The three-year Pediatric Critical Care Fellowship curriculum prepares fellows for careers in academic medicine through a combination of comprehensive clinical training, didactic experiences, case-based discussions, journal clubs, simulations and mentored scholarship activity.
The early part of the fellowship emphasizes the development of clinical skills, while the latter part of the curriculum supports meaningful engagement in a focused scholarly project. A core didactic curriculum is integrated throughout the fellowship, enforcing core competencies specified by the American Board of Pediatrics (ABP).
Fellows spend approximately half of the fellowship (18 months) on clinical rotations in the intensive care units and electives, with the other half engaged in scholarly work (18 months).
Up to six months of clinical time are spent in the cardiovascular ICU and in other ICU-based electives. Fellows are integral to teaching all rotating pediatric residents, students and visiting fellows throughout the three years.
Mayo Clinic has other Accreditation Council for Graduate Medical Education (ACGME)-approved pediatric subspecialty fellowships, so combined training in a second subspecialty, such as cardiology or anesthesiology, may be arranged to meet ABP requirements.
Under the supervision of pediatric critical care medicine faculty, fellows direct patient care on the Pediatric Intensive Care Unit, cardiovascular intensive care unit and ECMO services.
The first year of fellowship focuses on the development of core knowledge, bedside management and procedural skills, while the second and third years emphasize supervisory skills, unit management and communication within a multidisciplinary environment.
In July of the first year, fellows participate in a two-week critical care "boot camp" orienting to ICU facilities and attending simulation sessions as well as procedural skills and communication workshops.
Night duties consist of intermittent four-night "service weeks," which protects research blocks from overnight call. The night service fellow covers both the pediatric and cardiovascular intensive care unit services with in-house faculty to maximize the training in postoperative care of cardiac surgical patients and management of extracorporeal life support.
Pediatric Intensive Care Unit (PICU)
The PICU service is a mixed medical-surgical and trauma service that provides comprehensive care to critically ill children. Mayo Clinic is a tertiary care referral center for a five-state region and cares for children with a broad spectrum of single-system and multisystem diseases, including bone marrow transplant, solid-organ transplant and trauma (Level 1 Pediatric Trauma Center).
The pediatric critical care faculty and fellows oversee care of patients in the PICU in collaboration with surgical and medical subspecialty services. Fellows directly manage patient care, supervise PICU residents and nurses, and are integrally involved in admission and transfer of patients from the emergency room, pediatric ward and operating rooms.
Fellows develop proficiency in procedural skills including airway management, vascular access, procedural sedation and resuscitation. In addition, they serve as medical control for critically ill pediatric air and ground transports with graded autonomy. The PICU fellow serves as the leader of the pediatric code and rapid response teams.
Cardiovascular Intensive Care Unit (CICU)
The pediatric CICU service cares for patients with congenital and acquired heart disease. In addition, all neonatal and pediatric extracorporeal life support (ECLS) is performed in the CICU, including ventricular assist devices.
Fellows are directly supervised by the CICU attending physician and are responsible for all aspects of patient care. Physician assistants are essential members of the team and staff the CICU round-the-clock. In addition, Mayo Clinic has a very active adult congenital heart disease program, and the pediatric CICU team assumes care for post-surgical patients. Mayo Clinic is a referral center for heart and lung transplantation.
Fellows complete a two-week mandatory operating room-based elective in pediatric anesthesia for an intensive education in airway management, sedation and vascular access. Each fellow must also complete a two-week pediatric bronchoscopy elective, complemented by a mini didactic series dedicated to bronchoscopy skills that is integrated into the core PICU curriculum.
For fellows seeking additional clinical experience in areas of pediatric critical care, elective rotations are available in cardiology (echocardiography, catheterization and electrophysiology), pulmonary medicine and anesthesiology, among others.
Fellows attend a weekly PICU core didactic series to develop essential knowledge in pediatric critical care medicine. Lectures are given by faculty, fellows and invited lecturers from across Mayo Clinic.
Fellow-led case-based discussions, morbidity and mortality conferences, and journal clubs are held monthly. Neurocritical care cases are discussed in regularly scheduled "brain rounds" attended by our pediatric neurointensive care epileptologist and child neurology residents.
The Department of Pediatric and Adolescent Medicine has developed a monthly lecture series to coordinate the educational curriculum for all pediatric subspecialty fellows. Previous topics include academic writing, quality improvement, bioethics, the science of health care delivery and fellow research in progress.
