Letter from the Director, Fellowship Training
Dear fellow applicant,
Baylor College of Medicine is committed to training the academic leaders of the 21st century. The Pediatric Critical Care Section currently consists of 19 full-time pediatric critical care physicians.
Clinical Training
The primary clinical training of fellows occurs in the 31-bed multi-disciplinary Pediatric Intensive Care Unit and 36-bed Progressive Care Unit (step-down) at Texas Children's Hospital. Texas Children's, the largest pediatric hospital in the United States, is a 456-bed freestanding facility affiliated with the BCM. This is an exciting time to join us at Texas Children's as we have recently completed the largest expansion project ever at the Texas Medical Center. In addition, Texas Children's has started the largest investment and program expansion ever by a single pediatric organization, Vision 2010. This project focuses on research and accessibility which includes neurological research institute, maternity center and suburban hospital. The goal of this expansion is to secure Texas Children's Hospital’s role as a pre-eminent pediatric institution and to anticipate the future of children's health regionally, nationally and internationally.
PICU
At present, the PICU has over 2100 admissions a year with 700 patients requiring assisted ventilation or other advanced support such as oscillatory ventilation, nitric oxide administration, extra-corporeal membrane oxygenation or other extracorporeal cardiac support. It is a multi-disciplinary ICU, which supports the primary through quaternary patient population of southeast Texas with patients admitted from all major medical and surgical subspecialties.
PCU
Our PCU also has over 1800 admissions per year and is specifically designed for children who require long-term technology support, those with residual PICU morbidities requiring transition to home, and the management of children who require more intensive physician and nursing support. Critical Care faculty and fellows, residents, nurse practitioners and physician assistants staff both the PICU and PCU.
Transport
Other exciting educational opportunities include the Kangaroo Crew Transport Team, our mobile intensive care unit team responsible for the transport of critically ill neonates and pediatric patients. The majority of the patients are transported by a dedicated RN/RT transport team. Fellows are involved in providing pediatric transport for a minority of patients that require the presence of a physician.
Other
With the growth of Texas Children's there are many other learning opportunities for the critical care fellows. These include an expanded Bone Marrow Transport Unit, establishment of a Pediatric Lung Transplant program with 10-15 cases a year, greater space for both the emergency center and the operating rooms, and the development of the Pediatric Heart Center. The Pediatric Heart Center deserves specific mention, as the Perioperative Cardiothoracic service is one of the largest in the country with over 750 surgical procedures a year.
Program Structure
Year One
The first year of the Pediatric Critical Care fellowship program consists of eight to nine months of clinical responsibility including:
- Four-Six PICU months
- One-Two PCU months
- One CVICU month
- One Anesthesia month
The remaining months are devoted to identification of a research mentor and determining a research project.
Year Two
The second year of the fellowship program is designed around the trainee's research interests, whether in clinical or laboratory protocols. The second year consists of three-four months of clinical service including:
- One-Two PICU months
- One PCU month
- One CVICU month
The remainder of the second year is devoted to research. During July of their second year, fellows participate in the Fundamentals of Clinical Investigation course, a training course unique to BCM. Clinical fellows from throughout the College participate in this in-depth four-week educational experience. Fellows review the principles of biometrics, biostatistics, and epidemiology and basic computer skills, including computer software, library utilization and reference management.
Year three
The third year of training is devoted to completing research projects, preparing data for national presentations, and polishing clinical leadership skills. The third year consists of four-six months of clinical service including:
- One-Two PICU months
- One Junior attending month
- One-Two PCU months
- One CVICU month
Call
The call schedule averages once in every six to seven nights over the three-year period and is spread evenly through all three years. We have also devised a night float system to comply with ACGME guidelines regarding resident work hours.
Didactic Education
Our curriculum is a mixture of didactic lectures, directed reading conferences, morbidity and mortality conferences and journal clubs. The fellows and faculty play an active role in both scheduling and participating in these conferences. Conferences occur twice a week. We have a monthly conference series entitled "Seminars in Evidence-Based Medicine", which introduces the concepts of evidence-based medicine in order to develop effective appraisal skills and apply relevant results of research to clinical practice.
Research
All fellows engage actively in research projects. The primary learning mode is a "research mentorship" therefore particular care is given to the matching of "mentor" to "fellow". We do not constrain our fellows to specific questions, laboratories, or mentors as there are so many questions to be answered in our patient population. Fellows present their research during the Critical Care Section's "Research Workshops." Our Associate Fellowship Director, Michele Mariscalco, M.D., assists fellows in identifying a mentor and research project. She along with other members of the Critical Care Medicine section and fellow’s primary mentor oversee the fellow research progress. Mentors include experienced investigators within our section and cross specialties and interests across the Texas Medical Center. Current research in the section includes the nutritional requirements of the critically ill pediatric patients, developmental aspects of nutrition, inflammation and immune function, basic and pathophysiologic mechanisms of liver, lung, and heart function, long term follow-up of critically ill children, outcomes analysis, and the effect of sepsis and stress on gut motility, muscle and glucose metabolism. .
Additional Research Opportunities
For those individuals who identify basic investigation (at the bench or bedside) as a critical part of their future, we have some exciting unique opportunities. We have an ongoing T32 Training Grant”: “Research Training in Critical Care Medicine”, this in addition to other fellowship-training grant support through a variety of sources allows us to train individuals who will ask critical questions of direct relevance in our patient population focusing on pathophysiology, pharmacology and outcomes of critical illness in the developing host. Individuals supported on these grants are afforded prolonged, focused periods under the mentorship of senior investigators in the Department of Pediatrics and throughout BCM. We have a track record of fellows who pursued these paths and were successful in obtaining NIH young investigator grants. We also have developed a unique opportunity for individual trainees to combine clinical training in pediatric critical care medicine and rigorous research training in the nutrition and metabolism of critically ill children. This fellowship, sponsored jointly by the Section of Pediatric Critical Care Medicine and the Children's Nutritional Research Center located at the Texas Medical Center, provides ample opportunity for the trainee to be exceptionally trained in nutrition and metabolism as well as the care of critically ill children.
Applicant Eligibility and the Application Process
Our program does participate in the Electronic Residency Application Service (ERAS) www.aamc.org/eras and National Residency Matching Program (NRMP) for Pediatric Critical Care Medicine http://www.nrmp.org .
We will consider applications from individuals completing the PL-III year prior to the onset of the fellowship. Graduates of foreign medical schools must be able to meet the requirements of the Health Professions Educational Assistance Act of 1976 (USPL 94-484) of the U.S. Immigration and Nationality Act for the three-year fellowship. In addition, it is expected that applicants will be able to successfully obtain physician licensure from the Texas State Board of Medical Examiners, if not before beginning the program, then soon into the first year.
A Life in Houston link could also be found online under our Fellowship Training area. Interview visits require a minimum of one full day and many applicants choose to spend 1˝ days with us.
If you wish to speak to someone regarding our fellowship program or our application process, please feel free to contact me or our Fellowship administrator, Pat Salazar, at 832-826-6208.
Sincerely,
Hossein Tcharmtchi, M.D.
Director, Fellowship Training Program
Associate Professor
Section of Critical Care Medicine
Department of Pediatrics
Baylor College of Medicine
