Welcome!
Welcome to the PICU subspecialty residency/ fellowship program! If you have any questions or concerns
now or at anytime during the fellowship program, please let me know. I’m happy to chat anytime.
Your time with us will be busy but educational (and hopefully even a little fun every once in a while). Here
is a brief overview of your responsibilities, as well as what your time with us will look like.
Definitions
First of all, you will have seen that I have used the terms PICU ‘resident’ and ‘fellow’. If your training
makes you Royal College (of Physicians and Surgeons of Canada) eligible for certification in PICU (you
have an FRCP(C) already in a core specialty area), then you are a resident. If you are internationally trained
and the Royal College does not recognize your core training, then you are a ‘fellow’. This is just semantics;
your training will be identical, and we will treat you the same. You will see that I use the terms often
interchangeably. You are different from ‘rotating residents’, these being residents that are still doing their
core training in Emergency Medicine, Anesthesia, and Pediatrics.
Rotation/ Schedule
Your 2-year schedule will be divided into 13 4-week blocks annually. You will complete 15 blocks of
ICU, divided between the PICU and the CVICU. The fellow schedule is made in the spring of the prior
academic year by myself and Angie/ Sandy.
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ICU rotations: you will have a ‘graduated experience’ in the ICU. This means that in your first
month or two in the ICU, you will take a senior resident role within the unit, taking primary
responsibility for some of the more complex ICU patients. As you become more comfortable with
our system, you will take more of a supervisory role within the unit, not taking primary
responsibility for the patients, but instead overseeing the rotating residents in their care of the
patients. Your role on rounds will be to give your opinion on diagnosis/ management of each
patient after the resident has given their opinion and before the intensivist on service makes the
ultimate management decision. By the beginning of the second year of fellowship, our hope is that
you will be able to run rounds, taking over the role of the on service intensivist. The intensivist
will still be there on rounds, providing their opinion, but you should be able to increasingly take a
leadership role. Night call will be approximately 6-7 nights/ 4 weeks in first year, 5-6 nights in 4
weeks in your second fellowship year.
Off-service rotations
o Anesthesia: you will do a month of anesthesia during your first year of fellowship. The
objective of this rotation is to acquire/refine the airway skills that are fundamental to
becoming a good pediatric intensivist. You will also have some opportunity to see how
the cardiac Operating Room (OR) functions, and get a sense as to how pediatric cardiac
anesthesia and PICU overlap, recognizing how what happens in the OR has a major
impact on post-operative (ie. PICU) care. Suggestions include spending time in the
pediatric cardiac operating room, time in the pediatric ENT OR, pediatric cardiac
catheterization anesthesia, and even the pediatric pain service. You will do some
weekend call in the PICU, but no weekday call, allowing you to minimize the amount of
time that you are absent from the OR post-call and optimize your anesthesia experience.
There is no anesthesia call mandated as part of this rotation.
o Neonatal Intensive Care: you will do a month of NICU in the Stollery site NICU, a
(predominantly) surgical NICU. While there, you will function much like a rotating
resident, doing in house call for their unit. The rotation will allow you to see what pre and
post-PICU care is like for many of our cardiac surgical neonates, including pre-operative
management and some initial post-operative management of non-pump cases.
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You will also get some experience looking after neonates with other non-cardiac surgical
conditions. The NICU rotation will also provide you with a different perspective on the
care of this patient population. Your contact neonatologist for the rotation is Dr Chloe
Joynt.
Adult Critical Care: In the second year of your Royal College track training program,
you have the option of a month of Adult Critical Care Medicine at the University
Hospital site. This will give you a perspective of the continuity of critical care (NICU to
adult ICU). You will rotate through as a resident, doing in-house call in that setting.
