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Pediatric Hospital Medicine Fellowship


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The University of Colorado School of Medicine’s Department of Pediatrics and Children's Hospital Colorado offers a 2-3 year fellowship in Pediatric Hospital Medicine.  The goals of the fellowship are to provide physicians who are board certified or board eligible in pediatrics with in-depth training in pediatric hospital medicine that will prepare them for a career in academic or clinical hospital medicine.  Fellows work closely with our section members on our main campus and have the opportunity to work at our 6 Network of Care sites.  Our 2-3 year program offers:
 
•Superior academic training in a professional, collegial atmosphere
•One on one working relationship between fellows and supervising faculty
•Clinical experience on inpatient academic teaching services as well as community hospital settings
•PHM teaching conferences, M&M, journal clubs, and research conferences
•Participate in education of medical students, residents, PA's and Nurse Practitioners
•A breadth of academic research opportunities including clinical outcomes, quality improvement,  mixed methods, process improvement
•Unique leadership development opportunities 
Overview
 
A primary focus of our training program is to provide comprehensive training in the clinical care of hospitalized children and infants, including a broad scope of pediatric hospitalist practice at both our tertiary teaching hospital and in community hospital settings. Fellows will primarily lead in the care of hospitalized children on the general medical teams at Children’s Hospital Colorado - a state of the art facility that opened in 2007. Fellows will also rotate at one or more of Children’s Hospital of Colorado’s Network of Care sites - satellite campuses providing inpatient pediatric care in a community hospital setting. In addition, fellows will have the opportunity to explore specific areas of clinical interest with clinical electives including, but not limited to, neonatology, newborn nursery, intensive care, pulmonology, and gastroenterology. Under the supervision of a large and diverse faculty, trainees gain exposure to a broad spectrum of clinical problems in a variety of settings. Fellows will receive ample opportunities to learn all of the common procedures employed in pediatric hospital medicine.
 
Scope
 
Fellows in our program will develop the clinical skills necessary to prepare them to competently and confidently manage the broad spectrum of conditions that fall within the practice of pediatric hospital medicine. The combination of multiple clinical sites, each with distinct patient populations, enhances the opportunities to become familiar with a wide breadth of complexity and acuity. In addition to the common problems for which children are hospitalized, the patient population at Children’s Hospital of Colorado includes a large number of patients with rare, complex and/or chronic medical needs, including patients referred from around the mountain west and western Great Plains. In this setting, the hospitalist is often coordinating care among multiple medical and surgical specialists as well as identifying long term health care needs. The patient population in the Network of Care generally represents the scope of illnesses generally cared for in community hospitals such as respiratory infections, asthma, urinary tract infections, and similar low complexity hospitalized children who do not require subspecialty consultants. Among the services provided by the hospitalist service are procedural sedation, metabolic lumbar puncture, medical consults for patients on the surgical service and for patients on the neuropsychiatric unit, and co-management of complex surgical spine patients. It is expected that fellows will be proficient at procedural sedation and lumbar puncture early in the first year of training and that first year fellows will demonstrate excellent communication with consultants, primary care providers, nurses, ancillary staff, and colleagues.
 
Expectations and Responsibilities
 
To prepare trainees to function as effective hospitalists upon completion of their fellowship, fellows are encouraged to assume graduated responsibility for patient care over the course of their two years. Late in the first year, and certainly during the second year, fellows are expected to direct clinical care during rounds, with the supervision of a faculty attending. 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 and medical students, both through didactic lectures and extemporaneous bedside teaching.
 
Supervision
 
The fellow is supervised by a member of the faculty. During the daytime, three attending physicians are assigned to Children’s Hospital Colorado and one is assigned to each Network of Care site. During night call at Children's Hospital Colorado and at each Network of Care site, a faculty member will take call from home - an on-call fellow is paired with a faculty member, and will also take call from home. 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.
 
Clinical Schedule
 
All clinical activity during fellowship occurs at Children’s Hospital Colorado or a Network of Care site. The clinical schedule is broken into discrete one or two week blocks and over the course of the fellowship each trainee will spend 12 weeks on a clinical service each year. Fellows spend 8 weeks on service on one of the three hospitalist teams at Children’s Hospital Colorado during their first year of training and have four weeks of clinical elective time. During the second year, fellows spend five weeks on service at the main campus and have three weeks of service in the Network of Care in additional to another 4 weeks of clinical elective time. Clinical elective time could include, but is not limited to, neonatology, well newborn nursery, anesthesia, intensive care, pulmonology, gastroenterology, and infectious disease.
 
