4 months, including rotations in the PICU and CICU, as well as electives. Elective rotations available during the three years are designed to provide additional educational opportunities in specific areas relevant to the care of critically ill children. At present, they include Cardiothoracic Surgery, Nephrology, Adult Critical Care Medicine, Advanced Anesthesiology and Adult Neuro-Intensive Care; others are available depending on each fellow's specific interests. The majority of the fellow's time during years 2 and 3 is reserved for research. It is anticipated that as of July 2009 when we migrate to a night float system, research time will be largely call free. Research is performed under the guidance of an experienced principal investigator (mentor) in either the clinical or basic sciences. Mentors may be selected from any department/program within Washington University. Indeed, fellows are encouraged to look broadly when choosing a research mentor. The program is highly supportive of initiatives directed at the development of physician-scholars (both basic science and clinical research), including the Pediatric Scientist Development Program and the Clinical Research Training Center (CRTC) at Washington University that is part of the Institute of Clinical and Translational Sciences (ICTS). Along with the experience obtained from the various clinical rotations, fellows are expected to base their development as clinicians on sound knowledge of the biological processes that underlie critical illnesses, the diagnostic and therapeutic methods of the subspecialty, and the processes used in the critical evaluation of clinical information. To guide acquisition of this knowledge, a clinical curriculum has been prepared. The specific items in this curriculum will be covered in teaching conferences within the Division of Pediatric Critical Care Medicine (Monday M&M conference [bi-monthly], Monday QI conference [bi-monthly], Wednesday fellow conference [weekly], Thursday journal club [monthly], Thursday research in progress conference [monthly], Thursday fellow case of the month conference [monthly]) or the Department of Pediatrics (Tuesday fellow conference). The Fellowship Program participates both in ERAS and in the National Resident Matching Program for Pediatric Critical Care Medicine. For fellowship training beginning in July 2010, applicants can download the ERAS Applicant User Guide beginning in mid-late June 2009. The ERAS application service will open July 1st, 2009. At this time, applicants may begin to work on their applications and upload their application materials. For our fellowship, we will require the common application form (CAF), personal statement, three letters of reference and a picture. Please consult the ERAS web site for further details. We will begin to access applications beginning July 15th. Completed applications are screened and selected applicants are invited to travel to St. Louis to meet with our faculty and fellows and tour the facilities. These interviews will commence in late July and continue until October/November. We will partially offset the cost of this visit. For the NRMP Pediatric Critical Care match, applicants may register beginning August 12, 2009. Rank order list submission commences October 7th, 2009 and closes November 18th, 2009. Match day is December 2nd, 2009. Please consult the NRMP web site for further details. If you require additional in formation, please contact:
Tracey Erdman
Department of Pediatrics
Division of Critical Care Medicine
Washington University School of Medicine
St. Louis Children's Hospital
One Children's Place, Suite 5S20
St. Louis, MO 63110.
The Division of Pediatric Critical Care Medicine offers a Pediatric Critical Care Fellowship accredited by the Accreditation Council for Graduate Medical Education. Clinical training is received at St. Louis Children's Hospital, a nationally recognized pediatric quaternary referral center on the campus of the Washington University Medical Center. St. Louis Children's Hospital serves eastern and southern Missouri, central and southern Illinois, northwestern Kentucky, western Indiana, as well as the broader national and international communities. Pediatric intensive care services at St. Louis Children's Hospital (a regional and national referral center) are provided in two state-of-the-art ICU's, a 24-bed PICU (general medical and surgical intensive care) and a 12-bed CICU (cardiac and cardiothoracic intensive care). These two intensive care units boast active medical/surgical and cardiac services (~ 8000 patient days/year). The PICU and CICU are supported by all pediatric medical and surgical specialties. In addition, they support an ECMO program, a hemofiltration service and a busy solid organ transplant program (kidney, liver, heart, lung), including the largest pediatric lung transplant program in the world. Interventional radiology, CT and cardiac catheterization suites are located immediately adjacent to both intensive care units. PCCM fellows and faculty assist with all pediatric critical care transports (~ 1500 transports annually, making it one of the busiest pediatric transport services in the country). Fellows also participate as members of the transport team and are exposed to the management of a regional referral system. Finally, St. Louis Children's Hospital has a busy Emergency Department (~ 60,000 visits/year), including a Level 1 trauma center and the only pediatric burn center in the region. The Pediatric Critical Care faculty consists of ten physicians. All faculty have academic appointments through the Washington University School of Medicine. Faculty are all board certified in Pediatrics and in Pediatric Critical Care Medicine. In addition, some faculty are also board certified in Anesthesia or Pediatric Cardiology. Pediatric Critical Care faculty have diverse scholarly interests encompassing both the clinical and basic sciences, in addition to their responsibilities for patient care and education. Clinical research interests include pulmonary hypertension, traumatic brain injury, quality/medical error reduction and the epidemiology of critical illness in children. We have a vibrant clinical research program. At present, the Division of Pediatric Critical Care Medicine is supporting 11 clinical trials, with 6 more trials beginning within the next year. These trials include (but are not limited to) studies in: - Traumatic brain injury
- RBC biology and vasoregulation
- Surfactant use in pediatric respiratory failure
- Pulmonary hypertension
- Reperfusion injury
- Nosocomial infection
- Glycemic control in the ICU setting
- Therapeutic hypothermia (traumatic brain injury and cardiac arrest)
