Critical Care Medicine Fellowship

Cincinnati Children’s serves as the primary children’s hospital for Southern Ohio, Northern Kentucky and Eastern Indiana as well as serving as a quaternary national and international referral center for many subspecialty medical and surgical teams. The breadth of the clinical experience at Cincinnati Children’s covers the full range of life-threatening medical disorders. We are the primary trauma center in Southwestern Ohio and routinely care for infant, school-age children, and adolescents with severe trauma. We care for the full array of patients receiving organ and bone marrow transplantation, our surgeons are active with liver, small bowel, kidney, heart, and lung transplants. Additionally, we care for children who receive many unique surgeries performed by Cincinnati Children's surgeons including complex airway reconstruction, cardiothoracic and neurosurgery, genitourinary, and craniofacial reconstruction.

Our PICU cares for patients on all forms of extracorporeal support including extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT), molecular adsorbent recirculation system (MARS), ventricular assist devices (VAD), and many other services. Of the over 2750 admissions yearly, approximately 1/3 are surgical and 2/3 are medical patients. The Cardiac Intensive Care unit admits over 750 patients yearly. Our program provides an unmatched clinical experience to prepare fellows for academic careers in Pediatric Critical Care Medicine.

During the three-year fellowship, fellows complete 12 four-week blocks of clinical service in the PICU, one four-week block with anesthesiology and four four-week blocks in the CICU with the remaining 22 blocks of the fellowship dedicated to research and scholarly activity and elective time, if desired.

Schedule by Year:

 

Four-Week Blocks	Year 1	Year 2	Year 3
PICU Service	6	4	2
CICU Service	1	2	1
Research	5	7	10
Anesthesia	1

As shown above, during the first year, five blocks are devoted to fellows’ research interests. In the second year of training, fellows spend six blocks on clinical service in the PICU/CCU, with the remainder of time spent in research pursuits. The third year is tailored to the individual needs of each fellow, but includes at least nine to 10 blocks of research and two blocks as a junior-level attending in the PICU. A strong emphasis is placed on independent decision making by the fellows, especially as they gain experience.

Fellows perform in-house call every fourth night when “on service” and every seventh night when “off service.” The ICU is covered by two teams, consisting of one attending, two fellows, four residents, one advanced practice registered nurse, and a full complement of social work, nutrition, pharmacy, Child Life and pastoral care support. Each night is covered by two fellows and two residents, one advanced practice registered nurse, and one in house attending.

Through a combination of clinical experiences, didactics and case conferences, fellows become thoroughly knowledgeable and competent in managing various critical-care situations, including single- and multiple-organ failure in both previously healthy and extremely medically complex infants, children and adolescents. Critical Care fellows learn the theoretical and practical aspects of invasive and non-invasive monitoring and support, as well as the complexities of working with a variety of medical and surgical subspecialists. Our fellows also serve as medical control for our busy transport team.

Our structured academic program is as follows:

• Tuesday afternoons: Fellow ‘Research Foundation’ Seminars, Research in Progress, Faculty Research Seminars and Career Development Seminars
• Wednesday afternoons: Fellow Fundamental Conferences consisting of a mixture of didactic and experiential sessions.
• Thursday afternoons: Fellows Rounds (Group case discussions, Ethics, Morbidity and Mortality Conferences, Faculty Forum)
• Comprehensive in-situ and lab- based simulation program with multiple sessions per month.

All of these educational experiences provide a robust foundation for the pathophysiology of organ failure in a variety of contexts and to review the state-of-the-art evidence-based care for these problems. The Graduate Medical Education Committee at Cincinnati Children’s also provides an excellent core curriculum addressing many aspects of the ACGME core competencies.

Academic opportunities are available throughout the duration of fellowship. Faculty members continuously present opportunities for the fellows to engage in the process of academia – ranging from participating in clinical improvement work, reviewing manuscripts submitted for peer-review publication, writing editorials/review articles/book chapters, and capitalizing on tremendous research capital. Fellows serve as primary mentors, educators, and role-models for our highly ranked and regarded pediatric residency program – and have frequently garnered hospital wide recognition (teaching awards, service awards).

A primary strength of our fellowship is the tremendous depth and breadth of scholarly activity. Our program is focused on providing our fellow trainees with the necessary foundation required for a lifelong pursuit of research and scholarly activity. We have many unique opportunities available inclusive of basic science, clinical trials and research, simulation science, quality improvement, advocacy and education. Our previous fellows have an impressive record of accomplishments including securement of grant funding, multiple publications, attainment of advanced degrees, presentations and awards at national meetings. High level opportunities within the division include training in basic science research and translational research with accomplished NIH-funded clinician scientists and PhD scientists. We also work with fellows to leverage the internationally recognized research resources available at Cincinnati Children’s Hospital to identify and match up to additional mentors outside the division who can guide them in pursuing research interests beyond the scope of our division-wide research efforts.

Download a visual representation of how our faculty are engaged in every stage of biomedical research, investigating critical illness from the bench to the bedside and beyond.

We share an NIH T-32 training grant with the Department of Surgery at the University of Cincinnati. This grant provides funding for fellows to stay an additional year to further their training in UC’s basic science research program.

Other scholarly opportunities include full support for advanced degrees:

• Master’s Degree in Education
• Master of Science in Clinical Research
• The Quality Scholars Program
• Master’s Degree in Public Health

Mentorship is paramount for fellows in training. Our fellows are partnered with designated faculty mentors early on in their first year to help guide clinical, research, academic, job, and professional progress. Specific attention is paid to identification of a clinical and academic niche. Research mentors also contribute significantly to the development of our fellows. Peer-to-peer mentorship within the fellowship is also heavily emphasized.