Fellowship Training Program
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M. Hossein Tcharmtchi, M.D. is the director of the Pediatric Critical Care Medicine Fellowship training program.
The primary clinical training of our fellows occurs in the 31-bed multidisciplinary Pediatric Intensive Care Unit, 21-bed Cardiovascular Intensive Care Unit and 36-bed Progressive Care Unit (step-down) at Texas Children's Hospital. Texas Children's Hospital, one of the largest pediatric hospitals 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 Hospital has recently completed the largest investment and program expansion ever by a single pediatric organization, Vision 2010. This project included TCH’s stand-alone Neurological Research Institute which opened in 2010; the new West Campus which has been fully operational since March 2011, and the Pavilion for Women since February 2012. 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.
With the growth of Texas Children's Hospital, there are many other learning opportunities for the critical care fellow. These include an expanded Bone Marrow Transport Unit, Pediatric Lung Transplant program (TCH has the busiest lung transplant program in the country), Pediatric Liver and Kidney Transplantation, and level 1 Trauma service. Texas Children’s Hospital is a core pediatric site for the development and application of mechanical support as a bridge to cardiac transplantation, and recently implanted the first Total Artificial Heart in a pediatric patient.
Pediatric Intensive Care Unit
The PICU has over 2400 admissions a year with majority of patients requiring assisted ventilation or other advanced support such as oscillatory ventilation, nitric oxide administration, extra-corporeal membrane oxygenation or other extracorporeal support including the Novalung for extracorporeal respiratory support. Our multidisciplinary ICU supports the primary through quaternary patient population of southeast Texas with patients admitted from all major medical and surgical subspecialties. We are also lung, heart, liver and renal transplant center, and in 2010 attained level 1 trauma status. Critical Care faculty and fellows, residents, nurse practitioners and physician assistants staff the PICU. There is 24/7 in-house coverage by our faculty, fellows and advanced level practitioners.
Cardiovascular Intensive Care Unit
The Cardiovascular Intensive Care 21 bed unit is fully dedicated to critically-ill children and young adults with congenital or acquired cardiac disease. Pediatric heart surgery has been performed at Texas Children’s Hospital since it opened in 1954. Our team of heart surgeons performs more than 800 cardiopulmonary bypass surgeries annually, including cardiac and lung transplantation, and extracorporeal circulatory support. Critical Care faculty and fellows, Cardiology faculty and fellows, CV anesthesia faculty and fellows, nurse practitioners and physician assistants staff CVICU. There is 24/7 in-house coverage by our faculty, fellows and advanced level practitioners.
Progressive Care Unit
PCU cares for more than 2500 admissions a year and is designated for children who require more intensive physician and nursing support that cannot be provided in the acute care areas. In addition, children who require long-term technology support, as well as those with residual PICU morbidities requiring transition to home are admitted to PCU. Critical Care faculty and fellows, residents, nurse practitioners and physician assistants staff PCU. There is 24/7 in-house coverage by our faculty, fellows and advanced level practitioners.
The Kangaroo Crew Transport Team, our mobile intensive care unit team, is 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 during their transport rotation in providing pediatric transport for a minority of patients that require the presence of a physician.
Pediatric Critical Care Fellows are taught technical skills, including invasive procedures and resuscitation, using the latest simulation technology. High Fidelity Patient Simulators are also used to recreate emergencies in order to allow fellows to develop crisis resource management skills such as teamwork, communication, and resource utilization, while also applying emergency algorithms to realistic scenarios. With access to a state of the art Simulation Center solely dedicated to the Texas Children’s Hospital, new simulation opportunities are constantly being developed to address educational opportunities identified in the clinical setting.
Our curriculum is a mixture of didactic lectures, self-directed reading conferences, morbidity and mortality conferences, patient care conferences, basic physiology conferences and journal clubs. The fellows and supervising faculty play an active role in both scheduling and participating in these conferences. Conferences occur twice a week. In addition, we have a conference series entitled "Seminars in Evidence-Based Medicine" occurring every other month, which offers advanced level concepts of evidence-based medicine. Our fellows acquire effective appraisal skills and application of evidence to clinical practice.
Clinical Orientation Program
The clinical orientation program is a three-day in situ simulation-based curriculum which introduces incoming first year fellows to procedural and communication skills relevant to their first year of fellowship. The purpose of this curriculum is to provide a safe environment for fellows to acquire and apply the knowledge, skills and behaviors required to perform in high stakes environments such as the Pediatric Intensive Care Unit. The core topics covered in this 3 day curriculum are airway management, vascular access, transport triage and Rapid Response Team communication.
All fellows engage in research projects. Our program follows ABP principles guiding the assessment of scholarly activity. The primary learning mode is a "research mentorship", therefore particular care is given to matching of the right mentors to the fellows. We do not constrain our fellows to specific questions, laboratories, or mentors as there are such diverse questions to be answered in our patient population.
Our section has an excellent track record of translational research, increasing clinical research profile and ongoing research in medical education and bioethics. We currently have a broad range of research collaborations. These include studies on nutritional requirements in critical illness, developmental aspects of nutrition, inflammation and immune function, coagulopathy, traumatic brain injury, 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. Educational scholarships include application of evidence-based pedagogy to optimize clinical learning and quality improvement, innovations for clinical instruction, assessment and feedback and medical simulation for crisis resource management.
Fellows present their research during the Critical Care Section's "Research Workshops”. Our program assists fellows in identifying a primary mentor and research project. The primary research mentor along with other members of the Critical Care Medicine section who serve as Scholarly Oversight Committee chairs oversee the fellow’s research progress. Mentors include experienced investigators within our Pediatric Critical Care section and cross specialties and interests across the Texas Medical Center.
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 has allowed us to support the highest ranked individuals in their research into pathophysiology, pharmacology or outcomes of critical illness in the developing host. Individuals supported on these grants are afforded prolonged, focused periods of research under the mentorship of senior investigators in the Department of Pediatrics and throughout BCM. We have an excellent 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 fellows 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.
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Baylor College of Medicine
Departments Nationally Ranked in the Top 20 for NIH Research Funding (Source: Blue Ridge Institute for Medical Research, 2011)
- 1st – Genetics
- 3rd – Anatomy/Cell Biology
- 4th – Pediatrics
- 9th – Physical Medicine
- 9th – Physiology
- 13th – Neuroscience
- 13th – Urology
- 15th – Biochemistry
- 15th – Pathology
- 17th - Otolaryngology
National Ranking of Texas Medical Schools – FY 2011 NIH Research Funding (Source: Blue Ridge Institute for Medical Research, 2011)
- Baylor College of Medicine 17th
- 17th – $206.8 Million
- UT Southwestern 22nd
- 23nd – $169.7 Million
- UT San Antonio HSC 51st
- 52nd – $ 74.5 Million
- UTMB, Galveston 53rd
- 50th – $ 71.8 Million
- UT Houston Medical School 60th
- 53 – $ 55.1 Million
- Texas A&M HSC 101st
- 94th – $ 13.3 Million
- Texas Tech HSC 112th
- 118th – $ 7.2 Million