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Education

Yale-New Haven Children's Hospital Pediatric Emergency Medicine Fellowship

The Yale-New Haven Children's Hospital Pediatric Emergency Medicine Fellowship started in the summer of 2000. It has since grown tremendously in size as well as in depth. The fellowship training program received full 5-year accreditation in August, 2002. One fellow or two fellows are accepted each year for this three-year fellowship.

The overall objective of the training program is to provide the trainees with excellent clinical training, resources to pursue independent research, and unique opportunities for educational pursuits. Our philosophy is that by providing a strong foundation during the early parts of the fellowship and a stimulating environment, the trainee will acquire the skills necessary for independence in clinical decision-making, research design, and educational and administrative endeavors.

Educational Settings

Yale-New Haven Children's Hospital is the premiere full-spectrum Pediatrics facility for the state of Connecticut. YNHCH provides primary care to children in the New Haven area, Level I trauma care, and tertiary care to patients from a wide referral base including Southern Connecticut and Eastern New York. There is a very busy 18-bed PICU and Pediatric Critical Care Fellowship Program, as well as an active pediatric transport team. The hospital is directly linked to the Yale University School of Medicine by a skywalk. The hospital's location within the larger 900-bed Yale-New Haven Hospital allows a full complement of state-of-the art services while prioritizing the unique needs of children.

10 PEM faculty members and 4 PEM fellows in the Emergency Medicine Section of the Department of Pediatrics staff the Pediatric Emergency Department of Yale-New Haven Children's Hospital. We are involved in teaching medical students, physician-associate students, pre-hospital providers, and residents in pediatrics and emergency medicine. Our group is active in clinical research in various areas of pediatric emergency medicine including ultrasonography, injury prevention, asthma, head trauma, violence, adolescent issues, pediatric disaster medicine education, international health and febrile infants. The Pediatric Emergency Department of Yale-New Haven Children's Hospital is adjacent to the Adult Emergency Department of Yale-New Haven Hospital, with side-by-side trauma resuscitation suites. Although each department functions independently, the close proximity provides a unique setting for sharing of knowledge and teaching opportunities.

Time Allocation of Rotations

Please Note: This outline is for illustration puposes, and is subject to change.

Elective Options

If desired, electives can be combined, e.g., half radilogy and half dermatology, etc.

Schedule

First Year: Fellows work 14-16 shifts per 28- day block when in the PED. Shifts are 8 hours, except two-three 12-hour weekend shifts. During the first year, fellows complete the anesthesia month, the trauma month, and critical care. While in the Pediatric Intensive Care Unit, PEM fellows function as critical care fellows. The PICU month focuses on honing knowledge of physiology, sharpening team leadership and teaching skills

Second Year: 12-14 shifts per block, including two 12-hour weekend shifts. Fellows complete the month of toxicology, either at the Connecticut Poison Control Center.

Third Year: 10-12 Shifts per block, including two 12-hour weekend shifts. Elective Month, Dental/ENT, other rotations by special arrangement.

Clinical Training in the Emergency Department

Clinical training occurs during the three fellowship years. Assignments in the PED during the first 3-6 months of fellowship focus on developing the knowledge and skills necessary to practice independently and to supervise. These fellow shifts are supervised by the attending PED physician. Beginning in the second half of the first year, fellows begin practice as senior physician for overnight shifts, approximately two per month. During the second and third years, the fellow refines the skills of running the emergency department and promoting flow, with further autonomy.

Throughout the Fellowship, there is an emphasis on concise, accurate documentation of patient encounters and procedures performed. Additionally, fellows will keep a log of procedures performed, from the prosaic to the extraordinary.

Fellows take the annual specialty in-training exam (SITE), and are reimbursed for the exam after its completion.

Fellows should complete a brief chart note on all patients seen, and document procedures completed. Additionally, a procedure log is kept across the 3 years.

Vacation - 4 weeks/year, to be taken during PED months.

Development of Teaching Skills

Clinical

Fellow provides supervision and teaching of medical students and residents (pediatric, and emergency medicine) in PED.

Didactic

• Presentations for Pediatric and Emergency Medicine Residents.
• PALS instructor, providing the course with the PEM team for residents, nurses, and practicing physicians.
• Fellows provide formal presentations at PEM Morning Conference, Pediatric Morning Conference, and Morbidity and Mortality Conference.

Evaluation

Teaching skills are evaluated by PED attendings/fellowship director, with biannual feedback.

Development of Research Skills

Education

Fellows receive formal training in research design and statistics, and become competent in the use of a personal computer for writing and research. The research study design and introduction to statistical analysis seminars are scheduled early in the first year. Statistical guidance is available in the section. Fellows are assigned to a scholarship oversight committee which has responsibility for supervising the fellow's research efforts. This committee meets biannually and reports to the fellowship director who monitors research activity and productivity. Manuscript and abstract preparation skills are emphasized in didactic and individual sessions.

Mentoring

Each fellow will choose a faculty member to assist him/her in developing and conducting a research project. The faculty mentor will provide advice on study design, data collection, abstract preparation and manuscript writing. The fellowship director will be available to provide advice and is responsible for monitoring the fellow's progress in research. The section enjoys a warm relationship with the parent department of Pediatrics, and fellows are encouraged to seek mentoring and scholarship oversight committee members within the section and the department.

Focused Time

In addition to six months of focused time for research, the fellowship has been designed to allow on-going time for research during most months of training.

Research Expectations

The fellow is expected to explore research interests and plan a research project in the first year. A significant work of publishable quality is completed during the second and third years and presented at local, regional, and national conferences. The fellow will be encouraged to collaborate on additional projects as appropriate.

Areas of Research

Research may be done in any area of pediatric emergency medicine. Some current research interests in our group include new methods of disaster medicine, asthma, injury prevention, international medicine, head trauma and violence prevention.

Statistical Analysis

Available within the Department of Pediatrics.

Development of Administrative Skills

Quality Improvement

• Fellows will participate in weekly section business meetings.
• Fellows will participate in the monthly section QI meeting.
• Fellows are encouraged to take on an administrative project during training.

Administrative Skills

Medical Director will involve fellow in various administrative problems, e.g. patient complaints, staffing, development of policies/procedures, supervision of staff, budget, etc.

Risk Management

Fellow will become familiar with concepts of risk management and essentials of emergency department documentation.

Miscellaneous

PEM Fellow Conference. Weekly conference on selected topics and case presentations. Monthly radiology rounds with Pediatric Radiology Staff.

PEM Fellow Journal Club

Funding & Support of Fellows

• Salary at level of PG-4/5/6.
• Standard benefits including malpractice, life, and disability insurance.
• Financial support for required courses (ATLS, ACLS), and research and computer courses.
• Access to statistical support.
• Office space with computer.
• Meal Stipend.
• Incentive/book fund.
• Optional moonlighting with the Critical Care Transport Team at the discretion of the fellowship director.

Requirments of Fellowship Applicants

• Completion of approved pediatric or emergency medicine residency.
• Acceptability for CT licensure.
• Certification of ATLS and PALS (may be completed during first year of fellowship).
• Application process is through the Electronic Residency Application Service (ERAS).

Faculty Responsible for Fellowship

Current Fellows

Fellowship Graduates