The Pediatric Critical Care Medicine Fellowship at NewYork-Presbyterian Hospital/Weill Cornell Medical Center is an ACGME-accredited three-year program intended to prepare the pediatrician for subspecialty certification in critical care by the American Board of Pediatrics. The major goal of the program is the development of technical and cognitive competence in managing critically ill children, with additional emphasis on the acquisition of administrative and investigative skills.
Our fellowship program is centered in the 23-bed multidisciplinary Pediatric Intensive Care Unit (PICU) which includes a three-bed, state-of-the-art Pediatric Neurocritical Care Unit. The Division of Pediatric Critical Care Medicine is responsible for children from one day to 21 years of age with complex medical and surgical illness. The unit is "closed" and the critical care staff is responsible for all aspects of patient care in collaboration with referring and consulting services. Infants and children recover in the PICU following cardiothoracic, neurologic, airway and other complex surgeries.
Sources for patient referrals include the inpatient pediatric units of NewYork-Presbyterian Hospital (NYP) and the NewYork-Presbyterian Komansky Children’s Hospital the emergency departments and pediatric service units of other NYPH Healthcare System institutions, as well as non-network hospitals in New York, New Jersey and Connecticut. NewYork-Presbyterian Hospital/Weill Cornell Medical Center is designated as a Level 1 trauma center for both adults and children. The unit is staffed by pediatric critical care nurses who work exclusively within the PICU and regularly participate in rounds, multidisciplinary conferences and other teaching activities.
The medical staff consists of eleven pediatric critical care attending physicians and six pediatric critical care fellows. Pediatric and anesthetic residents, as well as Physician Assistants (PAs) working under direct supervision of an attending physician and critical care fellow, support the critical care staff. A fellow and attending physician are staffed in the PICU 24 hours a day.
The NewYork-Presbyterian/Weill Cornell Medicine PICU has close and longstanding affiliations with Memorial Sloan Kettering Cancer Center (MSKCC) and the Hospital for Special Surgery (HSS), both of which transfer critically ill children to our unit. In addition to particular expertise in the delivery of oncologic and neurologic critical care, we also care for children with critical burn injuries in a collaborative fashion with medical and nursing staff of the William Randolph Hearst Burn Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. NYPH maintains an active local and regional transport system staffed by paramedics and physicians.
The Division of Pediatric Critical Care Medicine's educational program is detailed below. Fellow responsibilities are covered by the service attending during lectures, to optimize the learning environment and ensure fellow attendance.
- Fellow lecture series: A core lecture series based on the fundamentals of critical care. These lectures occur Wednesday mornings at 7:30 am to capture all fellow and are meant to be “chalk talks” with preparation done in advance (assigned readings). They are fellow led with faculty mentors.
- Case management conference: As described, these conferences are utilized to review interesting, difficult and complex cases. The service fellows alternate weeks and are responsible for the case presentation, and questions they would like answered. We utilize this conference to discuss complex physiology, different management styles, ethical questions, etc.
- Divisional conference: These are weekly conferences held on Mondays for all PICU faculty, fellows, and housestaff. They cover a variety of topics and are presented by PICU and pediatric sub-specialty faculty. Journal club is also presented during this time slot, and used to review not only recent literature, but also to critically appraise the literature and increase understanding surrounding common statistical analysis.
- Research meeting: These meetings occur 2x/month on Tuesday afternoons at 3pm. More about our program can be seen under the research section.
- Simulation: Regularly scheduled, interdisciplinary simulations are scheduled for each of the fellows throughout the academic year. These occur largely in the Sim Center and are meant to complement the didactic and case based conferences.
- QA conferences: Our morbidity and mortality conference occurs monthly. The goal is to review any significant events in the month prior, as well as any mortalities, in an effort to improve systems, minimize errors, and improve patient care. Each month, there is a fellow assigned to this who is responsible for obtaining facts, putting the presentation together, and leading the discussion.
- Interdisciplinary critical care medicine conferences: Weekly multidisciplinary ICU conferences held in collaboration with our adult medical, cardiothoracic and neurocritical care colleagues.
- Ultrasound conference: Once a month, as a group we review concepts of ultrasound skills and practice on manikins and patients based of the SCCM Pediatric Ultrasound Curriculum.
- Departmental conferences: Grand Rounds are held for all pediatric staff on Tuesday morning at 8:30. Rounds are paused to enable fellow attendance. Professors rounds occur every Friday, and cover a multitude of topics including difficult cases and research updates.
Clinical training is accomplished by having fellows fully engaged in the delivery of patient care. The majority of a fellow's clinical experience is in the Pediatric Intensive Care Unit, with clinical time occurring primarily in the first two years.
