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.
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.
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.
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.
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.
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.