Call Responsibilities
 
Fellows take call from home throughout their weeks on the hospitalist service both at the main campus of Children’s Hospital Colorado and for all sites in the Network of Care. When on-call at Children's Hospital Colorado, the fellow supervises pediatric housestaff and is paired with an on-call and at home faculty member. When on-call for a Network of Care site, the fellow takes calls directly from nurses, referring physicians, and the site’s emergency department; the fellow with be paired with an on-call faculty member taking call from home. As with all aspects of clinical training, the program encourages progressive responsibility and increasing autonomy when on-call.
 
Clinical Scholarship
 
Throughout the fellowship, the fellow is expected to demonstrate excellence and growth in the provision of evidence-based care, understanding and application of clinical care guidelines, appropriate utilization of resources and consults, and communications with patients, families, and other health care providers. The fellow will attend appropriate clinical conferences including Hospitalist Morbidity and Mortality, resident morning report, and Hospitalist CME. Progressive responsibilities will include participation in the development of clinical care guidelines and translating clinical questions into research.   ​
Overview
 
Research goals for all fellows include cultivating the skills needed to critically evaluate clinical research performed by others and producing scholarly work.  All fellows will receive basic research methodology and will be asked to pick an area of interest in pediatric hospital medicine. Those wanting to develop skills needed to perform original independent research will do so through didactic and experiential learning.  These fellows will be encouraged to complete a hypothesis-driven secondary analysis and to acquire background information for a primary data collection project to be completed in the second year.  Opportunities exist for projects in all areas of inpatient pediatrics, including clinical effectiveness, medical education, translational research, health services research and Quality Improvement. Fellows choosing hospital-based QI research as their scholarly focus will receive training in rigorous QI analytical methods. Projects will be designed to improve performance with concentration on methods to promote internal and external validity.  Areas of study will include: statistical process control, cluster randomized controlled trials, interrupted time series, pre-post studies with a strong comparison group, and other similar quasi-experimental or experimental designs.  Research curriculum will be coordinated by Karen Wilson, MD, MPH, Section Head of PHM and Michelle Torok, PhD, Epidemiologist, Children’s Outcomes Research Program/Colorado Health Outcomes Program.  Quality Improvement curriculum will be coordinated by Amy Tyler, MD, Director of Quality and Assistant Professor, Section of PHM, in collaboration with Dan Hyman, MD, MMM, Chief Quality Officer and Associate Professor, Section of PHM.
 
Expectations
 
Fellows will be encouraged to present their scholarly work at local, regional and/or national meetings. Additionally, they will be asked to attend specific workshops through the Center for Faculty Development, monthly Pediatric Hospital Medicine Research Meetings and section meetings, bimonthly. Fellows may have the opportunity to pursue a master's degree through the School of Public Health or the CCTSI: Colorado Clinical and Translational Sciences Institute.
 
Opportunities and Resources
 
Research opportunities and mentorship are available to our fellows not only with our nationally-recognized faculty, but with other researchers on the UCSOM campus and at affiliated research centers. We have strong ties with the University Of Colorado School Of Public Health, the CCTSI Clinical Science Graduate Training Program, the Children’s Outcomes Research Program,  Denver Health Medical Center, the Colorado Department of Health, National Jewish Hospital, Kaiser Permanente and Pediatric Research in Inpatient Settings (PRIS).
 
Furthermore, the Pediatric Hospital Medicine faculty direct epidemiologic, health services, medical education, quality improvement and clinical research that utilizes sources such as the Kids’ Inpatient Database and the Pediatric Health Information System database, as well as data from the hospital.The Section also has a full-time MPH research coordinator who is available for fellows for help with data collection, IRB applications, database management, and abstract and paper submission as well as a half-time PhD-level epidemiologist who is available for methodologic and statistical consultation.
 
Timeline
 
During the first year, all fellows will learn about the research process through coursework and mentorship.  Those interested will further develop these skills by conducting a secondary data analysis project with the opportunity to initiate a primary data collection project during their second year.
 
