Critical Care Medicine Fellowship
Curriculum

The PCCM fellowship curriculum combines comprehensive clinical training, didactic experiences, and mentored scholarship activity to prepare fellows for careers in academic pediatric critical care. The program is 3 years in duration and is fully accredited by the ACGME. All components of the educational program have structured goals and objectives focused on developing core competencies specified by the American Board of Pediatrics. Initial emphasis is on developing and ensuring clinical competence, with the latter part of the curriculum directed at supporting meaningful accomplishment in a focused area of scholarly activity. Clinical training is complemented by an integrated didactic curriculum covering the full spectrum of pediatric critical care topics. The first year of training is focused on learning the core physiology, pathophysiology, bedside management, and procedures necessary for the effective practice of PCCM. In the second year of the fellowship, increasing emphasis is placed on supervising the clinical services, and in the third year, fellows develop administrative and leadership experience in the ICUs by functioning at the level of “acting” attending with the back up and oversight of the PCCM faculty. Throughout the fellowship, PCCM fellows are integrally involved in the teaching of pediatric residents, students, and other subspecialty fellows rotating through the ICUs.

The University of Washington/Seattle Children’s Hospital has ACGME approved fellowship programs in all pediatric subspecialties, thus, combined training in a second subspecialty of pediatrics along with Pediatric Critical Care Medicine may be arranged with prior approval of the American Board of Pediatrics.

Clinical Training

Under the supervision of PCCM faculty, fellows direct clinical care in the pediatric intensive care unit (PICU), the cardiac intensive care unit (CICU), and on the extracorporeal life support service at Seattle Children’s Hospital, and in the Burn/Trauma PICU at Harborview Medical Center (HMC), the regional trauma referral center serving Washington, Alaska, Wyoming, Montana, and Idaho.  PCCM fellows take in-house call on the PICU and CICU services at Seattle Children’s Hospital. Night call on the Burn/Trauma rotations at HMC is home call and PCCM fellows return to the hospital to supervise patient care as needed.  At the beginning of training incoming fellows participate in intensive two-week “Boot Camp” which includes a core lecture series, orientation to the Children’s Hospital and ICU facilities, CPOE/Health information systems, ICU nursing and respiratory departments, PALS recertification (if needed), and participation in a two-day ECMO/ECLS workshop.

Fellowship clinical training includes the following rotations:

1. Pediatric Intensive Care Unit: The PICU Service at Seattle Children’s Hospital is a mixed medical/surgical service providing comprehensive care to critically ill children. Working collaboratively with our pediatric subspecialty and surgical colleagues, PCCM faculty and fellows oversee the care of ALL patients in the PICU.  As the major tertiary pediatric critical care referral center for the Pacific Northwest and Alaska, the PICU manages the full spectrum of pediatric critical illness including respiratory failure, cardiovascular failure, neurological disorders, hematology/oncology/BMT, solid organ transplant, and major orthopedic, neurosurgical, pediatric, plastic/reconstructive, and ENT surgery. On the PICU rotations, fellows directly manage patient care, supervising pediatric residents and PICU nurses. Fellows develop competence in all critical care procedures including airway management, vascular access, procedural sedation, and resuscitation. The PICU fellow serves as the leader of the hospital code blue, rapid response, and ECPR (extracorporeal cardiopulmonary resuscitation) teams and is integrally involved in evaluating all patients for admission to the PICU. The PICU service directs ECMO/ECLS care for patients with respiratory failure and works collaboratively with the NICU and pediatric surgical services for their patients requiring extracorporeal support.
2. Cardiac Intensive Care Unit: The CICU service provides critical care for neonates, infants and children with congenital and acquired heart disease.  Under the direct supervision of the CICU attending physician, PCCM fellows are responsible for all facets of patient care, including daily rounds and order-writing, as well as communication with the patient, their family, and other members of the multidisciplinary care team. Fellows are responsible for management of all patients on the CICU service, including pre-operative neonates in the NICU and all patients on mechanical cardiac support.  The Seattle Children’s Heart Center is the major provider of comprehensive pediatric cardiac care in the region and the CICU service supports active programs in congenital heart surgery, cardiac transplantation, heart failure management, electrophysiology, and pulmonary hypertension.
3. Burn/Trauma Critical Care:  Harborview Medical Center (HMC) in downtown Seattle is the major trauma referral center for the region providing comprehensive around-the-clock management for children with major trauma/burns. The PICU team works in close collaboration with trauma and neurosurgeons and directly supervises patient care on the General Trauma and Neurological Trauma  patients in the PICU and jointly covers children on the Burns service. PCCM fellows rotate through the HMC PICU in the second and third years and take home call, directly supervising pediatrics residents in the care of critically injured and burned children.
4. Anesthesia and Sedation: PCCM receive comprehensive education in airway management, anesthesia, and sedation from the PCCM and Anesthesia Department faculty at Seattle Children’s Hospital. Early in the first year, PCCM fellows have an intensive two-week airway skills OR-based rotation under the supervision of the Anesthesia faculty. Later in the first year, fellows have a comprehensive one-month long rotation OR-based in general pediatric anesthesia that reinforces airway skills and emphasizes the principles of pharmacology, anesthesia, and procedural sedation to neonatal and pediatric patients.  Second year PCCM fellows participate in a Sedation rotation that develops the skills and knowledge base to safely provide procedural sedation outside of the operating room. Working with Anesthesia Department faculty, PCCM fellows provide procedural sedation in the radiology department, endoscopy suite, and in outpatient clinics.
5. Electives: For fellows seeking additional clinical experiences in focused areas of pediatric critical care, elective rotations are available in areas including, but not limited, to cardiology (Echocardiography, catheterization lab, electrophysiology), pulmonary medicine, anesthesia, or neurotrauma.

