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Pediatric Intensive Care Unit
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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 faculty work closely with each fellow throughout their three years of training to tailor their 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 of 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.
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In addition to bedside teaching and daily case-based discussions on work rounds, the fellows attend weekly didactic teaching conferences covering a wide array of topics, including basic pathophysiology and management of critical care illness and disease, biostatistics, innovative therapies and more.
Fellow’s Lecture Series: Dedicated fellow lectures are held weekly throughout the academic year and are taught by a mix of faculty and co-fellows. They include introductory topics such as respiratory physiology and mechanical ventilation, and progress to cover topic areas highlighted by the American Board of Pediatrics for critical care medicine.
Departmental Conference: Pediatric critical care lectures are held weekly for the entire department and are presented by a variety of MGH faculty, as well as visiting lecturers.
Morbidity and Mortality Conference: M&M conference is held monthly and presented by the prior month’s on-service fellow. These conferences review important cases from the month, as well as highlight teaching in cases that resulted in a mortality or major morbidity.
Journal Club: With the help of a faculty mentor, fellows are expected to prepare a journal club presentation on a recent topic pertinent to pediatric critical care.
Case Conference: This interdisciplinary conference is presented by a PICU fellow and typically reviews a recent complex case. The conference is attended by invited subspecialists and the entire PICU care team in order to learn and discuss cases which involved many integrated decisions and multiple teams.
Faculty Rounds: Presented monthly by the on-service PICU fellow, this conference aims to discuss the highlights of difficult or interesting cases currently in the unit, with discussion and input from other PICU attendings.
Neurocritical Care Conference: Held monthly, this conference is a collaboration of neurology, neurocritical care, trauma, and neurosurgery. Topics include recent case presentations, literature reviews, and current topics in the field.
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.
Fellows are taught monthly in difficult clinical scenarios with the aid of medical simulation. Utilizing two life-like simulation mannequins, fellows are taught together to work through difficult clinical scenarios in real-time. Simulations are also held in the unit together with residents, nursing, and respiratory therapy. Fellows have the opportunity to design clinical cases and run and de-brief simulations within the unit. Fellows also have the opportunity to assist with simulation exercises held at outside hospitals designed for pediatric hospitalists and other sub-specialties.
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.
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.
Clinical training occurs primarily at the Massachusetts General Hospital Pediatric Intensive Care Unit, a 14-bed medical/surgical unit located on Bigelow 6. 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.
Additional clinical training occurs in pediatric burn care at Shriners’ Hospitals for Children, and in the 32-bed cardiac intensive care unit (CICU) at Boston Children's Hospital.
Fellows also learn the art of delivering procedural sedation as part of a robust inpatient/outpatient sedation program located within the MGH PICU.
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.
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.
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.
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.
“Cerebral near infrared spectroscopy insensitively detects cerebral venous oxygen saturations following stage 1 palliation”: Erin Rescoe, MD
“Use of MRI in the Acute Management of Pediatric Traumatic Brain Injury”: Niharika Samtani, MD. Read more.
Rescoe, E, Tang, X, Perry, D, Sleeper, L DiNardo, J, Kussman, B, Kheir, J. Cerebral near-infrared spectroscopy insensitively detects low cerebral venous oxygen saturations after stage 1 palliation. The Journal of Thoracic and Cardiovascular Sur. June 2017. Article in Press.
Bortcosh, W. Siedner, M. Carroll, R. Utility of the Urine Reagent Strip Leukocyte Esterase Assay for the Diagnosis of Meningitis in Resource- Limited Settings: Meta-Analysis. Trop Med Int Health. 2017 Jun 19. doi: 10.1111/tmi.12913. [Epub ahead of print].
Flaherty, MR., Raybould,T, Jamal-Allial,A., Kaafarani,H.,Lee,J.,Gervasini,A.,Ginsburg, R.,Mandell,M., Donelan,K.,Masiakos,P. Impact of a State Concussion Law on Physician Practice in the Care of Sports-Related Concussions. J.Peds. 2016 Nov;178:268-274.
Erin Rescoe, MD: “Cerebral near infrared spectroscopy insensitively detects cerebral venous oxygen saturations following stage 1 palliation” Poster presentation at the American Heart Association National Conference 2016
Michael Flaherty, DO: “The Effect of Massachusetts State Legislation on Off-Road Vehicle Injuries in Children” Platform and poster presentation at the American Academy of Pediatrics Meeting, San Francisco, CA October 2016. Read more.
Duran C, Noviski N. Fiberoptic flexible bronchoscopy in children with pulmonary disease (Broncoscopía con fibra óptica en el paciente pediátrico). In: Quiñones E, Ugazzi F, Donoso F, and Endara S, eds. Bases de neumología pediátrica. Quito: Ed. Noción; 2006. p. 126-35.
Tsifansky M, Duran C, Noviski, N. Asma Casi Mortal. Epidemiología, Fisipatología Y Manejo. In: Quinones, E, Ugazzi, M, Campos, S, Donoso, F, Noviski, N. eds. Bases de pediatria critica, 4th ed. Quito: Cmiuio; 2007. p. 102-08. Read more.
Byrnes, C. Harvard Macy Fellowship in Education, 2008-2009.
Finkelstein, R. Winner of the Massachusetts State Basic Science Competition, 2010 American College of Surgeons Committee on Trauma Competition. Read more.
Thank you for your interest in the Pediatric Critical Care Medicine Fellowship at the MassGeneral Hospital for Children. We accept applications electronically through ERAS (Electronic Residency Application Service) on the July application cycle.
We participate in the NRMP Match program (National Resident Matching Program) on the Pediatric Specialties Fall Match cycle for fellowships. To register, please see instructions for applicants under “Fellowship”.
ERAS opens for applications in June each year, and programs receive applications in mid-July. Applicants are encouraged to complete applications as soon as possible or by August 15th, which affords ample time for the program to review all applications and schedule personal interviews for competitive applicants. Interviews are held between September and early November, before the December match date. Matched applicants begin fellowship training the following July. Applications should include the following documents via ERAS:
Applicants must have graduated from an ACGME-accredited Pediatrics or Medicine-Pediatrics residency program in the United States, or accredited Canadian equivalent. We prefer applicants who will be board eligible or certified in Pediatrics as determined by the American Board of Pediatrics. International Medical Graduates: Applicants must be ECFMG certified. We sponsor J1-ECFMG and H1B visas for competitive applicants. Applicants must not have exceeded maximums of stay for a visa. There must be a minimum of 3 three years remaining on the applicant’s visa in order to complete fellowship training. To apply through ERAS click here: ECFMG ERAS Support 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 at firstname.lastname@example.org .
MGHfC Critical Care Medicine Fellowship Program CPZS-5 175 Cambridge Street Boston, MA 02114 Phone: 617-724-4380 Fax: 617-724-4391
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 email@example.com
Phoebe Yager, MD Fellowship Program Director Chief, Pediatric Critical Care Medicine firstname.lastname@example.org
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