Pediatrics at CU School of Medicine is among the best in the nation! World-class pediatric residency program and research facilities. Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado

The primary focus of our training program is to provide comprehensive training in Pediatric Emergency Medicine (PEM) to allow the graduate to independently manage all problems that would fall under the purview of a Pediatric Emergency Medicine subspecialist. Fellows rotate primarily through Children’s Hospital Colorado (Children's Colorado). Children's Colorado is a new, state of the art facility that opened in 2007 on the Anschutz Medical Campus, which includes the University of Colorado Hospital (adult tertiary care) and the School of Medicine. Fellows rotate through Denver Health Medical Center (DHMC) for Emergency Medicine training, which includes Toxicology, Emergency Medicine and Trauma, and an Ultrasound Mini-Fellowship. Under the supervision of a large and diverse faculty, trainees gain exposure to patients with a broad spectrum of clinical problems. Learning from direct patient care is augmented by a comprehensive series of lectures and conferences focused on Pediatric Emergency Medicine. Fellows receive ample opportunities to provide care for acutely ill or injured children and youth of all ages, and to learn all of the common procedures employed in Pediatric Emergency Medicine.

Fellows in our program develop the clinical skills necessary to prepare them to competently and confidently manage the broad spectrum of conditions which fall within the practice of Pediatric Emergency Medicine. Children's Colorado is the only free-standing, tertiary care pediatric hospital in Colorado. The hospital has a large referral area receiving transfers from surrounding states including New Mexico, Kansas, Nebraska, South Dakota, Montana and Wyoming. Children's Colorado is the only Level 1 Trauma Center for Pediatrics in the state of Colorado as verified by the American College of Surgeons Committee on Trauma. It also functions as the local community hospital. Emergency department (ED) visits exceed 65,000 per year with approximately 4000 patients arriving by ambulance. Approximately 1200 children each year meet state criteria for inclusion in the state trauma registry (inclusion criteria: patients admitted to the hospital, transferred via EMS from either another hospital or the scene, and deaths). Fellows are expected to be the primary airway management specialist in most resuscitations and historically have performed 80% of the endo-tracheal intubations in the ED. The clinical learning goals of the first two years of fellowship center around taking care of the highest acuity patients directly with a PEM Attending. They will gain significant experience in managing respiratory emergencies, toxicologic emergencies, abdominal emergencies, infectious disease emergencies, psychiatric emergencies and managing complex transports. In the second year, fellows are expected to do supervisory shifts, with the primary attending as on-site backup, in order to gain experience in running a busy ED. This involves precepting residents and medical students, taking referral calls, as well as managing flow through the department. The experiences gained through fellowship will result in a well-trained PEM attending that can manage a very busy ED with a broad range of acuity and presenting complaints.

Denver Health Medical Center serves Denver as the public “safety net” institution and includes the Rocky Mountain Regional Trauma Center (area academic Level 1 Trauma Center), the Denver 911 emergency response system, Rocky Mountain Center for Medical Response to Terrorism, Mass Casualties, and Epidemics, and the Rocky Mountain Poison and Drug Center (RMPDC). During the toxicology rotation at RMPDC, the fellows gain familiarity with the assessment and management of toxicologic problems through daily rounds when the toxicology team. Interesting cases are discussed from calls received during the prior 24 hours from a 5 state region which includes Colorado, Montana, Idaho, southern Nevada and Hawaii. During the Emergency Medicine and Trauma rotation, fellows are exposed to the principles of the diagnosis and management of major and minor trauma, medical emergencies including acute myocardial infarction, stroke, congestive heart failure, pulmonary embolism and toxicologic overdose as well as obstetric/gynecologic and psychiatric emergencies. During the Ultrasound Mini-Fellowship, the fellow develops advanced skills in the use of ultrasonography for the assessment of the abdomen and chest in trauma (e-FAST exam), to obtain vascular access, to assess soft tissue and musculoskeletal injuries, to assess pregnant women, perform procedures, evaluate volume status and cardiac function.