In addition, pediatric critical care faculty are carrying out fundamental basic research, investigating the genetics of growth control and tissue regeneration, cardiomyocyte metabolomics, the pathobiology of invasive streptococcal infections and fundamental red blood cell physiology and vasoregulation. Faculty are heavily involved in the field at the national level, with leadership roles in the Pediatric Cardiac Critical Care Society, the American Board of Pediatrics Sub-board of Pediatric Critical Care Medicine, the Society for Critical Care Medicine, the Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI), the Society for Pediatric Research (SPR) and the NACHRI/Virtual PICU consortium. The primary objective of the Pediatric Critical Care Medicine fellowship is to prepare individuals for an academic career in Pediatric Critical Care Medicine. Accordingly, the program's specific goal is to provide trainees with the knowledge and basic experience to become: - Accomplished clinicians, through:
- Guided study of the pathophysiology of medical and surgical critical illness in infants and children
- Learning of skills in diagnostic and therapeutic procedures used in the management of these patients
- Development of the attitudes and communication skills appropriate to facilitate interaction with patients, families, physicians, nurses, and other health professionals
- Effective medical educators, through:
- Contact with appropriate role models at the bedside and during didactic presentations
- Critical commentary by faculty on didactic presentations and participation in conferences organized or led by the trainee
- Carefully monitored supervision of residents and medical students
- Promising researchers in basic science and clinical investigation, through:
- Supervised progression toward formulation of testable research hypothesis
- Learning of proper experimental design and methodology
- Efficient administrators, through supervised acquisition of experience in management and problem solving in a multidisciplinary pediatric intensive care unit
To fulfill its objectives, as outlined above, the Critical Care Program's curriculum is designed to allow a gradual acquisition of both cognitive knowledge and practical skills. Initially, the focus is on the basic assessment and therapy of organ system dysfunction. Thereafter, fellows are encouraged to develop increasing sophistication in their understanding of disease processes and management, leading to independent decision-making and the ability to supervise others. Based on this progression, fellows receive increasing levels of responsibility in patient care, teaching, and supervision of junior fellows, house staff and medical students, and clinical administration during the three years of fellowship. The first year is fully structured, almost entirely clinical, and designed to provide the fellow with the necessary experience to become an excellent clinician. Clinical rotations include: - Eight months of Pediatric Intensive Care Medicine (including multiple rotations in both the PICU and the CICU). Fellows are primarily responsible for all medical patients and co-manage all surgical patients. Beginning July 2009, we will move to a system wherein fellows on clinical service will cover the PICU and CICU either as part of the daytime team or as a night float.
- One month of Pediatric Anesthesiology early in the year, designed to teach airway management, invasive monitoring and the pharmacology of sedation and anesthesia.
- One month of Cardiac Catheterization, designed to teach hemodynamics and vascular access.
- One month of elective.
- The remaining month is available for vacation and to begin the process of selecting a scholarly project that will commence during the second year.
Clinical rotations during the second and third years are generally limited to 3-4 months, including rotations in the PICU and CICU, as well as electives. Elective rotations available during the three years are designed to provide additional educational opportunities in specific areas relevant to the care of critically ill children. At present, they include Cardiothoracic Surgery, Nephrology, Adult Critical Care Medicine, Advanced Anesthesiology and Adult Neuro-Intensive Care; others are available depending on each fellow's specific interests. The majority of the fellow's time during years 2 and 3 is reserved for research. It is anticipated that as of July 2009 when we migrate to a night float system, research time will be largely call free. Research is performed under the guidance of an experienced principal investigator (mentor) in either the clinical or basic sciences. Mentors may be selected from any department/program within Washington University. Indeed, fellows are encouraged to look broadly when choosing a research mentor. The program is highly supportive of initiatives directed at the development of physician-scholars (both basic science and clinical research), including the Pediatric Scientist Development Program and the Clinical Research Training Center (CRTC) at Washington University that is part of the Institute of Clinical and Translational Sciences (ICTS). Along with the experience obtained from the various clinical rotations, fellows are expected to base their development as clinicians on sound knowledge of the biological processes that underlie critical illnesses, the diagnostic and therapeutic methods of the subspecialty, and the processes used in the critical evaluation of clinical information. To guide acquisition of this knowledge, a clinical curriculum has been prepared. The specific items in this curriculum will be covered in teaching conferences within the Division of Pediatric Critical Care Medicine (Monday M&M conference [bi-monthly], Monday QI conference [bi-monthly], Wednesday fellow conference [weekly], Thursday journal club [monthly], Thursday research in progress conference [monthly], Thursday fellow case of the month conference [monthly]) or the Department of Pediatrics (Tuesday fellow conference). The Fellowship Program participates both in ERAS and in the National Resident Matching Program for Pediatric Critical Care Medicine. For fellowship training beginning in July 2010, applicants can download the ERAS Applicant User Guide beginning in mid-late June 2009. The ERAS application service will open July 1st, 2009. At this time, applicants may begin to work on their applications and upload their application materials. For our fellowship, we will require the common application form (CAF), personal statement, three letters of reference and a picture. Please consult the ERAS web site for further details. We will begin to access applications beginning July 15th. Completed applications are screened and selected applicants are invited to travel to St. Louis to meet with our faculty and fellows and tour the facilities. These interviews will commence in late July and continue until October/November. We will partially offset the cost of this visit. For the NRMP Pediatric Critical Care match, applicants may register beginning August 12, 2009. Rank order list submission commences October 7th, 2009 and closes November 18th, 2009. Match day is December 2nd, 2009. Please consult the NRMP web site for further details. If you require additional in formation, please contact:
Tracey Erdman
Department of Pediatrics
Division of Critical Care Medicine
Washington University School of Medicine
St. Louis Children's Hospital
One Children's Place, Suite 5S20
St. Louis, MO 63110.
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