Research blocks: The objective of these rotations is not to turn you out as a clinical
researcher, but more to give you an understanding and some experience in what is
entailed in putting together and completing a clinical research project in PICU. You will
have 2 blocks of research. The focus of the first year rotations is to identify a topic of
interest, do the necessary supportive literature search, draft a study proposal, and then go
through the necessary ethics approval process. If you get this done by the end of first
year, you will be well prepared to complete your project by the end of second year. The
progress of your project will be supervised by Dr Ari Joffe, our fellowship program’s
research coordinator. Although Ari will supervise and guide you through the necessary
steps, you can still do your project(s) with any of the intensivists within our unit. This
does not preclude you doing case reports in addition to your ‘primary’ project. We (and
the Department of Pediatrics) will support you in presenting any projects not only in our
regional ICU or Departmental research days, but also in national/ international
conferences. Our hope is that upon completion of the project, that with assistance you
will be able to submit the project as a paper for peer review and publication. Your call
during these rotations will be ‘reduced’ (6 calls a month in the PICU instead of 7 calls a
month).
Elective/selectives rotations: You have some selective time to pick broaden your
educational experience. Possible options include (but are not limited to) pediatric
cardiology, pediatric infectious diseases, trauma, pediatric emergency medicine, pediatric
neurology/ stroke, thrombosis medicine, transport medicine. Selective rotations must
take place in Edmonton and you will required to do PICU call during your selective.
Elective blocks are call-free and can be done outside of Edmonton.
All
selectives/electives should be discussed with me first to ensure they will conform to the
guidelines of the program.
American Board of Pediatrics
 For some trainees, it may be possible to take a third year of training (here or elsewhere) to meet
requirements for certification of the American Board of Pediatrics. If you are interested in this
(even potentially), please let me know early on so we can plan ahead.
Post Call
The new provincial resident contract states that you can only be on site in the PICU for 24 hours, plus 2
hours of handover time. What this boils down to is that you are free to leave the PICU (or any of your
rotations) at 0900 hrs. Ask me if you have further questions in regards this.
Mentorship
We try and pair all of our trainees with a mentor from the ICU. This individual is there to talk to about
whatever you need to talk about. They are there to provide support for you that is outside the traditional
program director hierarchy.
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Teaching Responsibilities
As a PICU fellow, you will take on increasing responsibilities in teaching as you become more senior in the
program. This is in addition to the expectations of teaching junior house staff when you are on service/ on
call. You will find that you usually learn the most by learning enough to teach someone else about a topic.
Here is an overview of the teaching settings that you will be part of:
 House staff ‘coffee rounds’: in addition to your bedside teaching role, you will be asked to
facilitate teaching for the rotation residents. These sessions are not expected to be lectures, rather
case-based discussions of common ICU problems (shock, respiratory failure, basic ventilation,
etc). Remember, these are residents; they don’t need to know about ECMO from you, it is more
important that they learn about septic shock, ARDS, near drowning, etc.
 PICU ‘Grand Rounds’: once each year you will be responsible for presenting a topic at our
Wednesday morning rounds (~75 minutes). This is a didactic session, where you should take a
topic of interest to you, and present a state of the art review on the topic (appropriate not only for
fellows, but for PICU consultants as well). It is always good (for you) if it stems from an
interesting case that you have been involved with. When you get your scheduled date, come and
talk to me and we can discuss what kind of topics might be appropriate. This is not a talk that is
directed to the level of the rotating residents, although they will be present.
 PICU Journal Club: once each year you will be expected to present an article/ articles at our
PICU journal club. You will present a paper in an evidence based medicine fashion (I will show
you where to find the template to follow in order to do this), and then facilitate discussion around
the article. Although it is always nice to know about the content of the topic being discussed, the
main emphasis of the session is dissection of the paper/ study, not a review of the topic itself.
Educational Rounds that PICU fellows should participate in (compulsory unless otherwise noted;
medical staff will cover you so that you can attend)
 Pediatric Critical Care Half-Day: All pediatric critical care trainees have protected teaching
time on Thursdays from 12:00 to 16:00. These sessions are mandatory and you are excused from
clinical duties to attend. 12:00-13:00 is fellow-directed teaching, currently known as Roger’s
rounds. From 13:00 to 16:00, a number of speakers have been organized to give you sessions on a
variety of critical care topics. These topics are based on a 2-year rotation so you should be
exposed to every topic over the two year training program. You will receive simulation-based
training approximately 6-8 times per year which will focus on procedural skills, case management
and team training.
