The Pediatric Intensive Care Unit (PICU) receives some of the most complex and time sensitive cases in pediatric medicine. When pediatric patients are admitted to a PICU, highly trained sub-specialist intensivists begin a race against time to stabilize and save these young lives. Under the umbrella of one of the finest pediatric care departments in the nation, the Division of Pediatric Critical Care, within the Department of Pediatrics at the Indiana University School of Medicine and an integral part of Riley Children’s Heath, provides specialists with a state-of-the-art facility to apply innovative medical practices alongside family-centered care.
Due to the vast wealth of knowledge, experience and merit afforded by the department’s medical team, the Division of Pediatric Critical Care is a phenomenal choice for pediatricians looking to pursue fellowship training within the subspecialty of pediatric intensive critical care.
With 36 state-of-the-art beds, the Riley Children’s PICU has been named by The Children’s Hospital Association as having one of the highest acuity patient mixes in the United States, which highlights the team’s ability to care for children with high-stakes medical challenges. The clinical program represents all subspecialties and provides procedural services such as extracorporeal membrane oxygenation, dialysis, high-frequency oscillatory ventilation and inhaled nitric oxide administration.
The unit also boasts an active and high volume pediatric surgical sub-specialty presence, sedation team, a state-wide transfer team and a 24-bed cardiac critical care unit with an internationally recognized medical team.
For third year fellow Nicole J. Jackson, MD, MSc, the subspeciality training provided by the PICU division proved beneficial for many reasons, but her initial draw to the school was due to the diversity of patient types and size of the institution.
Due to Riley Hospital for Children being located in Indiana’s capital city, Riley Children’s PICU serves near 80% of the entire state. This geographical positioning in Indianapolis gives fellows the opportunity to encounter one of the nation’s most diverse pool of patient cases while experiencing high acuity.
“For us fellows, or trainees in general, this is important because it’s better to see everything now than to go to another hospital later and see a bunch of things we've never encountered," Jackson said.
Another beneficial aspect of the fellowship training is what the attending physicians, who are the fully licensed physicians who oversee patient care and supervise fellows, call “graduated autonomy.” In the first year of the fellowship program, fellows focus on shadowing the attending physicians and doing procedures. Over the course of the next two years, attendings gradually begin to step back and allow fellows to run the floor with more autonomy.
“By the second and third year, you’re kind of just running things on your own, even though the attending is there to help,” Jackson said.
Born in Panama and raised in Miami, Florida, Jackson commented on the transition to the Midwest. “The people here are really nice and inviting. Everyone — the attendings, the fellows, the NPs, the nursing staff — are just very friendly. It’s very helpful, especially when you're going into a very intense fellowship like at IU.”
Geoffrey Derven recently stepped into PICU’s fellowship coordinator position. As the program coordinator, he makes sure that while fellows participate in the rigorous and high intensity training, they have all the resources needed to thrive.
“It's a high intensity program with very, very long clinical hours,” Derven said. “There's a lot of regulatory oversight and expectations that must be met and things that need to be documented and recorded. I'm here to help facilitate all of that and make sure they get all the work that they're doing documented, recorded and reported, including research projects like the Scholarly Oversight Committee project.”
Research within the division proves fruitful due to the rich involvement in multi-center studies. The focus of critical topics range from innovatory medical practices to the costs and impacts of healthcare utilization, all of which aim to improve patient care and outcomes.
“Some institutions focus on one certain type of research, whereas here, the attendings have a lot of interests,” Jackson said. “Here, you can find different types of mentors who are focused on the interests you want to develop while you try to figure out what type of attending you want to be.”
The PICU fellowship not only offers specialized training to physicians, but the breadth of perspective needed to stand as leaders in the field.
“Not only are they learning to specialize, but they are developing ways to improve and better the field,” Derven said.
As Jackson makes her final moves to complete her PICU fellowship, she is getting ready to start an additional one-year fellowship in neurocritical care.
“It will be a time for me to see things from a neurology, neurosurgery and adult perspective that I might not see in peds, but it's important because, I would say, much of what we do in the ICU is to save the brain,” Jackson said. “Doing a year fellowship gives you more time to just focus on one particular organ, whereas in the ICU, we focus on everything.”
Alongside the three-year PICU fellowship program, the division also offers a one-year pediatric cardiac intensive care fellowship, which offers an additional opportunity for pediatricians to gain expertise necessary to care for complex patients with critical cardiac disease.
For more information about the PICU fellowship programs, visit the Division of Pediatric Critical Care website or contact Geoffrey Derven.