Early in their training, fellows are encouraged to learn (and demonstrate proficiency in performing) all of the procedures that would be expected of a Pediatric Emergency Medicine subspecialist. This would include endotracheal intubation, rapid sequence induction, bag-valve-mask ventilation, tracheostomy tube replacement, synchronized cardioversion, defibrillation, thoracostomy tube placement, intraosseous access, central venous catherization, UVC line placement, gastrostomy tube replacement, lumbar puncture, laceration repair, foreign body removal, procedural sedation, incision and drainage, nasal packing, regional nerve blocks, slit lamp examination, closed reduction and splinting, arthrocentesis and dislocation reduction.

To prepare trainees to function as effective Pediatric Emergency Medicine subspecialists upon completion of their fellowship, the fellows assume graduated responsibility for patient care over the course of their three years. During the first two years, fellows are primarily responsible for direct patient care with supervision by a faculty attending. During the third year, fellows are expected to manage the Emergency Department. Fellows are expected to actively seek the most up-to-date information to guide clinical care whenever possible. Likewise, fellows are expected to take an active role in teaching the pediatric housestaff, both through didactic lectures and extemporaneous bedside teaching.

During the first and second years, the fellows are directly supervised by faculty. During the third year, the fellows are given autonomy in the treatment and management of patients, although typically a faculty member concomitantly is on shift as the ED is double-covered by PEM. However, back-up is always available by phone, or in person if needed by the Medical Director or Fellowship Program Director. At each stage of training, the goal is to provide a level of supervision that ensures patient safety and maximizes education while promoting the trainee’s sense of independence and autonomy.

PEM Fellowship Year 1:

The rotations during the first year include the Children's Colorado ED (PEM-Children's Colorado), Anesthesia, Emergency Medicine and Trauma at Denver Health Medical Center (DHMC), Pediatric Critical Care, Toxicology at the Rocky Mountain Poison and Drug Center and a Research Month.  There is no in-house call except for the month of Critical Care when the fellow is on no more than every fourth night and averages every fifth night.

PEM Fellowship Year 2:

The rotations during the second year include the Children's Colorado ED (PEM-Children's Colorado), Emergency Medicine and Trauma at Denver Health Medical Center (DHMC), an Elective, Sports Medicine and Orthopedics and five Research Months. There is no in-house call. Parallel shifts are designed to provide the second year fellow with experience supervising, handling referral and transports call, and managing the ED under the direct supervision of a PEM attending in preparation for the third year.

PEM Fellowship Year 3:

The rotations during the third year include the Children's Colorado ED (PEM-Children's Colorado), Ultrasound Mini-Fellowship at Denver Health Medical Center (DHMC), an Elective and 6 Research Months. There is no in-house call. During the third year, the fellow is one of the primary supervisor in the ED and usually acts independently with back-up readily available.

There is no in-house call except for the month of Pediatric Critical Care during the first year when the fellow is on no more than every fourth night and averages every fifth night.

Fellows actively participate in a number of regularly scheduled conferences devoted to clinical care:

• Morbidity and Mortality Conference: This conference takes place every other month and is attended by attending physicians, fellows, and subspecialty physicians (as warranted by the topic). Difficult cases are presented by fellows and faculty members, with particular attention given to identifying system issues affecting outcome and reviewing critical decision-making.
• Combined Children's Colorado and DHMC Pediatric Emergency Medicine Conference: This conference occurs quarterly and is attending by both Pediatric Emergency Medicine and Emergency Medicine physicians from Children's Colorado, DHMC and the University of Colorado Emergency Medicine program. Difficult cases are presented in an effort to identify systems issues and decision-making.
• Radiology Discrepancy Conference: This conference takes place every other month and is attended by PEM attending physicians, fellows and radiology attending. X-rays interpreted incorrectly by ED physicians are reviewed as well as interesting radiologic findings.

In addition to these conferences, fellows attend numerous other educational conferences that focus on clinical issues.  These conferences are listed under the Education tab.