Additional formal coursework available during the Pediatric Critical Care Fellowship includes:
PICU fellows in their first year complete the Pediatric Fundamental Critical Care Support course through the Society of Critical Care Medicine and maintain active Pediatric Advanced Life Support certification, with the option of becoming instructors in both courses.
Mayo Clinic offers access to graduate-level coursework appropriate to the individual fellow's training program. Master's-level and other abbreviated programs in clinical and translational research are available through the Center for Clinical and Translational Science (CCaTS).
As scholarly work is essential for an academic career, fellows will demonstrate meaningful accomplishment in a focused area of research. Faculty members serve as advisers to identify mentorship and develop a research interest early in the first year. Through its many research centers and programs, including the Children's Research Center, Mayo Clinic is home to extensive research relevant to pediatric critical care medicine, and the Pediatric Critical Care Fellowship is dedicated to helping fellows take full advantage of these resources.
Research and career planning is guided by a formal scholarship oversight committee to meet fellow goals. Areas of research concentration within the Division of Pediatric Critical Care Medicine include brain injury and repair, bioethics, inflammation, global health, quality improvement, neurodevelopmental outcomes, and extracorporeal membrane oxygenation.
In addition, the Critical Care Independent Multidisciplinary Program has access to acclaimed resources for epidemiologic, clinical and translational research, including:
Pediatric critical care fellows are highly active in simulation-based training throughout the fellowship, both as participants and as instructors. Multidisciplinary simulations occur at Mayo Clinic's state-of-the-art Multidisciplinary Simulation Center. In addition, "in situ" simulations occur in both the Pediatric Intensive Care Unit and the emergency department.
Pediatric education programs include:
- Pediatric acute care emergencies curriculum — pediatric critical care, neonatal intensive care unit and pediatric emergency department cases developed by these divisions are directed toward resident education
- Emergency response (code) and rapid response team training — fellow-led monthly multidisciplinary team training for PICU residents, respiratory therapists and nursing staff
- Pediatric transport team training
- ECMO simulation — both adult and pediatric, based at Mayo Clinic Hospital, Saint Marys Campus
- In situ simulations — monthly multidisciplinary ICU-level scenarios held in PICU or emergency department for on-service staff
Mayo Clinic focuses significant time and resources on the education of quality improvement, which includes learning ways to work together more effectively and efficiently, reduce waste, or improve outcomes.
The Mayo Clinic Quality Academy offers a Mayo Quality Fellows program that provides quality improvement education and certification for individuals and teams. Pediatric Critical Care fellows complete a focused quality improvement project and become Bronze- and Silver-level certified through the Quality Academy. Quality Academy certifications provide a pathway to pursue additional external certifications in quality improvement, such as through the American Society for Quality, if desired.
Recent quality improvement projects in the PICU have focused on the implementation of multidisciplinary family-centered rounds, operating room-to-ICU handoff processes, and implementation of routine delirium assessment (pCAM-ICU) of PICU patients.
Licensed fellows in the second and third years of the Pediatric Critical Care Fellowship are allowed to provide moonlighting coverage in accordance with Mayo Clinic moonlighting policies. Moonlighting should not interfere with required learning and must not violate ACGME work hour rules. Given the rigor of a critical care fellowship, moonlighting is generally discouraged.
The Mayo Clinic campus in Rochester, Minnesota, features state-of-the-art laboratory and clinical facilities. Located within Mayo Eugenio Litta Children's Hospital at Mayo Clinic Hospital, Saint Marys Campus, the Pediatric Intensive Care Unit has 16 dedicated beds for the comprehensive care of critically ill neonates and children.
The PICU admits more than 1,100 medical and surgical patients every year from a five-state referral region with a total catchment area of approximately 3 million people. Conditions treated vary from common community-based single-organ critical illness to highly complex disorders.
Mayo Clinic is a Level 1 Pediatric Trauma Center with active neurological; orthopedic; ear, nose and throat; transplant; and general surgery programs in addition to all recognized pediatric medical subspecialties. This variety provides a rich patient mix and encourages interaction with staff in other areas, including those outside the core pediatric groups.
The PICU team includes pediatric residents, fellows, nurses, pharmacists, nutritionists, social workers, therapists and child life specialists that facilitate a multidisciplinary approach to patient-centered care.
The Cardiovascular Intensive Care Unit provides care for patients immediately after surgical correction of congenital heart disease and is the center for the extracorporeal life support (ECLS), heart and lung transplant, and adult congenital heart disease programs. There are 11 dedicated pediatric beds in the CICU, which sees approximately 225 pediatric heart and 400 adult congenital heart cases each year.
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