Scholarship

Essential to preparation for a career in academic pediatrics, PCCM fellows will demonstrate meaningful accomplishment in a focused area of scholarly activity.  The University of Washington and Seattle Children’s Hospital has acclaimed programs in several areas relevant to pediatric critical care medicine, and the PCCM fellowship faculty and program are committed to helping fellows take full advantage of these resources.  A comprehensive system of PCCM based division advisors, a scholarship oversight committee, and the Department of Pediatrics Fellows College provides mentoring and support to customize the scholarly activity to meet each fellow’s academic and career planning goals.  Recent PCCM fellows have focused on basic, clinical, and translational research, bioethics, quality improvement/ICU administration, medical education, epidemiology, outcomes/health services research, and global health among other areas.

The Department of Pediatrics has developed a Fellows College to coordinate the core educational curriculum for all Pediatric Subspecialty Fellows. This includes courses such as:

1. Biostatistics
2. Ethical principles involving clinical research and patient care
3. Clinical and laboratory research methodology, study design
4. Grant writing
5. Abstract and Manuscript writing
6. Critical literature review
7. Principles of evidence-based medicine
8. Principles of adult learning
9. Cultural competency
10. Curriculum development
11. Delivery of information, communication skills
12. How to provide feedback to learners
13. Assessment of educational outcomes
14. HIPAA training
15. Economics of health care
16. Prevention of medical errors and quality improvement

The University of Washington offers access to graduate level coursework that may be an appropriate component of the individual fellow’s training program. Fellows may choose to complete a Masters degree or certificate program during their training, and PCCM fellows have completed programs in Public Health, Epidemiology, Bioethics, and Medical Management. When appropriate, opportunities for funding to support additional training beyond the 3-year core program can be pursued.

All PCCM faculty are active in scholarly activity and several projects receive ongoing support from the National Institutes of Health and other sources of extramural funding (See faculty page for individual research interests).

Areas of concentration within the PCCM division include:

INFLAMMATION RESEARCH:  PCCM faculty maintain active basic, clinical and translational research programs focused on sepsis, acute lung injury, and shock. 

CLINICAL RESEARCH: Several faculty are involved in a variety of clinical projects. Examples of active projects include study of the long term effects of critical illness in children, neurological aspects of diabetic ketoacidosis, lung injury in stem cell transplant patients, regulation of low cardiac output syndrome after congenital heart surgery, and ECMO outcomes among many active projects. The division is proud to be an original member of the NIH-supported Pediatric Critical Care Research Network and is an active participant in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) group.

BIOETHICS: Several PCCM faculty and fellows are engaged in research related to bioethical issues that arise in the pediatric critical care setting. There is extensive collaboration with the Seattle Children's Hospital Treuman Katz Center for Pediatric Bioethics and the Pediatric Advanced Care Team. During the PCCM fellowship, fellows have the opportunity to simultaneously complete a Bioethics Fellowship with the Treuman Katz Center and/or a Masters in Bioethics and Humanities at the University of Washington. Numerous active research projects are ongoing. A major area of research focus is the ethical issues that arise in the delivery of ECLS. Faculty in the PCCM division have founded the Seattle Ethics in ECLS (SEE) Consortium research group to address these issues. Other active research projects are directed at addressing improved communication at the end-of-life, ethical considerations in decision-making during resuscitations, resource utilization in disasters and for medically complex care, and the role of moral objections in critical care medicine.

QUALITY IMPROVEMENT: Active projects include reducing ICU nosocomial infection rates, implementing “projects are directed standard work” concepts patient care to improve outcomes and efficiency. The PCCM division is an active participant in the NACHRI study group. 

Pediatric Cardiac Intensive Care Fellowship

This 4th year CICU fellowship program provides advanced training for PCCM specialists interested in a career in Pediatric Cardiac Intensive Care. Fellows will learn to manage the full spectrum of pediatric critical heart disease including peri-operative congenital heart disease, heart failure, cardiac transplant, and mechanical circulatory support. Training also includes rotations in echocardiography, interventional cardiology, electrophysiology, and cardiac surgery.