Pediatric Critical Care Fellowship Program Accredited by the Indian Society of Critical Care Medicine : Pediatric Critical Care Council & The Intensive Care Chapter of the Indian Academy of Pediatrics Copyright : The contents of this document are the sole property of Lotus Children s Hospital and no parts or the whole document be reproduced, copied or modified without the written permission of the CEO of Lotus Children s Hospital. Unauthorized copying, printing or dissemination by print / electronic means will attract stringent legal action against those involved! India s Finest Children s Hospital
Welcome to the Lotus Children's Hospital Pediatric Critical Care Fellowship Program. Our program is fully accredited by The Indian Society of Critical Care Medicine and Indian Academy of Pediatrics - Intensive Care Chapter. The fellowship program has been established with a goal to provide a rich, varied educational and clinical experience so that the fellow will be proficient in his/her ability to care for and manage critically ill children; providing the fellow with research opportunities in any of a number of fields that may be of interest to him/her; and to encourage involvement in the education of pediatric postgraduates, as well as other health care professionals including nursing staff. At the end of the fellowship, the fellow will be well positioned to pursue a Pediatric Critical Care career as a full fledged 'Consultant Pediatric Intensivist '. This information is meant to provide candidates an overview of our fellowship, the Pediatric Critical Care Fellow's responsibilities and a resource to answer some frequently asked questions that candidates may have as they pursue or start their fellowship.
Pediatric Intensive Care Staff at Lotus Children s Hospital: Dr. V.S.V. Prasad, MD Peds ( A.I.I.M.S. New Delhi ) AB Peds ( USA) Chief Neonatologist & Pediatric Intensivist. Chief Executive Officer Director - Pediatric Critical Care Fellowship Program Dr. Anjul Dayal, DNB Peds, Fellowship Ped.Intensive Care (ISCCM-IAP) Consultant Pediatric Intensivist Dr. M. Sridhar, MD Peds, Fellowship Ped.Intensive Care (ISCCM-IAP) Consultant Pediatric Intensivist Dr. V. Krishna Prasada Rao, MD, DCH Fellowship in Neonatology (Australia) Consultant Neonatologist & Pediatrician Dr. K.V.A.R. Neelima, MD Peds Consultant Neonatologist Department of Pediatrics at Lotus Children's Hospital: The Department of Pediatrics is a large, academically oriented service. All major pediatric subspecialties are well represented and as a Fellow in the Division of Pediatric Critical Care the candidate will work closely with all subspecialists in Pediatrics, including Endocrinology, Cardiology, Hematology / Oncology, Nephrology, Neurology, Genetics and Metabolism, General Pediatrics, and many of the surgical subspecialties ( including Pediatric General Surgery, Pediatric Cardiothoracic Surgery, ENT Surgery, Orthopedics, Neurosurgery etc.). Educational Resources : The library will be furnished with the books and journals and also internet access for online journal subscriptions. The main library is situated at the 5th floor and can be accessed during official hours delineated by the management. There is also a Departmental Library situated in the PICU. Curriculum During the two years fellowship, the fellow will have a number of clinical rotations to provide him/her with the opportunity and expertise necessary to effectively manage critically ill children by the time he/she completes the fellowship. The following is a brief description of the rotations, followed by a template of what the two years entrail for the Pediatric Critical Care Fellow. Pediatric Intensive Care Unit: Fellows on rotation here actively direct, under the supervision of the Director of the Pediatric Critical Care Program / Consultant Pediatric Intensivist / Senior Consultant / On-Call Consultant, the management of critically ill children in the PICU. A majority of a fellow's ICU clinical time is spent herein this unit. Pediatric Cardiac Intensive Care Unit: During the fellowship the fellow will gain experience in the management of pediatric cardiac post - operative patients as well as be involved in the perioperative management of children admitted or evaluated by the Pediatric Cardiology and Pediatric Cardiac Surgery Service. 3
Pediatric Cardiology: Lotus Children's Hospital is only one of the few exclusive Pediatric hospitals around the world, where there is the facility of Cardiac Catheterization Laboratory. During the fellowship, the fellow will be trained in observing diagnostic and therapeutic cardiac interventional procedures in the Catheterization Laboratory, as well as provide intravenous conscious sedation / mild anesthesia for children undergoing catheterization. The fellow will have exposure to interpreting catheterization data with the pediatric cardiologists. Fellows will have the opportunity in learning basic echocardiography * under the supervision of Dr. Kavitha Chintala Consultant Pediatric Cardiologists (* Optional) 4 Pediatric Anesthesiology: Two months of the fellowship will be spent on an anesthesia rotation under Pediatric Anesthesiologists. Specific goals of this rotation include gaining a focused expertise in a variety of procedures (endotracheal intubation, airway management, central venous and arterial line placement, etc.), the use of many sedative / anesthetic agents including the reversal of such agents, and the peri - operative management of children undergoing a variety of surgical procedures including neonatal surgery.
