This is the core rotation for Critical Care Fellowship. The total time spent in this rotation is eight months divided into weekly blocks over the three years of training.  

1. 1. The fellow will be part of the team in the PICU

   2. The team is comprised of an attending physician, a fellow, pediatric and ER residents and medical students.

   3. The role of the fellow is to develop graded responsibility in leading the team under the supervision of the attending physician. 

 Most of the primary service in the PICU will occur during the first year of fellowship.

Pediatric airway assessment and management and procedural sedation are essential skills during the Pediatric Critical Care Medicine subspecialty training. To provide additional more focused opportunity to acquire these skills our program offers one month of rotation time in Pediatric Anesthesia in collaboration with Anesthesia department in the first year of training.

 Time is spent in the Pediatric operating rooms working closely with the attending pediatric anesthesiologist. The fellow is assigned to two different areas, first two weeks for procedural sedation and last two weeks is spent in cardiac anesthesia room to learn basics of cardiopulmonary bypass under close anesthesia attending supervision. The following is the description of goals and objectives, responsibilities of resident and anesthesia attending, rotation information and evaluation process.

Faculty - Dr. Ranu Jain, , Fellowship Program Director, Pediatric Anesthesiology Fellowship

 Daily schedule

•  Every afternoon the PICU subspecialty resident will be assigned to a pediatric anesthesiologist for the following day, depending on the OR schedule.

•  Subspecialty resident should contact the assigned attending that same afternoon/evening to discuss cases for the next day.

• Subspecialty resident should meet with the attending shortly before 7 am in the pediatric holding area.

•  Subspecialty resident will then work with this attending in the assigned area/OR.

• Subspecialty resident will be relieved for the time to attend required lectures.

• Subspecialty resident will be relieved in the afternoon depending on the case load in the assigned OR.

•  Subspecialty resident is encouraged to attend anesthesia lectures in the morning.

•  Subspecialty residents are welcome to attend/participate in the pediatric anesthesia journal club, hold every three months in the evening at an attending’s home.

Children with cancer are a unique and challenging subset of patients within Pediatric Critical Care Medicine, and the intricacies of care for these patients involves understanding the complexity of oncologic care and its associated complications, as well as management of acute oncologic emergencies, such as spinal cord compression, hyperleukocytosis, tumor lysis syndrome, organ failure from cancer or its treatment, airway compression, neutropenic fever, and superior vena cava syndrome. Knowledge of the care of a child with cancer is essential during PCCM subspecialty training. 

This one-month rotation is designed to allow pediatric critical care subspecialty residents to learn about and experience critical care in the setting of an oncology facility. The following is the rotation goals.

• Understand the principles of critical care in the setting of pediatric oncology 

• Provide critical care for pediatric oncologic patients

•  Perform and develop proficiency in lumbar punctures and bone marrow aspirations and biopsies for children with cancer undergoing invasive procedures

Faculty - Dr. Linette Ewing, Director, Pediatric Intensive Care Unit, MD Anderson., Dr. Shehla Razvi, Rotation Supervisor, Pediatric Intensive Care Unit, MD Anderson.

Daily schedule - Daily rounds with ICU team.

• Pediatric critical care subspecialty resident will contact Dr.Ewing to discuss specifics of when and where to arrive. For the inpatient portion- arrival to PICU by 7 am

• Subspecialty resident should be at MD Anderson daily as directed by the PCCM faculty unless they are postcall from call at CMHH (in which case they should be excused from all duties at MDA) or it is their assigned day off. The resident will not be expected to work on the weekend unless it is an assigned call shift.

• Take after hours call in CMHH PICU as assigned by the PCCM Program Director. This call will be limited in number to 4 over 4 weeks so as to minimize its effect on the clinical experience at MDA.

May also round on HSCT unit patients, and oncology floor patients, depending on ICU census and acuity. Any other conferences or activities up to discretion of supervising PICU attending at MD Anderson.

Focus should be on gaining maximum exposure to management of critically ill patients.

The University of Texas Health Science Center at Houston PCCM Fellowship provides an average of 13 months of “research” rotations throughout the three year fellowship. The fellow is expected to identify, participate and complete a scholarly activity as described by the American Board of Pediatrics.

The ABP has expanded the options for projects but did not dilute the rigor expected. Scholarly activity can include, but is not limited to, clinical research, basic science research, meta-analysis, Cochrane review, educational curriculum design, and Master’s level program with a thesis.

Rotations are provided in monthly time periods with increasing numbers of months as the fellow advances in training. Oversight of all scholarly activity is provided by Divisional Scholarship Oversight Committee (SOC).

PCCM Divisional Conference 

•  Case Conference

• Core Physiology Lectures

•  Journal Club Conference

• Fellowship Faculty Division Lecture

• EBM State of the Art Review

• Patient Review Conference

• Morbidity and Mortality Service Conference(M&M)

Pediatric Department Conferences 

• Pediatric Core Lecture Series (100% attendance required)

• Pediatric Grand Rounds

Hospital Committees