Massachusetts General Hospital | MassGeneral Hospital for Children

Thank you for your interest in the Pediatric Critical Care Medicine (PCCM) fellowship at MassGeneral Hospital for Children/Harvard Medical School. The primary objective of the fellowship program is to provide fellows with a learning environment that will enable them to become expert practitioners and leaders in the field of Pediatric Critical Care Medicine. The fellowship director works closely with each fellow throughout their three years of training to tailor his/her experience to meet individual career aspirations. In the past this has included the design of ABP-approved dual subspecialty training in PCCM and other pediatric subspecialties, including emergency medicine and pulmonology.

The program is configured to support seven clinical fellows following the track toward certification by the sub-board of Pediatric Critical Care at the American Board of Pediatrics. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). 

The goals of the program are four-fold:

1) To provide fellows with an understanding of the pathophysiology of life-threatening disease and injury, and the cognitive and technical skills necessary to independently diagnose and manage critically ill infants, children and adolescents.

2) To foster an environment of intellectual curiosity, advance the fellows’ knowledge of the basic principles of research and mentor each fellow in the pursuit of scholarly activity related to pediatric critical care.

3) To enable fellows to become effective educators in pediatric critical care medicine.

4) To help the fellows become efficient administrators, through supervised acquisition of experience in management and problem-solving in a multidisciplinary pediatric intensive care unit.

The PICU fellow works closely with the on-service attending physician and is given graduated responsibility in his/her management of the service. The philosophy of the PICU faculty is that responsibility should increase commensurate with the increase in knowledge and skills that are gained over the three-year fellowship.

Conferences

In addition to bedside teaching and daily case-based discussions on work rounds, the fellows attend weekly didactic teaching conferences (two, hour-long sessions per week) covering a wide array of topics, including basic pathophysiology and management of critical care illness and disease, biostatistics, innovative therapies and more.

Fellows participate in a Leadership Curriculum designed to teach leadership and crisis resource management skills. This curriculum includes participation in simulated case scenarios and attendance of didactic conferences. The emphasis of the curriculum is to improve communication and leadership skills during a crisis, with topics including:

• Role clarification during a clinical crisis
• Communication between medical team members during a crisis
• Communication styles that facilitate co-operation
• Closed loop communication when assigning or accepting tasks
• Speaking up against authority during a crisis

Fellows also participate in an Ethics Curriculum that includes rotating didactic lectures as well as group sessions with families who volunteer to come share with the group their memories of past PICU hospitalizations. The family symposium includes a Mother Grief Group, where families of children who have died in the PICU reflect with staff over the effective and ineffective communication styles they experienced during their ICU stay and the lasting impact these interactions had on them. The Ethics Curriculum also includes a Religious, Spiritual and Cultural Forum, where representatives from various religious faiths and cultures discuss recent cases, allowing the fellow to gain a better perspective of what critical illness and death mean to each one. It also teaches the fellows how to discuss particular concepts, such as brain death, in a culturally sensitive manner.

Fellows are expected to prepare for and participate in monthly morbidity and mortality conferences and journal clubs.

Fellows also participate in a monthly Collaborative Practice Meeting, a multidisciplinary conference focused on quality improvement efforts in the PICU.

Beyond these division-specific conferences, fellows are encouraged to take advantage of the many other didactic conferences offered by MassGeneral Hospital for Children, including Pediatric Grand Rounds, Trauma Conference, Pediatric ECMO conference, Pediatric Transport Conference, Pediatric Ethics Committee meetings and lecture series, and Adult Critical Care/Anesthesia/Pulmonary Conference.

Telemedicine

There are three components to the telemedicine service provided through the MassGeneral Hospital for Children PICU.

First, through our state-of-the art telemedicine link, we provide live video conferencing between the PICU and select patient rooms in emergency departments at outlying community hospitals. Via this link, fellows provide on-demand medical advice and guidance to help assess, and if needed, stabilize critically ill infants and children and prepare them for transport to the PICU.