Neonatal Intensive Care Unit : Fellows will do three months on the Neonatology Service. Fellows will be expected to work with the Senior Consultant Neonatologists ( Dr. V.S.V. Prasad / Dr. V. Krishna Prasada Rao / Dr. K.V.A.R. Neelima) and gain expertise in unique aspects of the management of critically ill newborn and premature children including conventional mechanical ventilation, high frequency oscillatory ventilation, inhaled nitric oxide therapy, etc. Sedation & Analgesia : Fellows will be assigned to the provision of and the administration of intravenous conscious sedation and airway management for pediatric inpatients undergoing invasive diagnostic / therapeutic procedures under the direction of a Consultant Pediatric Intensivist. Most of these procedures will be performed in the PICU or the Radiology Department where children are undergoing invasive therapeutic or diagnostic procedures ( Eg: Ultrasound Guided Renal Biopsy, etc ). Intravenous Conscious Sedation may be required on the Pediatric Floors for procedures such as Bone Marrow Aspiration / Biopsy, Spinal Tap in difficult children, etc. Sample Template of Pediatric Critical CareTraining What follows is a sample template of which rotations a PICU fellow will have during their two year fellowship. It should be noted that there is a certain amount of flexibility in the schedule has been built in depending upon individual fellow and program needs. However, by the end of the two years, each fellow would have a similar broad experience. Year One: The main focus of this year is clinical, although fellows are encouraged to consider future research ideas. Pediatric Advanced Life Support ( PALS ) Courses and Neonatal Advanced Life Support ( NALS) Courses should be taken by the fellow within three months of joining the institution and should have passed and become certified in both PALS and NALS conducted by the designated professional bodies. First Two months: morning sessions would be spent in Anesthesia, to get fully trained in elective intubation techniques and rapid sequence intubation. After Anesthesia posting in the morning, the fellow would return to the PICU to execute the morning rounds with the Consultant Pediatriclntensivists and takecareof procedures, order writing,cross consulting specialists and the necessary paperwork and documentation work the in the Pediatric Intensive Care Unit. Second Four Months : The fellow would work mainly in the Pediatric Intensive Care Unit and also the Emergency Room handling emergency pediatric admissions, performing invasive diagnostic and therapeutic procedures in the PICU and learn interpretation of laboratory and clinical data including radiology. The next Four Months : The fellow will work in the Pediatric Cardiac Intensive Care Unit, and have access and knowledge to postoperative cardiovascular physiology, the art and science of hemodynamic management and cardiac pacing, etc. Thefellow will be allowed into the Cardiac Operating Room to observe and learn cardiac perfusion techniques, intraoperative surgical management, and the principles of providing cardioplegia and hypothermic circulatory arrest.
Year Two: The First Three Months : The Fellow will rotate in the Neonatal Intensive Care unit. He/She will learn the finer nuances of respiratory and cardiovascular support of the critically ill neonate and learn advanced ventilatory techniques including high frequency oscillatory ventilation and inhaled nitric oxide therapy. The Second Six Months : The Fellow will return to the Pediatric Intensive Care Unit and the main focus include apart from clinical time, is to learning the fine art of parent and family counseling. The fellow is expected to be available and with the PICU Consultant/s during counseling sessions to learn how to communicate, empathize and update the family about their child's progress in the PICU. During the second year the fellow is suppose to pursue his/her clinical research project and actively teach the junior residents and nursing staff. The Last Three Months : The Fellow will finish all requirement of the Fellowship Programme & Undergoes extensive 'Mock' exams under the supervision of the Pediatric intensivists to prepare for the exit examination in December As fellows progress satisfactorily through their second year of training, they assume progressively more responsibility and autonomy for guiding work rounds and monitoring the function of the unit throughout course.
On Calls: During the tenure of the entire Pediatric Critical Care training program, the fellow will do in - house on calls covering both the intensive care units ( PICU, NICU ) including the post operative cardiac ICU, and general pediatrics and the Emergency Room. On weekdays, your on-call responsibilities begin at 8 AM that, and continue till the next day morning till 11 AM. After clinical rounds, the fellow will be relieved. It is expected that fellows will stay back if the previous night call was not busy to learn as much as possible till 8AM the following morning. Weekend call runs 8AM to 12noon. Educational Activities: A number of educational conferences are provided throughout the week that the pediatric fellows are expected to attend, unless clinical responsibilities render them unable to do so. There is journal club and topic presentation at the auditorium on Lotus Children's Hospital and apart form that the fellow has to attend all the academic activity that will be planned and given to you and month in advance. There will the both written and viva voce examination at the end of every month. Research: The PICU fellow has to submit a research project before the completion of the fellowship. PICU fellows have the opportunity to pursue research interests in a wide variety of areas (clinical and basic science) within Department of Pediatric Critical Care. Most of research experience will be during your second year. During your first year however, you should consider what potential research interests you have, and begin exploring them. The fellowship director can help guide you through your initial research options. Critical Care Transports: As the PICU fellow on clinical service, you may be asked to speak with a physician / pediatrician regarding the transport of a sick child from an outside institution. The PICU fellow will be responsible in organizing, conducting and safely transporting a sick child / neonate from a referral hospital ( both within the twin cities as well as out of station and out of state ). Direct conduct of critical transports is an integral part of training of the PICU fellow. Stipend for Pediatric Critical CareFellowship Program : A stipend for Pediatric Critical Care Fellows will be paid commensurate with the qualification, education & Clinical expertise of the applicants. The amount will be subject to the mandatory deduction of the prevailing tax at source as per the Income Tax laws of the Government of A.P. The balance will be paid to the candidate by cheque every month or credited to the account of the fellow directly by electronic transfer of funds. The Pediatric Critical Care fellow's stipend will also be subject to deductions as per the Human Resources Policies of Lotus Children's Hospital for non compliance of the educational programme/s, lapses in conduct, unauthorized leave, etc. Dr. V.S.V. Prasad Director Pediatric Intensive Care Program
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