UCSF/CHO Pediatric Critical Care

UCSF/CHO Pediatric Critical CareFellowship Program

Overview

Goals

Training program• Clinical• Career development

Mentoring

Alumni

Work environment

Life in the Bay area

In a nutshell…

The UCSF/CHO Pediatric Critical Care Program is a:

• Moderately sized• Academically oriented fellowship• Located in San Francisco and Oakland CA

Goals/Philosophy

To train top notch competent, compassionate clinicians destined for success in academic environments

Trainees will be well prepared to engage in meaningful research in a variety of fields related to critical care medicine

To achieve this, we will provide:• A strong clinical training program• Exposure to basic, translational, and clinical research • Opportunities to develop superior teaching skills• Strong mentorship and career development

Overview of Training Program

Fellow as Clinician

Fellow as Investigator

Fellow as Educator

Fellowship Overview

1st Year

Master clinical critical care medicine

Identify a career focus

2nd and 3rd Years (and…)

Build a career focus

Solidify clinical skills

Developing Fellows as Clinicians

Nuts and bolts of year 1

(13: 4-week-rotations)

Anesthesia (CHO) 1

ICU Service 8

Research 3

Vacation 1

Developing Fellows as Clinicians

Nuts and bolts of year 2ICU Service 5

Adult ICU 1

Research 6

Vacation 1

Nuts and bolts of year 3ICU Service 2

Elective 1

Research 9

Vacation 1

Developing Fellows as Clinicians

Formal clinical learning opportunities• Fellow’s Conference• Journal Club• PICU & CICU M&M Conference• Pre-Surgery Cardiac Cath Conference• ECLS Conference• Pediatric Grand Rounds• Adult ICU Lecture Series• Joint Pediatric, Adult, & Neonatal ICU

Lectures

Developing Fellows as Clinicians

Clinical Resources• UCSF Children’s Hospital: 120 in-patient beds, 6,300

annual discharges, 50,000 clinic visits- PICU: 14 beds; CICU: 8 beds, 9 intermediate beds- ~1,200 annual ICU admissions, ~250 open cardiac cases- Transplant - bone marrow, kidney, liver, small bowel- Rapid deployment ECLS

Developing Fellows as Clinicians

Clinical Resources• Children’s Hospital Oakland: 170 in-patient beds, 9,200

annual discharges, 100,000 clinic visits, 26,000 annual ED visits

- PICU: 23 beds- 1,800 annual ICU admissions, ~150 open cardiac cases- Pediatric Trauma Center of Northern California

Developing Fellows as Clinicians: Night Call

• CHO:• every 4th night

• UCSF: • 2 week 12 hr PM shifts• 2 weekends off

per rotation

•Non-clinical months

are call free except:• 12 Saturdays (24 hr

shifts)

in 2nd and 3rd year

Building Your Career

Goal: Train top notch clinicians for academically-focused careersWhat does it take to get a great academic job?

• Excellent clinician• Tangible scholarly work: Clinical, translational, or basic

research; Master Educator• Board certification

Developing Fellows as Investigators

Goals • Help fellows develop academic focus and area of expertise• Prepare fellows to secure K08 or K23 funding• Enable graduates to launch successful academic careers as

independent investigators

Developing Fellows as Investigators

Options:• Basic/Bench Research• Translational Research• Clinical Research• Master Educator

Finding a lab/mentor• Not restricted to Division/Department• Investigators at Parnassus, Mission Bay,

CHORI, Berkeley, Lawrence Livermore, etc. are all potential choices

Developing Fellows as Investigators

Research Resources• UCSF: >1,200 active basic/translational

science labs- Cardiovascular Research Institute- The Gladstone Institute- Biomedical Sciences Training Program- Program in Biological Sciences

• Children’s Hospital Oakland Research Institute (CHORI)

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Developing Fellows as Investigators

Research Resources (Clinical Science)• Pediatric Clinical Research Center

• Department of Epidemiology and Biostatistics- Training in Clinical Research Program (TICR)

– The Master’s Degree Program

Developing Fellows as InvestigatorsOpportunities for all fellows

• Molecular Biology and Clinical Research Workshops (AACR/ASCO)

• Biomedical Sciences (BMS) Graduate Program- Basic science courses- Seminars

• CVRI Courses and seminars- Biostatistics- Science Writing- Art of Lecturing

• TICR (Training in Clinical Research - 6 weeks)• ATCR (Advanced Training in Clinical Research - 1 year)• Molecular Medicine Weekly Conference

NIH T32: Research Training in Pediatric Critical Care Medicine

Clinical-Translational Training

Laboratory Research Training

NeuroscienceProgram

CardiovascularProgram

PulmonaryProgram

• 4 year program which includes 2.5 years of protected research training• Both laboratory and clinical-translational tracks• Diverse mentored research opportunities

NIH T32: Research Training: “The Perks”

Advisory Committee

(Sterring Committe for the Department Program in Pediatric Science) (Drs. Hawgood, Irwin, + Wara)