First year fellows spend six-eight months on service in the PICU, with this time divided between red and blue teams. The red team is responsible for oncology and neurocritical care patients. The blue team is responsible for cardiothoracic surgery and burn patients, as well as consulting in the Burn Center. In addition, general medical and surgical patients are cared for by both of these teams. There is an active transport service. The first year is rounded out by two months of anesthesia, a one-month rotation in the MSKCC PICU, and one-two months of research preparation.
In the second year, service time is reduced to four-five months, and approximately seven-eight months are allocated for research activities. One of these clinical months is a rotation in the Cardiac Intensive Care Unit at Morgan Stanley Children’s Hospital.
The third year is devoted almost exclusively to research, with limited (2 ½ months) of clinical service. Individual fellows develop specific research programs, and attending staff and a Scholarship Oversight Committee supervise scholarly activity. There is elective time available during all three years. The Department of Pediatrics and Weill Cornell Medical College maintain a working partnership with the Weill Bugando University College of Health, and opportunities are available to experience an elective rotation in Mwanza, Tanzania.
Fellowship research at Weill Cornell Medicine is intended to provide fellows with the opportunity to explore academic interests, learn to develop research questions and study design, and become familiar with the regulatory and publication processes. Fellows may engage in basic science, translational or clinical research.
A formal research curriculum is delivered during monthly divisional research meetings, as well as monthly departmental research meetings. Learning is focused on study design (including, but not limited to, point prevalence studies, large database research and systematic reviews), practicums (EndNote, library services, and IRB) and “Research In Progress” sessions. All fellows participate in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Clinical Fellows Course and present their research at a national meeting (most commonly SCCM Annual Congress).
Recent fellowship research projects include:
- “Dexmedetomidine Use in Mechanically Ventilated Children: A Longitudinal Study”
- “Severe Sepsis and Septic Shock in the Pediatric Hematopoietic Cell Transplant Population”
- “Early Use of Anti-Seizure Medication in Mechanically Ventilated Traumatic Brain Injury Cases: a Retrospective Pediatric Health Information System Database Study”
PCCM faculty are engaged in basic science, translational and clinical research. Lab projects include the characterization of the microbiome of the lung in young children with viral bronchiolitis and the changes in annexin in children undergoing cardiopulmonary bypass.
The Cornell Assessment of Pediatric Delirium (CAPD) was developed and validated by Dr. Chani Traube. She continues to study the epidemiology and mechanistic underpinnings of delirium in critically ill children.
Dr Marianne Nellis is leading an international collaboration to develop platelet and plasma guidelines in critically ill children.
Dr. Christine Joyce is helping to lead an intervention focused on first line recognition of critical illness and acute intervention in developing countries.
We are active members of PALISI, BloodNet, and PediECMO, PALISI Global Health and PALISI HCT-Cancer Immunotherapy Subgroup. Please see a sample of recently published faculty research below.
Savneet Kaur, MBBS; Gabrielle Silver, MD; Susan Samuels, MD, Anna H. Rosen, MD, Meredith Weiss, MD; Elizabeth A. Mauer, MS, Linda M. Gerber, PhD,; Bruce M. Greenwald, MD,; Chani Traube, MD. Delirium and Developmental Disability: Improving Specificity of a Pediatric Delirium Screen. Pediatric Critical Care Medicine. May 2020, Vol 21(5): 409-414. https://journals.lww.com/pccmjournal/Abstract/2020/05000/Delirium_and_De...
Christine L. Joyce, MD, Joy D. Howell, MD, Megan Toal, MD, Emily Wasserman, MD, Robert A. Finkelstein, MDCM, Chani Traube, MD, James S. Killinger, MD, Umesh Joashi, MBBS, Bruce M. Greenwald, MD, Marianne E. Nellis, MD, MS. Critical Care for Coronavirus Disease 2019: Perspectives From the PICU to the Medical ICU. Critical Care Medicine. July 28, 2020 - Volume Online First - Issue: https://journals.lww.com/ccmjournal/Abstract/9000/Critical_Care_for_Coro...
Oliver Karam, MD, PhD; Ruchika Goel, MD, MPH; Heidi Dalton, MD; Marianne E. Nellis, MD, MS. Epidemiology of Hemostatic Transfusions in Children Supported by Extracorporeal Membrane Oxygenation. Critical Care Medicine. Published online, August 2020 Vol 48(8): e698-e705. https://journals.lww.com/ccmjournal/Abstract/2020/08000/Epidemiology_of_...
Pediatric Critical Care Medicine Fellowship salary is determined according to PGY level, and increases annually. Fellows receive four weeks of vacation and time/funding to attend educational meetings when invited to present. Standard fringe benefits are provided. Subsidized housing is available in the immediate vicinity of the hospital.
How to Apply
Applicants must be board-eligible or board-certified in pediatrics, and graduates of a United States residency program. A curriculum vitae, three letters of recommendation from the applicant's training program, and a personal interview are required. The Pediatric Critical Care Medicine Program supports and participates in NRMP fellowship matching.