Critical Care

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 months of clinical service in the PICU, one month with anesthesiology and four months in the CICU with the remaining 18 months of the fellowship dedicated to research and scholarly activity and elective time, if desired.

Schedule by Year:

As shown above, during the first year, four months are devoted to fellows’ research interests. In the second year of training, fellows spend six months 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 eight to nine months of research and two months 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 serve on 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 and a full complement of social work, nutrition, pharmacy, Child Life and pastoral care support. Each night and weekend is covered by two fellows and two residents.

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 directors for our busy transport team.

Our structured academic program is as follows:

• Tuesday afternoons: Fellow ‘Research Foundation’ Seminars, Research in Progress, Faculty Research Seminars
• Wednesday afternoons: Fellow Fundamental Didactic Conferences
• Thursday afternoons: Fellows Rounds (Group case discussions, Ethics, Morbidity and Mortality Conferences, Faculty Forum)

All of these didactics 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, and education. Our previous fellows have an impressive record of accomplishments including 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 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