The Pediatric Critical Care Medicine Fellowship at Dell Medical School strives to engage learners with a new and innovative approach to education that includes standard and flipped classroom didactics, small group learning sessions, web-based lecture series and multiple simulation-based courses designed to promote procedural competency and clinical excellence.
The program gives fellows a strong foundation of knowledge in evidence-based practice, pathophysiology, pharmacology, economics of health care, ethics and end-of-life care, medical literature and clinical research. Upon graduating, fellows leave the program highly capable of independent clinical practice and prepared to publish their research manuscript and pass their critical care boards within their first year of eligibility.
- PICU fellow didactic/flipped classroom lecture series
- Fellows-as-teachers resident lecture series
- CCU lecture series: “Fraser Rounds”
- Cardiac surgical planning
- Neurocritical care conference
- Pediatric grand rounds
- Chief rounds
- Morbidity and mortality review
- Board review series
- Journal club (PICU and cardiac)
- Pathophysiology case conference (simulation-based)
- Ultrasound and procedural lecture series (simulation-based)
- Interdisciplinary case conference (hospital wide)
- Fellows college (combined with all Dell Children’s Medical Center fellowships)
- Fellow research progress update
All clinical rotations take place at Dell Children’s Medical Center of Central Texas, primarily in the pediatric intensive care unit and the cardiac care unit. Rotations are between two to four weeks to allow fellows the opportunity to follow the natural progression of critical illness, from admission to recovery.
During each rotation, fellows are paired with a pediatric intensivist for consistency of supervision. All fellows have 24-hour access to an in-house, board-certified intensivist. Weekly learning and clinical goals are discussed at the beginning of each week, and feedback is provided regularly, both in real time and in writing, to show the fellows’ progress while in service. Feedback reflects all components of the Accreditation Council for Graduate Medical Education’s milestones, including clinical knowledge, system-based practice, procedural competency, professional development, communication with patients, families and other health care providers, teaching skills and leadership.
Clinical rotations are broken up throughout all three years of training. First-year fellows have a larger clinical load aimed at quickly cementing exposure to a high volume of critically ill patients in the PICU or CCU. Second-year fellows have a significant amount of time available for mentored clinical research to design and conduct their own independent research project. In the final year of the fellowship, rotations for third-year fellows have an equal mix of research and clinical time, with a month devoted to a “pre-attending” rotation. Third-year fellows are expected to run the clinical service independently while under the supervision of an attending physician on rounds for immediate bedside assistance. In-house call coverage is relatively spaced out throughout the three-year fellowship period.
Beyond clinical rotations in the PICU and CCU, fellows have required rotations in anesthesia, transport, neurocritical care and cardiology (which includes a cardiac catheterization lab, echocardiogram training and a transplant team). Additional elective rotations are also available and are geared toward each fellow’s individualized learning plan to align with their career goals.
As a new program, full nighttime PICU coverage cannot be met until all six fellows have matched to the program (expected by July 2025). Fellows will eventually provide in-house call coverage six nights a week in the PICU. Since quality, protected education is a top priority of the program, fellows will never be scheduled to be on-call the night before weekly lecture series and simulations. The first two classes of trainees will have significant influence on their call schedule, with their feedback and opinions crucial to the design of the coverage model. Fellows can expect to take nighttime calls averaged out to around one call (intermittent or night float) every five to six days. Four weeks of vacation are available to each fellow every year.
Extracorporeal membrane oxygenation/continuous kidney replacement therapy: Despite a robust, growing neonatology department, the PICU and CCU are currently the only two units at Dell Children’s capable of providing extracorporeal support from birth to adulthood. Fellows play an integral role in managing all patients who require this level of support while working collaboratively alongside all subspecialties who manage their care, including neonatology for critically ill neonates and infants, nephrology for patients requiring intermittent hemodialysis or continuous kidney replacement therapy and the extracorporeal membrane oxygenation team for veno-venous and veno-arterial cannulation in both units.
Freestanding CCU: In 2018, the cardiac care unit became an independent, freestanding ICU within Dell Children’s, and the hospital’s heart transplant team was formed a few years later. The program’s CCU provides care to all patients with congenital-or-acquired heart disease. Patient volume within the unit is robust, and corrective surgeries are done on a daily basis. Fellows rotate through the CCU each year of their training and are exposed to many pre- and post-operative patients.
Simulation lab/point-of-care ultrasound and video laryngoscopy: Fellows receive monthly education and training in a newly constructed simulation lab designed to improve clinical practice through simulated scenarios and mock codes. Fellows have access to point-of-care ultrasound machines and multiple forms of video-assisted laryngoscopy while on clinical rotations to improve procedural competency. All fellows acquire basic point-of-care ultrasound skills, with elective and research time allowing more in-depth skills acquisition.
Palliative care: The PICU has a wonderful relationship the program’s palliative care team, which supports difficult, care-altering discussions with patients and their families. Collaboratively, the program focuses on enhancing quality of life while staying sensitive to variations in the social, emotional, economical and spiritual support needed for each patient.
Quality improvement: The program’s quality and process improvement team plays a crucial role in reducing the incidence of hospital-associated events and developing standardized protocols designed to improve outcomes. Fellows receive constant exposure to quality initiatives and are required to implement their own quality improvement project during their three years of training under the mentorship of this team.
Global health: Collaborating with The University of Texas at Austin’s Global Health Program, this training promotes education, research and service to promote health equity for vulnerable populations. UT currently has training partnerships with Kenya and Mexico. With appropriate advance notice and administrative approvals, other sites can be considered for clinical rotation and research.
Advocacy: Mentorship in advocacy projects is available through Dell Med’s Department of Pediatrics’ Advocacy Committee, which focuses on legislative policy, education, community outreach, social determinants of health, innovation solutions and research.
Biomedical engineering/technology development: This training collaborates across multiple divisions with a focus on understanding pathophysiology of diseases and developing and applying biosensors to track and predict health. It also includes the potential development and licensing of technologies with support from UT’s Office of Technology Commercialization.
Every fellow is mentored by a scholarly oversight committee of three to four members, with at least one member being from outside the Division of Pediatric Critical Care. Fellows meet quarterly with their mentors and discuss progress on scholarly projects with the entire division. Fellows have mentors for both their quality- and clinical-based research projects.