First Year

• • 4 months Pediatric Intensive Care Unit (PICU)

  • 2 months Cardiac Intensive Care Unit (CVICU)

  • 2 weeks Cath Lab / Cardiology

  • 2 weeks Deep Sedation

  • 1 month Anesthesia

  • 4 months Research

Second Year

• • 3 months PICU

  • 1 month CVICU

  • 2 weeks Palliative Care

  • 7.5 months Research

Third Year

• 2 months PICU

• 1 month CVICU

• 9 months Research

Electives

Rotations are available in Critical Care Transport, Burn, Adult Critical Care, or any other critical care related rotations.

Point-of-Care Ultrasound (POCUS)

The fellows at Children's of Alabama have exposure to a longitudinal didactic curriculum in ultrasound and hands-on training in point-of-care (POCUS) ultrasound in the PICU. The longitudinal ultrasound educational series aims to foster clinical skills in integrating diagnostic and procedural ultrasound in the care of critically ill children. The series exposes trainees to various aspects of ultrasound, such as lectures, weekly hands-on sessions, and monthly image review sessions. The trainees also have an opportunity to participate in teaching, administrative, and research activities that will prepare them to be future leaders of critical care ultrasound at the local, regional, or national levels.

The educational series includes the following:

- Quarterly lectures on a diverse range of topics

- Participation in a national ultrasound educational series

- Exposure to a variety of ultrasound machines

- Proctored weekly hands-on scanning sessions

- Monthly image review and quality assurance sessions

- Opportunity to seek credentialing in POCUS to encourage independent practice and integration into patient care

- Ultrasound research

- Opportunities to educate medical students and residents

More information about the program can be obtained by contacting Dr. Vidit Bhargava vbhargava@uabmc.edu or Dr. Luke Burton wlburton@uabmc.edu.

Weekly Conferences

PICU Noon Conference- Case Conference held weekly and Morbidity and Mortality Conference held every other month.

PICU Fellows’ Conference- The text, Fuhrman Pediatric Critical Care, 4^th Edition, is used as the basis for the curriculum for this conference, with the entire textbook reviewed over a 3-year period.  Journal Club is also a part of the Fellows’ Conference, and is held 5-6 times each year.  Faculty facilitators assist fellows in selecting and presenting articles to be discussed at Journal Club. 

Combined Fellows’ Conference- Includes fellows from Neonatology, Pulmonary, and Critical Care. Although physiology topics are covered, the conference is also used to cover core curriculum topics that are helpful to fellows across subspecialities. Topics include research issues such as gathering and analyzing date; quality improvement topics; principles of diversity, equity, and inclusivity; and risk management topics. 

PeRCCUS- Pediatric Research Collaborative on Critical Care Ultrasound has created a teleconference on critical care ultrasound to standardize education. The series will include weekly lectures by faculty across the country addressing various important topics in critical care ultrasound. The lectures can be viewed live or asynchronously on PeRCCUS’s YouTube channel. Register Here.

Grand Rounds- features speakers from various departments here at UAB and external speakers from academic medical centers around the U.S. 

Monthly Conferences

PICU/ED/Hospitalist Combined Fellow Conference- This is a combined conference for Critical Care, Emergency Medicine and Hospitalist fellows and covers topics such as shock, abuse, toxicology and respiratory cases.

Fellows’ Round Table- is an interactive session for pediatric fellows from all programs to present their scholarly work (planned, ongoing, or completed) and receive feedback from other fellows and faculty, in order to provide guidance on improving research proposals, develop presentation skills, and promote cross-divisional interactions and collaborations.

Pediatric Fellow Core Educational Conference- Supplements individual divisional level educational efforts.  The primary focus is on topics that cross all fellowships such as library resources, contracts, leadership and mentorship.

The goal of the research experience is for the Critical Care fellow to learn sound methodology in designing and performing research studies and to learn how to correctly interpret and synthesize research data.  During this phase of training, the Critical Care Fellow will work under close guidance of the research mentor and the Scholarly Oversight Committee.  Fellows may choose any research mentor on the UAB campus – from clinical researchers, to translational researchers, to bench researchers.

UAB IRB Training

Recent Fellows' Research Projects

• Development of a novel delirium score for children in PICU

• Improving sepsis outcomes through implementation of goal-directed algorithms

• Long term PALS retention following Rapid Cycle Deliberate Practice

• Hyperchloremic metabolic acidosis and acute kidney injury

• Effect of Noninvasive ventilation vs. supplemental oxygen therapy on reintubation in high-risk infants following congenital heart surgery

• Monitoring Central Venous Pressure and its Relationship to Achieving Initial Therapeutic End Points and Fluid Overload in Patients with septic shock

• Tetranectin as a biomarker to predict low cardiac output state in pediatric patients following cardio-pulmonary bypass

• Heparanase sulfation patterns in pediatric sepsis

• Development of a machine-learning algorithm to predict extubation failure

• Using the Therapeutic Intervention Scoring System (TISS) in children with chronic critical illness

So What Is Quality Improvement?

Quality Improvement is a systematic, data-driven, iterative problem solving process that can be adapted to local context. 

Systematic: use of a standard methodology that ensures we do not “cut corners” when identifying, defining, measuring, and analyzing a problem. In other words, QI is not a NIKE project (“just do it”).

Data-driven: use of efficient and effective data gathering, measuring and analyzing techniques during baseline data collection as well as after implementation of an improvement. 

Iterative: small tests of change when implementing a proposed solution are key to learning quickly about potential success.

Adapted to local context: we must recognize that the local culture (of the unit, organization, etc.) and needs of our “customers” require us to adapt a solution for best fit.

This passage by Paul Batalden (Qual. Saf. Health Care 2007;16:2-3) is a good summary: The combined and unceasing efforts of everyone – health care professionals, patients and their families, researchers, payers, planners, administrators, educators – to make changes that will lead to

 - Better patient outcomes
 - Better system performance, and
 - Better professional development

Below is a table comparing some of the more popular QI methodologies with the approach we take at UAB.

Comparison of Different Quality Improvement Models

All residents and fellows at UAB/COA are provided a standard curriculum in QI and Patient Safety, through our Mini Quality Academy (MQA). This training provides the top 12 tools and skills needed to be an effective member of a robust QI team. It is offered in an adult-learning environment during a one day (8 hour) course. We are fortunate to additionally offer more in-depth training for those who wish to pursue a career in QI, Patient Safety, or Outcomes Research. These curricula include a Graduate Certificate Program in Healthcare Quality and Patient Safety, and a Master’s Degree in Healthcare Quality and Safety. Both of these programs are offered through the UAB School of Health Professions, and are excellent opportunities for our fellows to pursue during their training here.

 The general outline for our fellows’ QI activity spans the 3 years of fellowship. A typical timeline for this work:

Year 1

•  Attend the MQA

•  Make observations about processes within critical care that need improvement

•  Meet with QI mentor twice to begin to identify a candidate project

Year 2

•  Fully define QI project

•  Identify team members for QI project

•  Data collection, measurement, and analysis

•  Continue regular meetings with QI mentor

Year 3

• Implementation of improvement

• Ongoing monitoring of the change

• Preparation for publication of project

Children's of Alabama 

Critical Care Transport

Pediatric Simulation Center