Our fellowship program offers comprehensive clinical exposure to pediatric critical care medicine. Fellows are directly involved in the management of all PICU patients and assume increasing independence and autonomy as they progress through the training period.
The pediatric critical care unit is the primary inpatient service location for pediatric critical care fellows. As a “mixed” unit, we care for both general (medical/surgical) and cardiovascular surgical (CV) patients in a single unit, with separate clinical teams caring for these 2 populations. The curriculum is designed to allow increasing fellow responsibility and autonomy across the 3-year program.
During service months, fellows gain exposure to state of the art therapeutic and monitoring technologies, such as extracorporeal membranous oxygenation, intracranial pressure monitoring, negative-pressure ventilation, paced diaphragmatic stimulation, and continuous hemoglobin monitoring. In addition to leading the multidisciplinary PICU team, fellows play an active role in the medical management of all critically ill surgical patients. Examples of surgical subspecialists who commonly admit patients to the PICU include general surgery, trauma surgery, neurosurgery, orthopedic surgery, and otolaryngology. Medical and surgical consultative services are readily available to provide assistance and expertise. All children requiring cardiovascular surgery, including neonates, are managed post-operatively in the PICU.
The Division of Pediatric Critical Care Medicine consists of 9 board certified (or eligible) pediatric intensivists. In addition, 7 specialty trained advanced practice providers assist with around-the-clock patient management. The ICU is staffed by highly skilled critical care nurses, respiratory therapists, residents, students, clinical pharmacists, registered dietitians, physical/occupational/speech therapists, and social workers. The team-based approach facilitates commitment to a patient- and family-centered environment.
A general template of rotations across the 3 years is provided below. There will be 13 four-week rotations per academic year. Service time is split between the general and CV ICU services, with relatively more time spent on the general ICU service (night call involves coverage of both general and CV ICU patients). The majority of clinical service occurs during the first year. Additional first year rotations in anesthesiology and cardiovascular surgery provide additional exposure to airway management and operative approaches to congenital heart disease. This arrangement ensures the development of a strong foundation in the management of critically ill children early on in training, while also allowing more dedicated time in the latter years to focus on research and other individualized areas of interest through elective rotations (such as procedural sedation and pediatric critical care transport).
CV Surgery/Cath Lab
*Elective options: Pediatric critical care transport, Procedural sedation, Onco-critical care, Advanced heart failure, Simulation, Pulmonology/bronchoscopy, Echocardiography
Our program offers a growing list of research opportunities for our fellows, who spend over 40% of their 3-year program dedicated to research (17 four-week blocks over 3 years). Within the division of pediatric critical care medicine, we have faculty conducting scholarly work in clinical research, patient safety, quality improvement, medical education, and simulation. Fellows may also choose to align with mentors outside the division at the institution, either in collaboration with (or independently from) pediatric critical care faculty.
With faculty mentorship, fellows are expected to develop hypothesis-drive projects, test their hypotheses in academically appropriate fashion, analyze their collected data, and ultimately present and publish their results. The fellows’ schedule is balanced in such a way to allow introduction to scholarly opportunities in the first year while focusing mainly on clinical duties. This structure enables fellows to select a research project by the end of their first year of training, followed by more dedicated time in the latter 2 years to conduct their scholarly work.
In addition to independent scholarly work, faculty members in the division of pediatric critical care have collaborated with faculty members from other divisions on various scholarly projects and are eager to mentor fellows in these collaborations. Recent examples of collaboration include projects between critical faculty and representatives from hospitalist medicine, cardiology, hematology, emergency medicine, surgery, cardiovascular surgery, sedation services, and simulation divisions. Furthermore, the division of pediatric critical care medicine is a member of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) research collaborative and is actively engaged in several affiliated projects.
Although opportunities for fellows to participate in basic science research are currently limited on our campus, recent additions (both in the division of pediatric critical care medicine and in the department of pediatrics) create the potential to establish a basic science track in the near future.
The educational component of the fellowship program combines bedside teaching with various didactic opportunities. Some didactic experiences are designed specifically for PCCM fellows, others incorporate faculty in the division of critical care, while some include pediatric fellows from other disciplines within the institution. In addition to their own learning experiences, fellows have ample opportunities to teach other learners, whether in clinical situations, through didactic lectures, or in a simulated environment.
The formal lecture series designed specifically for PCCM fellows incorporates a variety of formats focused on topics relevant to critical care. The curriculum includes the following:
PICU case conference
in depth discussion of recent PICU cases
high level discussion of critical care physiology (e.g., ventilator management, renal replacement therapy, cardiopulmonary interactions, etc.)
review of landmark publications in pediatric critical care in addition to appraisal of recent relevant publications with focus on evidence-based concepts
practice questions to help prepare fellows to pass ABP PCCM board exam
morbidity and mortality conference for the pediatric intensive care unit
periodic updates from faculty and fellows of ongoing scholarly work, particularly in preparation for regional, national, or international presentations
Common curriculum for pediatric fellows (CCPF)
shared curriculum among all pediatric fellowship programs at the institution to cover elements of care that share commonalities across specialties
Cardiac catheterization conference
discussion of upcoming surgical and cath lab cases for that week
Cardiac core physiology conference
focused discussion on important cardiac critical care concepts
morbidity and mortality conference for the congenital heart program
multidisciplinary discussion of recent ECMO outcomes, literature updates, etc.
resident-led Department of Pediatrics morbidity, mortality, & improvement conference
weekly presentation covering wide variety of topics hosted by the Department of Pediatrics
Below is a template of didactic experiences for fellows in a typical 4 week block:
In addition to required educational experiences, there are additional optional opportunities available for fellows, such as:
Stanford Faculty Development Core Curriculum for Clinical Teaching program, which is offered locally
Pediatric Fundamental Critical Care Support, a Society of Critical Care Medicine-led program designed to improve the skills of those who care for critically ill children
Specialized training in point-of-care ultrasound (POCUS), including certification in POCUS through a program offered through the Department of Emergency Medicine
Simulation certification through a training program offered at Jump Simulation
Fellowship Program Director
Dr. Jon Gehlbach
Assistant Professor of Clinical Pediatrics [email protected]