Secondly, our telemedicine technology currently supports an international link between the Buen Samaritano Hospital in Aguadilla, Puerto Rico and our PICU. Under the supervision of the on-service attending, the fellow provides teaching and consultation on challenging pediatric cases presented by faculty in Puerto Rico.

Finally, this innovative technology is designed to support live video conferencing between the PICU team in-house overnight and the on-service attending, at home. Any member of the team may request a teleconference with the attending for the purpose of virtual bedside evaluation of a new patient, reassessment of a patient whose condition may be deteriorating, or a team meeting with other subspecialty consultants and family members at the bedside. One of the many advantages of this technology is that it allows the on-call fellow the opportunity to be on the frontline, independently leading the unit overnight while still having access to appropriate faculty supervision. All faculty live in close proximity to the hospital and can return to the hospital within minutes to provide direct supervision of the fellow when needed.

Read a recent article about the Mass General PICU Telemedicine Program.

Transport

The PICU at MassGeneral Hospital for Children provides an active critical care transport service for local and regional hospitals throughout New England. All transport calls are fielded by the PICU fellow by telephone or, in some cases, via telemedicine link between the PICU and the outlying hospital. The PICU fellow is required to assess the level of acuity of the patient and to identify the patient’s immediate and transport needs. He/she is expected to provide management advice to the referring physician, determine and coordinate the best mode of transport, and provide ongoing consultation with the transporting team en route to the PICU. All of this is done under the direct supervision of the on-service attending. Senior fellows interested in moonlighting as a transport physician may request permission from the Program Director to do so as long as these hours abide by the duty hours rules set by the ACGME.

Year 1

The block rotations in the first year of the Pediatric Intensive Care Unit (PICU) fellowship training are focused on the development of clinical skills in the ICU, advanced airway management, and an introduction to the principles of research design and performance. Clinical rotations typically include two months in the PICU, one month in the Pediatric Burn ICU at Shriners Hospitals for Children- Boston next door to Massachusetts General Hospital, one month in the Cardiac Intensive Care Unit at Children’s Hospital Boston, and one month in Anesthesia. Fellows also gain experience providing procedural sedation to infants and children undergoing painful procedures or studies requiring no movement.

The first-year fellow is expected to participate in regularly scheduled teaching conferences, morbidity and mortality conference, journal club, mock codes and fellow-run didactic teaching for pediatric residents and medical students on basic pediatric critical care topics.

With respect to scholarly activity, the first-year fellow is scheduled for approximately four months of dedicated research time during which he/she explores various research opportunities and begins laying the foundation for a scholarly project under the guidance of a research mentor.

Year 2

The second-year curriculum continues to provide clinical experience, including two months in the PICU, one month in the burn ICU and one month in the CICU. The second-year fellow is expected to display progressively independent thought and management skills during these service months. The remainder of the year is dedicated to research, with continued participation in weekly teaching conferences and continued contributions to the teaching of pediatric residents and medical students in pediatric critical care medicine.

Year 3

The third-year curriculum continues to focus more on research and teaching, though it also provides clinical experience, including one to two months in the PICU, one month in the burn ICU and one month in the CICU. The third-year fellow is expected to take responsibility for leading work rounds and team meetings and to take on a greater proportion of formal teaching in rounds and lectures. The remaining seven to eight months is dedicated to research, during which time the fellow is expected to complete his/her research project and often present his/her findings at a national conference.

A meaningful supervised research experience is an integral component of the Pediatric Critical Care fellowship at MassGeneral Hospital for Children (MGHfC). Support for the trainee’s research project begins in the first months of fellowship. First-year fellows meet with the Program Director at regular intervals to help identify an area of interest, to visit different labs and to meet with prospective mentors in the Mass General/Harvard system. Research opportunities abound throughout Mass General, Harvard Medical School, Harvard School for Public Health, as well as other academic health care centers in Boston. Offerings range from basic science and translational research to clinical investigation, ethics, international health and education. Each member of the PICU faculty is actively engaged in various types of scholarly activity, and many have acted as research mentors for past fellows. Other fellows have identified research projects and mentors beyond the PICU.