Fellows opting to stay three years will complete their primary data study and aim to present the findings at an academic conference or in a peer-reviewed medical journal.  They may also complete their Master’s thesis, submit a small grant application and begin writing their career development award.  These fellows will continue to learn advanced research methods and statistical analysis skills during their final year.
 
Scholarship Oversight Committees
 
Each fellow in their first year will identify a Scholarship Oversight Committee of three mentors, including one from outside the Department of Pediatrics.  

The educational goal of our fellowship is to train leaders in Academic Pediatric Hospital Medicine who are skilled in the education of trainees, patients, families, and the community at large.  Our fellows will complete our program ready to begin a career as an Academic Pediatric Hospitalist.

 
For professional development, fellows may select individual courses or pursue a Master’s Program at the Colorado School of Public Health (based at Anschutz Medical Campus)http://cctsi.ucdenver.edu/Pages/index.aspx.  Other learning opportunities include the Residents and Fellows as Medical Educators Elective, Pediatric Fellows’ Curriculum, and various workshops presented by the Academy of Medical Educators.
 
Fellows will have the opportunity to attend and occasionally present at the following Section of Pediatric Hospital Medicine and Department of Pediatrics conferences:

               1.  Pediatric Hospital Medicine (PHM) Research meeting
               2.  PHM Journal Club
               3.  PHM Continuing Medical Education
               4.  PHM Case Conference
               5.  Pediatric Grand Rounds
               6.  Morning Report
               7.  Pediatric Resident Noon Conference
 
Furthermore, fellows will be able to attend national conferences including Clinical Concepts & Conundrums in Pediatric Hospital Medicine, Pediatric Academic Societies’ annual meeting, and the Pediatric Hospital Medicine annual meeting.  The Pediatric Educational Excellence across the Continuum annual meeting may be of particular interest for rising educators!  Financial support for conference attendance may be available.
 
Educational scholarship is encouraged with several outstanding and nationally prominent faculty available to provide mentorship.​​
Overview

Fellows will receive training in basic quality improvement methodology with the expectation that by completion of fellowship each fellow will have the expertise to develop and lead quality improvement initiatives.  Training in quality improvement will be accomplished through both didactic and experiential learning. The curriculum will be coordinated by Amy Tyler, MD, Director of Quality and Assistant Professor, Section of PHM, in collaboration with Dan Hyman, MD, MMM, Chief Quality Officer and Associate Professor, Section of PHM.

Expectations
 
In addition to didactic sessions on QI methodology, fellows will be expected to actively participate in one or more quality improvement initiatives during their fellowship. Fellows will be encouraged to develop QI projects based on their interest(s) under the mentorship of the hospitalist section faculty.   Alternatively, fellows may choose to actively participate in ongoing quality and process improvement projects. 
 
Opportunities and Resources

The hospitalist section members are actively involved in QI work across the institution.  As such they are available to serve as mentors or co-collaborators on a range of projects.  Some areas of focus include improving: discharge efficiency, effectiveness and safety; provider communication with families; provider to provider communication; and documentation in the electronic health record. 
In addition to section mentorship, fellows will have the opportunity to work closely with members of the departments of Process Improvement and Quality and Patient Safety (link to websites here).
CHCO is also participating in the Ohio Children’s Hospitals’ Solutions for Patient Safety (OCHSPS) initiative “to eliminate preventable harm across all Children’s Hospitals in the United States.”  Many opportunities will exist for overlap with the OCHSP work and the PHM fellowship program.

Timeline

PHM fellows will participate in Quality Improvement training through the entire 2-3 years of the program.
Overview

Trainees in PHM fellowships are the hospital leaders of tomorrow.  We feel that a specific and robust approach to training in Leadership Development is an essential element of a comprehensive PHM fellowship program.

Expectations, Opportunities, and Resources
We will provide structured education in aspects of Leadership Development that will be offered in conjunction with People Development at CHCO.  Topics covered will include reading material on leadership style and effectiveness, personal evaluation of leadership styles, Crucial Conversations and communication models, and further development of specific leadership skills based on the fellow’s specific interests/career aspirations.

Timeline

PHM fellows will participate in Leadership training through the entire 2-3 years of the program.