Fellowships

PICU Group 2012


Overview


Welcome to the Pediatric Critical Care Medicine Fellowship at the University of North Carolina. The Pediatric Critical Care Medicine Fellowship program has undergone many exciting changes over the last few years. From the newly constructed NC Children’s Hospital, to the expanded twenty-bed PICU, to doubling the size of the faculty, Pediatric Critical Care Medicine (PCCM) at UNC has entered an exciting new era. This success has resulted in an unprecedented increase in applications for fellowship positions and a greater than 300% increase in UNC residents pursing PCCM as their career choice. These changes have been recognized by substantial awards as well. The PCCM faculty have won teaching awards and the fellows have won awards for their presentations at national and local meetings. Under the direction of Dr. Keith Kocis, the Pediatric Critical Care Fellowship has now become one of the premier multidisciplinary training programs in the Southeast.

The Pediatric Critical Care Medicine Fellowship is a three-year program accredited by the American Board of Pediatrics. The fellowship is designed to provide excellent educational opportunities, clinical training in all aspects of critical care, as well as strong research opportunities in both basic and clinical research. The primary clinical training takes place in the newly expanded 20-bed multi-disciplinary PICU, which is located in the North Carolina Children’s Hospital on the UNC medical campus in Chapel Hill, N.C.

The Division of Pediatric Critical Care Medicine is comprised of eight faculty members with board certification in pediatric critical care, anesthesia, and pediatric cardiology with additional expertise and training in pediatric anesthesia, pediatric cardiac anesthesia, and Masters of Public Health. The faculty represents a wide variety of interests and assorted backgrounds, providing a diverse educational experience. Some areas of interest are peri-operative management of congenital heart disease (CHD), respiratory mechanics, optimization of ventilation, diaphragm function, cardio-respiratory interactions, advanced modes of ventilation, pediatric pharmacology, simulation, patient safety, quality improvement, education, pediatric clinical trials, critical care in the global health arena and administration of the PICU.

Overall, 50% of the 3 year fellowship is spent in clinical training with the remaining 50% spent on research. The first year of the fellowship places emphasis on clinical practice. The second year is focused on research, while the final year is flexible and designed to provide individuals with clinical, research and educational opportunities to meet their educational and training needs.

Clinical Opportunities


The multidisciplinary nature of the program is evident in all aspects of the clinical training. More than 1200 admissions to the PICU each year ensures broad exposure to all aspects of critical care. The unit is a newly-constructed, state-of-the-art facility with all private rooms, several isolation rooms, and ample family support areas. The fellows are directly involved in all aspects of clinical management and decision-making for all PICU patients. The PICU functions as a closed unit. In addition, fellows provide direct supervision and help educate residents from pediatrics, anesthesiology, emergency medicine, etc and fourth year medical students. Our PICU uses nearly all forms of advanced life support technologies. Advanced ventilation modes are used and available, including Servo I, inline airway graphics, high frequency jet ventilation, high-frequency oscillatory ventilation, volumetric diffusive respiration (VDR) and inhaled nitric oxide. The PICU has a very active extracorporeal membrane oxygenation (ECMO) program with new state-of-the-art equipment that provides support for a wide variety of critical conditions in neonates and pediatric patients. The faculty all have their primary appointments in the Department of Anesthesiology, allowing for excellent education and training for the fellows. The fellows have a 4 week anesthesia rotation early in their first year to acquire necessary training in managing airways with additional advanced/difficult airway learning in the last year of training.

UNC is home to the state’s only burn center, which provides a tremendous opportunity for our fellows to help co-manage every pediatric patient admitted to either the PICU or Burn Center. Other clinical opportunities are also available and include rotations in pulmonary medicine, cardiology (including echocardiography and the cardiac catheterization laboratory), cardiovascular surgery, Transport Medicine, etc.

UNC has pioneered a 360 degree evaluation methodology. Using this approach, the fellow is evaluated by attending physicians, nurses and themselves twice a year. These evaluations incorporate all aspects of the fellows training including: Clinical, Research, Education, Interpersonal, and Administrative functions focusing on the core competencies. The Fellowship Director discusses the evaluation with each fellow which has been extremely helpful to the fellows as it provides them with formal feedback. In addition, the fellows evaluate the faculty and the program biannually to allow for continued advancement and improvement in the PCCM Fellowship.

Designed to be multi-disciplinary, the team in the PICU also includes dedicated pediatric respiratory therapists, pediatric pharmacists, child recreation therapy, physical therapy, occupational therapy, and social work. The closely knit relationship between the Pediatric nursing and physician staff is consistently rated as excellent.

Educational Opportunities


The UNC Pediatric Critical Care Fellowship has made education a priority. The educational component has been enhanced recently from direct feedback from the current fellows. This feedback occurs through monthly fellow/attending conferences, bi-annual formal evaluations, and an annual retreat. The fellows and attendings have worked with the Fellowship Director to develop a curriculum which achieves the goals of all participants and exceeds the expectations of the Sub-board of Pediatric Critical Care Medicine. This is achieved by several formal educational opportunities as well as multiple didactic opportunities. The UNC PCCM staff and invited guests provide formal lectures on all aspects of critical care. All lectures are located on a computer server that the fellows can access.

