The Fellowship in Pediatric Critical Care Medicine at New York - Presbyterian Hospital-New York 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.

Bruce M. Greenwald, MD
Director, Division of Pediatric Critical Care Medicine
Co- Director, Critical Care Fellowship Program

Joy D. Howell, MD
Director, Critical Care Fellowship Program

Pediatric Intensive Care Unit

The program is centered in a 20 bed multidisciplinary PICU in the Greenberg Pavilion of New York Presbyterian Hospital. The Division of Pediatric Critical Care is responsible for children from 1 day to 21 years old with complex medical and surgical illness. The unit is "closed" and the critical care staff is responsible for all aspects of the patient's care in collaboration with the referring and consulting services. Infants and children are recovered in the PICU following cardiothoracic and neurologic surgeries. Sources for patient referrals include the general wards of New York-Presbyterian Hospital, the Emergency Department, the Pediatric services of other New York Presbyterian Hospital Healthcare System hospitals as well as other hospitals in New York, New Jersey, and Connecticut. New York State has designated The New York Weill Cornell Medical Center as a Level 1 trauma center for both adults and children. The New York Weill Cornell Medical Center PICU has close affiliations with Memorial Sloan-Kettering Cancer Center and The Hospital for Special Surgery, both of which regularly transfer critically ill children to our unit. The Department of Pediatrics maintains an active local and regional transport system, staffed by paramedics and physicians.

Staff & Education

The unit is staffed by pediatric critical care trained nurses with a nurse:patient ratio of 1:1 to 1:1.5. Critical care nurses work only in the PICU and participate in rounds, multidisciplinary conferences and other teaching activities. The medical staff consists of six pediatric critical care attendings and six pediatric critical care fellows. Pediatric and Anesthesia residents, working under the direct supervision of the critical care fellow, support the critical care staff. There is a fellow in the PICU 24 hours a day. The full range of pediatric and surgical sub-specialties are represented in the facility and are available for consultation and referral.

The Fellowship

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. Additionally, PICU fellows have several months of consultative responsibilities in the New York - Presbyterian Hospital Burn Center (one of the largest in the world) and supervisory responsibilities in the Lauren Rosenberg Pediatric Observation Unit at Memorial Sloan-Kettering Cancer Center. First year fellows spend an average of eight months on service in the PICU with this time divided between the red and blue teams. The red team is responsible for oncology and neurosurgery patients as well as the Pediatric Observation Unit at Memorial Sloan- Kettering Cancer Center. The blue team is responsible for cardiothoracic surgery patients as well as for consults in the Weill Cornell Burn Unit. There are active procedural sedation and transport services. The first year is rounded out by two months of anesthesia and one month at the New York City Poison Center. The Division of Pediatric Critical Care educational program includes a core lecture series, case management conferences, an evidence-based medicine journal club, pathology reviews, morbidity and mortality conferences and, a research design and biostatistics course. In the second year, service time is reduced and approximately six months are allocated for research activities. The third year is devoted almost exclusively to research. A specific research program is developed by the individual fellow and attending staff. There is elective time available during all three years.

Research Program

Fellows are offered assignment to one of several laboratories conducting state of the art molecular biological and translational research. Didactic programs in research design, statistics and ethics complement the fellow's research activities. The Weill Medical College-Rockefeller University-Memorial Sloan-Kettering tri-institutional neighborhood is an exceedingly rich environment in which to look for research projects and mentors if one chooses to do work outside of the division. Ongoing clinical research programs in the areas of sepsis, respiratory failure and pharmacology are available to fellows.

Members of the Division are currently involved in the following research projects:

• Circadian clock genes and immune T-cell function
• The role of endogenous corticosterone in LPS-induced septic shock in mice
• Investigation of a novel RSV vaccine utilizing gene transfer therapy
• The role of IRAK-M in endotoxin tolerance
• Predictors of need for dopamine in children following neuroblastoma surgery
• An evaluation of pediatric resident education in the Pediatric Intensive Care Unit
• Hemofiltration & survival in bone marrow transplant ARDS
• Airway pressure release ventilation for pediatric respiratory failure
• Catheter related blood stream infections in the Pediatric Intensive Care Unit
• Outcome of pediatric septic shock and multiple organ system failure

Benefits

Salary is set according to the PGY level and increases annually. Fellows receive four weeks vacation and one week for educational meetings per year. The usual fringe benefits are provided. Subsidized housing is usually available in the immediate vicinity of the hospital.

Requirements

Applicants must be board eligible or 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 program supports and participates in the NRMP fellowship match. All accepted fellows must have a New York State Medical License.

Address inquires to

Joy D. Howell, MD
Division of Pediatric Critical Care Medicine
Department of Pediatrics
New York Presbyterian Hospital - Weill Cornell Medical Center
525 East 68th Street, Box 318
New York, N.Y. 10021-4873

Critical Care Fellowship Application