Critical Care Medicine Fellowship

PCCM fellowship training combines comprehensive clinical training with a structured educational curriculum and mentored scholarship activity to prepare fellows for careers in academic pediatric critical care. The 3-year program focuses on developing core competencies specified by the American Board of Pediatrics. Fellows who have already completed an ACGME-accredited pediatric subspecialty fellowship may apply for a 2-year training program, provided that they met the ABP scholarly activity requirements in their first fellowship.

Clinical Training

Incoming fellows participate in an intensive two-week “Boot Camp” which includes a core lecture series, PALS recertification, PFCCS training, procedural training using simulation, and an ECLS workshop.

Pediatric Intensive Care Unit – Seattle Children’s Hospital:

• The PICU at Seattle Children’s Hospital is a mixed medical/surgical service that is the major tertiary pediatric critical care referral center for the Pacific Northwest and Alaska.
• Fellows direct clinical care for children with the full spectrum of pediatric critical illness under the supervision of PCCM faculty.
• Fellows are the leaders of the hospital code blue, rapid response, and ECPR (extracorporeal cardiopulmonary resuscitation) teams and evaluate all patients in the emergency department prior to PICU admission.
• Fellows join PCCM faculty in providing medical control for pediatric patients transported by the Seattle Children’s Pediatric Transport Team and Airlift Northwest.
• Fellows teach pediatric and emergency medicine residents on their PICU rotations.
• Fellow rotations include 7-day stretches of daytime clinical service and in-house overnight call.

Cardiac Intensive Care Unit – Seattle Children’s Hospital:

• The CICU service provides critical care for neonates, infants and children with congenital and acquired heart disease. The Seattle Children’s Heart Center is the major provider of comprehensive pediatric cardiac care in the region and the CICU service supports active programs in congenital heart surgery, cardiac transplantation, heart failure management, electrophysiology, and pulmonary hypertension.
• Fellows are first-line care providers and direct clinical care for children with cardiac disease under the direct supervision of CICU faculty.
• Fellow rotations include 7-day stretches of daytime clinical service and in-house overnight call.

Trauma/Burns Intensive Care Unit – Harborview Medical Center:

• Harborview Medical Center (HMC) is the major trauma referral center for the Pacific Northwest region.
• Fellows direct care in collaboration with surgical services, including trauma surgery, neurosurgery, and burns for all patients under the age of 18 under the supervision of PCCM faculty.
• Fellows provide procedural sedation for children receiving wound care for major burn injuries under the supervision of HMC PCCM faculty.
• Fellows teach pediatric residents on their HMC rotations.
• Fellow rotations include 7-day stretches of clinical service that include home call.

Airway/Anesthesia/Sedation – Seattle Children’s Hospital:

• Fellows receive comprehensive training in airway management, anesthesia, and sedation from the PCCM and Anesthesia Department faculty at Seattle Children’s Hospital.
• First year fellows gain airway management skills learn basic principles of pediatric anesthesia in the operating room under the supervision of Anesthesia faculty.
• Second year fellows develop procedural sedation skills by providing sedation outside of the operating room under the supervision of Anesthesia faculty.

Scholarship

We believe that successful academic careers start by identifying an area of academic interest, contributing iteratively to new knowledge, and growing through proactive mentorship. Examples of areas of research focus within the PCCM Division are listed below. We encourage PCCM fellows to pursue their academic interests and help them to find mentorship either within the PCCM Division or elsewhere throughout the University of Washington system. Fellows all have a unique Scholarship Oversight Committee made up of faculty mentors who guide fellows in their academic endeavors and ensure they are making progress toward their career goals. Recent PCCM fellows have focused on basic, clinical, and translational research; bioethics; quality improvement/ICU administration; medical education; epidemiology; outcomes/health services research; and global health among other areas.

Fellows have access to graduate coursework through the University of Washington, including certificate programs and master’s degrees in Biostatistic, Epidemiology, Global Health, Health Services and Bioethics. Fellows must seek approval from their program director prior to enrolling in a graduate degree program.

All fellows at Seattle Children’s Hospital are part of the Fellows College, which provides additional professional development training in its core didactic series.

Areas of research focus:

INFLAMMATION RESEARCH

• Active basic, clinical and translational research programs focused on sepsis, acute lung injury, and shock.

CLINICAL RESEARCH

• Long-term outcomes, including post-discharge quality of life, emotional, and cognitive outcomes following septic shock, acute respiratory failure, or trauma; obesity and vascular endothelial dysfunction following the Fontan operation
• Quantification of intracellular oxygen kinetics with reflectance spectroscopy
• Risk factors for and outcomes of pediatric delirium
• Effects of medications and environmental factors on sleep in the PICU
• Health disparities in pediatric critical illness and congenital heart disease
• Resuscitation research, including improving identification of clinical deterioration during hospitalization and evaluating use of POC ultrasound in resuscitation
• Leadership of and participation in large, multicenter clinical trials, including Stress Hydrocortisone In Pediatric Septic Shock (SHIPSS), PRone and OScillation pediatric clinical trial (PROSpect), and Personalizing Outcomes after Child Cardiac Arrest (POCCA)
• Active participation in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

BIOETHICS

• Ethics in delivery of ECLS, including the Seattle Ethics in ECLS (SEE) Consortium research group
• Organizational ethics, including creating guidelines for international patient programs and evaluating inequities in solid organ transplant.

QUALITY IMPROVEMENT

• Resuscitation program, including evaluating compliance with post-arrest guidelines, impact of peripheral vasopressor use guideline, and multiple Pedi-ResQ projects
• Bioinformatics, including evaluating impact of clinical decision support tools on outcomes
• Single ventricle care, including the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC)
• Family communication, including evaluating use of video interpretation and impact of continuity attending involvement
• Stewardship of healthcare resources.

GLOBAL HEALTH

• Kenya. Evaluating feasibility of high flow implementation, developing a pediatric emergency and critical care training program in Sub-Saharan Africa,
• Peru. Evaluating impact and sustainability of high flow implementation, evaluating sepsis screening, determining resource availability for pediatric critical care in Peruvian district hospitals
• Nepal and Ghana. Evaluating strategies to reduce cookstove-related injuries
• SE Asia. Evaluating plasma biomarkers to predict outcomes after sepsis