PROGRAM DIRECTOR (Dr. Fineman)

ASSOCIATE DIRECTOR Laboratory Science Center

(Dr. Hawgood)

ASSOCIATE DIRECTOR Clinical-Translational Science Center

(Dr. Hulley)

CORE DIRECTOR Neuroscience (Dr. Ferriero)

CORE DIRECTOR Cardiovascular (Dr. Bernstein)

CORE DIRECTOR Pulmonary

(Dr. Matthay)

• Multiple layers of supervision and mentorship• Integrated with UCSF Fellow’s College• Educational stipend• Flexible clinical commitment• Funds for TICR and Masters in Clinical Research

Developing Fellows as Educators

Opportunities for teaching• Resident Lectures• Fellow’s Conference• Division Meetings• Chairman’s Rounds• Noon Conference• Bench to Bedside• Teachable moments with residents and

medical students

Developing Fellows as Educators

Opportunities for the Master Educator career track• Haile Debas Institute of Medical Education• Development of exportable learning

materials

Mentoring Program

“Mentors don’t just give advice; they make things happen for your career”-Art Weiss

School of Medicine ProgramsGraduate Program Seminar SeriesDepartmental Fellows’ CollegeDivisional Mentoring: Formal and informalFrequent feedback

• Division• Scholarship Oversight Committee (SOC)

Fellows’ College

Half-day workshop for all fellows, 3x per year• Prepare fellows for successful academic careers• Develop camaraderie

Topics:• Fellow as Clinician: How to do a consult; How to be an

effective supervisor; Transition from 3rd year to Fellow• Fellow as Investigator: Choosing a mentor/how to be a

mentee; How to choose a lab; How to write a grant; How to give a research talk

• Fellow as educator: How to give a talk; Teachable moments• Life after fellowship: Inside the NIH; Developing a CV;

Managing Life; Job searches; Negotiating

UCSF/CHO Pediatric Fellowship Alumni-Track Record

• In past 10 years, 60% Academic University Appointments (18/30)

• 7 Directors of Critical Care Medicine; 2 Vice-Chairs Pediatrics; Director of PALISI

• 13 current NIH-funded graduates (2 of 5 PCCM K12 awards)

Environment

The Hospital

The People

The Patients

San Francisco

Work Environment: The Hospital

UCSF Children’s Hospital• Hospital within a hospital• Tertiary to quaternary care facility in a University setting• Educational focus • Full ancillary pediatric trained support staff

Intensive care• PICU (31 beds)• ICN (55 beds)

Pediatric Clinical Research Center (PCRC)• NIH-sponsored research center for diverse clinical trials• Dedicated nurses, biostatistician, core laboratory

Ambulatory Care Center• Includes all specialty clinics

Work Environment: The Hospital

Children’s Hospital Oakland• Free-standing Children’s Hospital• Pediatric trauma center of Northern California• Very busy emergency department

Intensive care• PICU (23 beds)• ICN (55 beds)

CHORI• NIH-sponsored research center for diverse clinical trials• Dedicated nurses, biostatistician, core laboratory

Ambulatory Care Center• Includes all specialty clinics

Work Environment: The People

Team-oriented approach to care

• Diverse ICU faculty doctors• 9-11 fellows• Nurse practitioners• Clinical nurse specialists• Palliative care coordinator• Discharge planners• Social workers• Dedicated pharmacist• Dedicated nutritionist• Pediatric PT/OT/speech

therapists• Child-life specialists• Spiritual care specialists• Educational liaison

Work Environment: The People

Strengths of clinical service

•Integration/collaboration of laboratory scientists and clinicians•Great Housestaff•Awesome Fellows•Exceptional Ancillary Support

Work Environment: The Patients

Families from many different cultures with diverse socioeconomic status

Large referral base

Environment: Life in the Bay Area

Benefits: MANY! Culturally, extremely diverse

Geographically small (a “walk-around” city)

Unique weather (subtropical, never snows or

freezes) (But driving distance to snow!)

Food and fun capital of the U.S.

“Outdoors Unlimited”—land, sea, sky

Just a cool place to be!

Environment: Life in the Bay Area

Challenges: Cost of housing--$$ Unique weather--cool, fog Earthquakes (only occasionally!)

Solutions: Modest housing in a good neigh- borhood Public transportation savings NEW!!--$500/month housing

allowance Many on-line rental agencies Local landlords prefer residents and fellows

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Environment: Life in the Bay Area

Special Learning Opportunities

• NIH T32 - Research Training

• International Health

• Masters In Public Health - UC Berkeley

• Masters in Clinical Research (TICR)

• Sponsored International Conferences

UCSF/CHO Pediatric Fellowship Training Program

Fellows who thrive (not just survive) in our program:• Embrace diversity• Desire an environment small enough for personalized attention but

big enough to achieve the critical mass necessary for an excellent education

• Like to work hard and play hard and HAVE FUN!!!