Educational conferences include but are not limited to:

  • Weekly bedside conferences: Attendings, fellows and residents discuss a single clinical case of a patient admitted to the unit. This provides the fellows with a unique opportunity for education on a variety of clinical scenarios. The focus is on diagnosis, management, and future outcomes.
  • Semi-weekly fellow conferences consist of formal lectures by the attendings or fellows including journal club, research conference, topic reviews, and didactic lectures.
  • Monthly morbidity and mortality conferences provide an opportunity for a quality review of all aspects of the clinical practice.
  • Statistical analysis and research design lectures by PCCM Faculty members with specialized masters degrees.

Research Opportunities


The UNC Pediatric Critical Care Medicine Fellowship is designed to provide the best possible research opportunities for fellows. Recognizing the individual nature of each fellow, we have tailored several programs to achieve the goals defined by the individual fellow. At UNC, there are extensive research opportunities available to critical care fellows and strong protected research time. In the first year, fellows are encouraged to participate in a clinical research project and are introduced to the diverse research opportunities within and outside of the Division of Pediatric Critical Care Medicine. In the second and third years, extensive protected time is provided so that each fellow can complete their research requirements. There are several opportunities not only for clinical research but also for basic science research. The major focus of the research experience is to learn how to design a hypothesis-driven research project, acquire the necessary technical skills to test the hypothesis, analyze the data and present the work. All fellows’ research is expected to result in a first author peer reviewed manuscript in a high quality medical journal. In the second and third years, extensive protected time is provided so that each fellow can complete their research requirements. Education and review sessions occur at least monthly and provide the fellows with a significant amount of opportunity for review. Education and review sessions occur at least monthly and provide the fellows with a significant amount of opportunity for review. Each fellow’s research is developed and monitored by a Scholarly Oversight Committee comprised of at least 3 faculty with at least one PCCM faculty and other members with content specific expertise. All fellows' research is expected to result in a first author peer reviewed manuscript in a high quality medical journal. Research endeavors by our former fellows are presented below:

FellowResearch ProjectManuscript
Rebecca Carchman, MD 2002-2006 Glycemic control as a predictor of mortality in the PICU A new challenge in pediatric obesity: pediatric hyperglycemic hyperosmolar syndrome. Pediatr Crit Care Med. 2005 Jan;6(1):20-4. Link :Carchman
Mark Piehl, MD, MPH 2002-2006 Continuous invasive cardiac output monitoring in a piglet model of hemorrhagic shock Pulse contour cardiac output analysis in a piglet model of severe hemorrhagic shock. Crit Care Med. 2008 Apr;36(4):1189-95. Link:Piehl
Travis Honeycutt, MD 2002-2006 Randomized use of Probiotics in PICU patients Probiotic administration and the incidence of nosocomial infection in pediatric intensive care: a randomized placebo-controlled trial.  Pediatr Crit Care Med. 2007 Sep;8(5):452-8 Link: Honeycutt
Cheri Hanson, MD 2004-2007 Impact of a Pediatric Rapid Response System on cardiac arrests

A reduction in cardiac arrests and duration of clinical instability after implementation of a pediatric rapid response system. Qual Saf Health Care. 2009 Dec;18(6):500-4 Link Hanson1

Family alert: implementing direct family activation of a pediatric rapid response team. Jt Comm J Qual Patient Saf. 2009 Nov;35(11):575-80. Link Hanson2

Stacey Peterson-Carmichael, MD 2004-2008 (Dual Training with Pediatric Pulmonary)

 Pulmonary function monitoring in infants and children admitted Association of lower airway inflammation with physiologic findings in young children with cystic fibrosis. Pediatr Pulmonol. 2009 May;44(5):503-11. Link Peterson-Carmichael
Brian Olsen, MD 2005-2008 Assessment of Adrenal insufficiency in post operative cardiac patients Measuring cardiac output in critically ill infants and children: Are we still "talking the talk" or can we now "walk the walk"? Pediatr Crit Care Med. 2008 Jul;9(4):449-50. Link: Olsen
Bridget Donell, MD 2006-2009 Use of simulation training in medical student education In progress
Benny L. Joyner, Jr., MD, MPH 2006-2009 Inflammatory response of Pediatric Inhalation Injury Airway Inflammatory Responses in Pediatric and Adult Patients with Inhalation Injury. Publication pending
Nina Verdino, MD 2009-2012 Cardiac output monitoring using noninvasive and invasive techniques: USCOM vs PICCO In progress
Laura Czulada, DO 2009-2012 Multidisciplinary and family centered communication practices in the PICU In progress
Ivy Pointer, MD, MPH 2009-2012 Estimating the economic burden of abusive head trauma in the PICU In progress
Christina Lopez, DO 2011-2014

 

Meet Our Faculty

 

 

Meet Our Fellows

  • Lopez, Christina C. University of Florida The New York College of Osteopathic Medicine Subspecialty: Pediatric Critical Care

    • Application Process


    If the kind of training outlined here interests you, we would be happy to receive and consider your application. If you have any questions about this training program, please phone or write to the fellowship director. All applications are handled through the ERAS system. Interviews are scheduled from July 1 through October 30 prior to the AAMC Match

    Application package required:


    Please mail completed package to:
    Keith Kocis, MD, MS
    Division of Pediatric Critical Care Medicine
    204 MacNider Hall
    CB# 7221
    Chapel Hill, NC 27599-7221


    Questions and program inquiries can be directed to:
    Division of Pediatric Critical Care Medicine
    214 MacNider Hall
    CB# 7221
    Chapel Hill, NC 27599-7221
    (919) 966-7495