Children's Hospital of Michigan
Detroit, MI
Mary W. Lieh-Lai, MD
Children’s Hospital of Michigan is a 260-bed tertiary care center located in the heart of Detroit. It is the pediatric facility for the Detroit Medical Center complex and serves as the center for pediatric training for the Wayne State University School of Medicine. There are more than 1600 admissions per year to our 30 bed unit. Our seven pediatric critical care fellows are responsible for the care of patients from a diverse, urban and suburban population with a vast array of pathology including but are not limited to acute respiratory failure; fulminant infectious disease and sepsis; traumatic head injury; status epilepticus; oncologic complications including care of children following bone marrow or stem cell transplant; inborn errors of metabolism; and poisonings. The fellows provide post-operative care following high-risk surgical procedures including neurosurgery, orthopedic spinal surgery, airway reconstruction, and surgery for complex congenital and acquired heart disease including transplantation. They are proficient in all traditional ICU procedures as well as the implementation and management of patients on high frequency oscillatory/jet ventilation, continuous veno-venous hemodiafiltration, extracorporeal membrane oxygenation, and ventricular assist devices.
While this clinical experience is similar to other academic tertiary care referral centers, there are other aspects of our training program that are unique and represent best-teaching practices. First, in contrast to most pediatric intensive care fellowships, all of our fellows become proficient in bedside flexible bronchoscopy. They spend one month learning the skill at a local adult hospital under the guidance of adult pulmonologists, then hone their abilities at the bedside in the pediatric ICU under the direction of CCM division faculty members who are all certified to perform the procedure. Our division also owns a state-of-the-art bronchoscopy simulator with modules that allow the fellows further practice during their non-clinical months.
Secondly, our fellows have 2-3 two hour formal board examination review sessions each month. Two faculty members have served on the NBME USMLE committee and the American Board of Pediatrics sub-board of CCM. They share their question-writing expertise with the divisional faculty members by way of lectures and critique on how to write good questions. Using the content specifications for the PCCM Sub-Board examination, an ICU attending then prepares 3-5 certification-type questions for each session. A fellow then uses these questions to prepare a formal PowerPoint presentation on the topic. Once the presentation is prepared, it is converted into a Turning PointR presentation, which integrates an audience response system to allow the other fellows and attendings to actively participate in the presentation. The answers are recorded electronically. On a quarterly basis, the results are downloaded, tallied, and added to each fellow’s quarterly evaluation, providing an objective measure of fund of knowledge. The fellows additionally receive two additional hours of formal didactic lectures each week, a 1-hour cardiovascular lecture and a 1-hour respiratory or pharmacology lecture, both of which also integrate the audience response system for optimal participation. We believe that our board review series is an example of fellowship training “best-practice” because it is a well-developed exercise that provides faculty development in writing certification examination questions; and allows our fellows to learn about, and answer questions to almost all the content specifications for pediatric critical care medicine. This educational activity has lead to an increase in subspecialty in-training examination scores for our fellows and is a significant factor in our successful board pass rate (99.9%) for first time takers over the past 27 years.
Lastly, for the past 2 ½ years, the fellows have received via e-mail, one at least two Mondays per month, an additional mock board question created by the associate fellowship director with instructions to provide an answer and brief explanation by the end of the week. Answers and full explanations are then sent out on Friday. We believe our unique formal didactic experience is an excellent complement to our fellows’ tremendous clinical experience, which is substantiated by our exceptional board passage rate.
