Critical Care Medicine
The Pediatric Critical Care Medicine Fellowship at the University of North Carolina at Chapel Hill is one of the premier multidisciplinary training programs in the Southeast. Expansion in our division’s faculty and resources has resulted in an unprecedented increase in applications for fellowship positions.
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 and strong research opportunities in both basic and clinical research.
The primary clinical training takes place in the newly expanded 20-bed multi-disciplinary PICU, located in N.C. Children’s Hospital on the UNC medical campus in Chapel Hill, N.C.
About half of the three year fellowship is spent in clinical training and half is spent on research. The first year of the fellowship places emphasis on clinical practice. Fellows have a four 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. 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.
About our Division
The Division of Pediatric Critical Care Medicine in UNC’s Department of Pediatrics is comprised of nine faculty members with board certification in pediatric critical care, with additional faculty dual boarded in pediatric cardiology.
The multidisciplinary nature of our 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 PICU is a state-of-the-art facility featuring private rooms for all patients, isolation rooms and ample family support areas. It functions as a closed unit and uses nearly all forms of advanced life support technologies including advanced ventilation modes such as:
- Servo I;
- Inline airway graphics;
- High frequency jet ventilation;
- High-frequency oscillatory ventilation;
- Volumetric diffusive respiration (VDR); and
- Inhaled nitric oxide.
The PICU has an 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.
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 close-knit relationship between the pediatric nursing and physician staff is consistently rated as excellent.
Fellows are directly involved in all aspects of clinical management and decision-making for PICU patients. They also provide direct supervision and education to fourth year medical students and residents from pediatrics, anesthesiology, emergency medicine, as well as other departments.
UNC is home to the state’s only burn center, which provides an opportunity for our fellows to help co-manage every pediatric patient admitted to either the PICU or Burn Center. Our institution is also home to the N.C. Children’s Airway Center, one of the few pediatric airway centers nationwide. The Airway Center provide multidisciplinary evaluation and treatment of children with complex airway and swallowing disorders.
Other clinical opportunities available include rotations in pulmonary medicine, cardiology (including echocardiography and the cardiac catheterization laboratory), cardiovascular surgery, Transport Medicine and others.
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, providing 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.
At UNC, the PCCM Fellowship’s broad clinical training is heavily supplemented with an academic education curriculum that includes a mix of didactic and simulation based learning. The didactic program includes multidisciplinary conferences with our neurosurgery, cardiothoracic surgery, cardiology, pulmonary, and pediatric general surgery colleagues. In addition, the core PCCM curriculum involves a recurring lecture series designed to cover core PCCM topics over a 12 month period including lessons on pathophysiology, evidence-based medicine, and new and upcoming therapies. The simulation training involves high-fidelity simulators to cover a range of topics from skills training to crisis management to difficult conversations at the bedside.
The PCCM Fellows at UNC also participate in a biannual ECMO course, first as learners and subsequently as teachers, as well as a regional boot camp at the start of fellowship followed by a regional boot camp for senior fellows.
In addition to the conferences listed below, fellows are also mentored by PCCM faculty in delivering the core lecture series to residents rotating in the PICU and in facilitating simulation training. These experiences combine to provide a solid foundation to an academic career.
12:00pm Fellow Chalk Talk
2:00pm PICU Multidisciplinary Simulation (every other Monday)
2:30pm Cardiac M&M (once a month)
3:30pm Cardiac Cath Conference
3:00pm PICU M&M (once a month)
12:00pm Noon Conference
2:00pm PCCM Fellow Core Curriculum
3:00pm PCCM Fellow Core Curriculum
8:00am Pediatrics Grand Rounds
12:00pm Pediatric Schwartz Rounds (once a month)
2:30pm Critical Care Patient Safety and Quality Improvement Conference (once a month)
4:00pm ECMO Quality Review (once a month)
12:00pm Fellow Core Curriculum (every other Friday)
12:00pm Pediatric M&M (once a month)
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.
Critical care fellows are given extensive research opportunities in both clinical research and basic science research with strongly 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. Education and review sessions occur at least monthly and provide the fellows with a significant amount of opportunity for review.
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.
Each fellow’s research is developed and monitored by a Scholarly Oversight Committee comprised of at least three 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:
|Fellow||Research Project||Manuscript||Current Faculty Position|
|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||Mission Children’s Hospital,
|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||Wake Med,
|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||Wake Med,
|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
|N.C. Children’s Hospital|
|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||Duke Children’s Hospital|
|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||Children’s Mercy Hospital,
Kansas City, MO
|Bridget Donell, MD 2006-2009||Use of simulation training in medical student education||In progress||Wake Med,
|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.||N.C. Children’s Hospital|
|Nina Verdino, MD 2009-2012||Cardiac output monitoring using noninvasive and invasive techniques: USCOM vs PICCO||In progress||Vidant Children’s Hospital
|Laura Czulada, DO 2009-2012||Multidisciplinary and family centered communication practices in the PICU||In progress||Stony Brook,
Stony Brook, NY
|Ivy Pointer, MD, MPH 2009-2012||Estimating the economic burden of abusive head trauma in the PICU||In progress||Wake Med,
|Christina Lopez, DO 2011-2014||Improving communication with families of patients undergoing Pediatric Cardiac Surgery||In progress||University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School|
If the clinical, educational and research opportunities available through our division interest you, we are happy to receive and consider your application.
All applications are handled through the ERAS system.
Interviews are scheduled from August through the fall prior to the AAMC Match
Application package required:
- Current CV
- Personal statement
- 3 letters of recommendation
Questions and program inquiries can be directed to:
Division of Pediatric Critical Care Medicine
417 MacNider Hall
Chapel Hill, NC 27599-7221
Paul Shea, MD
Fellowship Program Coordinator