Some examples of scholarly activity undertaken by recent graduates include:

• Travel to Uganda to complete an international health study investigating the use of ultrasound technology in the evaluation of severe pediatric malaria. Resulted in manuscript entitled, “Ultrasound findings in Plasmodium falciparum malaria," Pediatric Critical Care Medicine, 2010.
• Serious Adverse Events during Procedural Sedation with Ketamine. Pediatric Emergency Care. 25(5):325-328. May 2009.
• Translational research employing a mouse model of traumatic brain injury and resulting in the following publication, “Novel role for mannose binding lectin in the pathogenesis of non-spatial memory acquisition after traumatic brain injury in mice.” Journal of Cerebral Blood Flow and Metabolism, 2008.
• “Microparticles for Inhalational Delivery of Antipseudomonal Antibiotics,” American Association of Pharmaceutical Scientists Journal (AAPS J), 2008.
• “Spray-dried lipid-hyaluronan-polymethacrylate microparticles for drug delivery in the peritoneum,” Journal of Biomedical Materials Research, 2008.
• Design and conduct of a leadership curriculum for the PCCM fellows at MGHfC, including a series of interactive lectures and simulation training.
• “Safety of sustained alveolar inflation for alveolar recruitment in pediatric patients with acute respiratory failure,” in submission.
• “Is the degree of neutropenia a risk factor for SBI among children without underlying disease?” Pediatrics, 2006.
• Completion of the Harvard Macy Fellowship in Education and subsequent completion of a project using closed malpractice cases to create medical simulation scenarios to evaluate pediatric residents’ core clinical competencies.
• Following completion of a Fellowship in Medical Ethics through the Harvard Medical School Division of Medical Ethics, completion of an ethics thesis, “Circulatory arrest in a brain dead organ donor: Is the use of cardiac compression permissible. Journal Intensive Care Medicine.” 2009 Nov-Dec.

After identifying a project and research mentor, a scholarship oversight committee (SOC) is created to oversee the scholarly activity of the fellow. In addition, trainees are introduced to basic science techniques, study design, data collection, statistical analysis, and other fundamental areas of study design through seminars offered throughout the Mass General/Harvard Medical School community.

Trainees interested in pursuing a fellowship in Pediatric Critical Care Medicine at MassGeneral Hospital for Children may submit an application online through the Electronic Residency Application Service (ERAS).

Completed applications should include the following documents:

• Common Application Form (CAF)
• Curriculum vitae
• Personal statement
• Three (3) letters of recommendation
• Wallet-sized photograph
• Official medical school transcript
• USMLE transcript
• ECFMG status report (international medical graduates only)

ERAS opens to trainees beginning July 1, 2011. Trainees are encouraged to submit their applications by September 1, 2011 to allow ample time to schedule personal interviews. The last date applications will be accepted is November 1, 2011. The interview period for applicants is July 14, 2011 to November 10, 2011.

Once your application has been received in its entirety and the information reviewed, competitive applicants will be contacted to arrange for a personal interview.

If you have any questions regarding our program, the application process, or the status of your application, please feel free to contact Pat McCarthy, Fellowship Coordinator, by telephone: 617-724-4380 or by e-mail:  pjmccarthy@partners.org

MGHfC Critical Care Medicine Fellowship Program

Phone: 617-724-4380
Fax: 617-724-4391

Public Transportation Access: yes
Disabled Access: yes

If you have any questions regarding our program, the application process or the status of your application, please don’t hesitate to contact us. We look forward to hearing from you and would be happy to talk to you more about how we might tailor the program to meet your individual needs.

Address:
MassGeneral Hospital for Children
Department of Pediatric Critical Care Medicine
175 Cambridge Street, CPZS-5
Boston, MA 02114

Patricia McCarthy
Fellowship Program Coordinator
pjmccarthy@partners.org

Phoebe Yager, MD
Fellowship Program Director
pyager@partners.org

Natan Noviski, MD
Chief, Pediatric Critical Care Medicine
Associate Chair, Department of Pediatrics
Massachusetts General Hospital for Children
nnoviski@partners.org