 Pediatric Common Academic Half-Day: The Department of Pediatrics has prepared a number
of half-day sessions for all trainees in the Department. They will occur approximately 4 times a
year and are mandatory. You are excused from clinical duties to attend.
 Adult ICU grand rounds: weekly, Sept-June; you will receive notification as to when they are
and who is presenting. There are often international speakers that present at these rounds, so they
can be very educational. (Tuesday 16:30)
 Department of Pediatrics Grand Rounds: Sept-June, Thursday at 0830; often presentations
relevant to PICU. The schedule is posted around the PICU and can also be found on the
Department of Pediatrics website.
 Pediatric QA/QI committees: There are a number of Quality Assurance committees that
function in ICU, reviewing mortalities, morbidities, and resuscitations. You are encouraged to
attend these meetings as they can be helpful educationally. You also may be asked to present
cases that you have been personally involved in.
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Transport Medicine Experience
Your experience in transport medicine will be at a number of levels over your fellowship years. Once we
are satisfied that you are comfortable with the basics of ICU/ critical care (airway, invasive lines), we will
sort out whether you are interested in doing transports. Our PICU team does ground (40%), helicopter
(20%) and plane (50%), throughout Western Canada and the Arctic; ~200 trips each year. The medical
participation is made up of ED, ICU, and anesthesia physicians (both senior residents and staff from all
areas), but overseen by the pediatric intensivist on call/ service. Unless you have a medical reason as to
why you cannot do transports (eg. severe motion sickness), you will be expected to at least perform
transports during the daytime. Night-time transport call, although you will be paid for this, is optional, and
will have to be balanced with the amount of in-house call that you are doing. Regardless of your
involvement in transports themselves, you will become involved in coordinating transports and triaging
referral calls. This will happen when you are a senior fellow, initially while being monitored (quite
literally) by the intensivist on call.
Conferences
You will have one paid conference (registration, airfare and accommodation, totaling up to $3000) each
year. If you complete research that is accepted for presentation at a meeting, we will pay for this
supplemental meeting as well.
PALS/ ATLS/ Critical Appraisal of the literature courses
We feel that it is important to have completed PALS prior to or during your fellowship. Neonatal
Resuscitation Program (NRP) is helpful as you will rotate through NICU (but it is not mandatory). With
your involvement in trauma care, ATLS is helpful as well, but not mandatory to be completed during
fellowship. Critical evaluation of the literature courses tend to run each fall within the faculty, and if you
are interested we can fund you to attend these. Funding for these courses can be discussed with me on an
individual basis.
Procedure logs
We will have you track your experience in ICU procedures with a web-based log system that will allow us
to insure that you are getting access to the procedures/ technical skills that are important. This is part of the
one45 system that allows us to evaluate you on-line and for you to evaluate us.
Evaluations
You will be evaluated by the staff people within the PICU every week when you are on ICU rotations. The
purpose of these assessments is to ensure that you are meeting the goals of training and to help identify
areas where you need to focus. I will meet with you every 3 months to discuss how things are going after
getting feedback from all of the intensivists. This does not preclude you seeking feedback from us in
between formal assessments, please come talk to us if you are concerned.
You are also expected to provide feedback (anonymous) to us to ensure that we are providing the best
educational experience that we can. Angie and Sandy will show you how this is done.
You will also do the American Critical Care In-training exams (American Board) during the spring of each
year. If you are Royal College –track (ask me if you do not know what this means), you will have the
option of writing the American Board exams in critical care pediatrics if you complete 3 years of boardrecognized critical care training (ask me about this if you are interested). Likewise, if you are Royal
College track, you will be expected to write the Royal College Pediatric Critical Care medicine exams at
the completion of your 2 years of training, in order to have your training recognized by the Royal College.
Again, welcome to the program!!!