New Application: Pediatric Critical Care Medicine
Review Committee for Pediatrics
ACGME
515 North State Street, Suite 2000, Chicago, Illinois 60654  312.755.5000  www.acgme.org
COMMON SUBSPECIALTY SECTION
FACULTY RESEARCH
1. Complete the table below regarding the involvement of faculty in research. Add rows as necessary.
[PR II.B.5.b)]
# of current
IRB approved
research
Name
projects
Program Director:
Total # of
current
funded
research
projects
# of current
research
projects with
peer review
funding
(subset of
total # in
previous
column)
#
presentations
at national
scientific
# publications
meetings in in peer review
the last 5
journals in the
years
last 5 years
Key Faculty:
Research Mentors Who Are Not Key Faculty:
2. List active research projects in the subspecialty. Add additional rows as necessary.
Project title
Funding
source
Put an “X for
funding
awarded by
peer review
process
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Years of
funding
(dates)
Faculty investigator and
role in grant (i.e. PI, Co-PI,
Co-investigator)
Updated 4/2015
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RESEARCH RESOURCES
1. Does the program provide research laboratory space and equipment? (if appropriate) [PR II.D.]
.................................................................................................................................... ☐ YES ☐ NO
2. Does the program provide financial support for research? ........................................... ☐ YES ☐ NO
3. Does the program provide computer and statistical consultation services? .................. ☐ YES ☐ NO
PROGRAM CURRICULUM
Goals and Objectives
Place an ‘X” in the box before the applicable response. [PR IV.A.2.]
Are there goals and objectives for all training
☐ YES ☐ NO
experiences?
Are they rotation and level specific?
☐ YES ☐ NO
How are they distributed?
☐ Hard Copy ☐ Electronic or web-based
If not web-based, when are they distributed to
☐ Prior to Each Rotation
☐ Annually
fellows?
☐ Once in Handbook
☐ Other
If not web-based, when are they distributed to
☐ Prior to Each Rotation
faculty?
☐ Annually
☐ Other
If web-based, do you send out reminders to access ☐ YES ☐ NO
them?
If yes, when do you send them?
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Collaboration between Programs
Are there meetings among the core Program
Director and subspecialty Program Directors?
How often do these meetings occur?
Who is typically involved in these meetings?
(check all that apply)
☐ YES ☐ NO
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☐ Core program director
☐ Subspecialty program director for this specialty
☐ Program directors from other subspecialties
General Subspecialty Curriculum
Topic
e.g., Biostatistics
Basic science as
related to the
Participants (place and X in the
appropriate column)
Where Taught in
Number of
Fellows in
Curriculum?
Structured
this
All
Residents &
(Name should Teaching Hours Discipline Subspecialty Subspecialty
match name in
Dedicated to
Will
Fellows
Fellows
conference list)
Topic Area?
Attend
Attend
Attend
Research
Course
14
X
Click here to
#
☐
☐
☐
enter text.
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Participants (place and X in the
appropriate column)
Where Taught in
Number of
Fellows in
Curriculum?
Structured
this
All
Residents &
(Name should Teaching Hours Discipline Subspecialty Subspecialty
match name in
Dedicated to
Will
Fellows
Fellows
conference list)
Topic Area?
Attend
Attend
Attend
Topic
application in clinical
subspecialty practice
Clinical subspecialty
Click here to
#
☐
☐
☐
content
enter text.
For the topics below, if the topic is not appropriate for your discipline (i.e., lab research for
fellows in developmental and behavioral pediatrics), enter N/A into column 1.
Biostatistics
Click here to
#
☐
☐
☐
enter text.
Lab research
Click here to
#
☐
☐
☐
methodology (if
enter text.
appropriate)
Clinical research
Click here to
#
☐
☐
☐
methodology
enter text.
Study design
Click here to
#
☐
☐
☐
enter text.
Grant preparation
Click here to
#
☐
☐
☐
enter text.
Preparation of
Click here to
#
☐
☐
☐
protocols for
enter text.
institutional review
board
Principles of evidenceClick here to
#
☐
☐
☐
based medicine/
enter text.
Critical literature
review
Quality Improvement
Click here to
#
☐
☐
☐
enter text.
Teaching skills
Click here to
#
☐
☐
☐
enter text.
Professionalism/Ethics
Click here to
#
☐
☐
☐
enter text.
Cultural Diversity
Click here to
#
☐
☐
☐
enter text.
Systems-based
Click here to
#
☐
☐
☐
practice (economics of
enter text.
healthcare, practice
management, clinical
outcomes, etc.)
Conferences
1. List regular subspecialty and interdepartmental conferences, rounds, etc., that are a part of the
subspecialty training program. Identify the "SITE" by using the corresponding number as appears
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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on the first and second pages of this form. Indicate the frequency, e.g., weekly, monthly, etc., and
whether conference attendance is required (R) or optional (0). List the planned role of the fellow in
this activity (e.g., conducts conference, presents case and participates in discussion, case
presentation only, participation limited to Q&A component, etc.). Add rows as necessary.
Conference
Site #
Frequency
R/O
Role of the Fellow
2. Describe the mechanism that will be used to ensure fellow attendance at required conferences.
State the degree to which faculty attendance is expected, and how this will be monitored.
Limit the response to 50 words
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Scholarship Oversight Committee
1. Will there be a scholarship oversight committee for every fellow? ................................ ☐ YES ☐ NO
2. How often will the committee meet with the fellow? ................................................... # times per year
Fellow Research Activities
1. Describe how the program will ensure a meaningful supervised research experience for the fellows,
beginning in their first year and extending throughout their training.
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2. If faculty outside the division will be actively involved in mentoring the fellows, identify the mentors
and describe how liaisons will be created between these mentors and the fellows that allows for
meaningful accomplishment of research.
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Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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SPECIALTY-SPECIFIC SECTION
PROGRAM PERSONNEL AND RESOURCES [PR VIII]
Other Professional Personnel
1. Indicate with a check mark the personnel who will interact regularly with fellows at each
participating site. [PR VIII.B.1]
Team Members
Mid-level providers (NPs, PAs, etc.)
Respiratory therapist
Social Work
Pharmacist/Pharmacologist/Toxicologist
Pediatric Nutritionist
Child life specialist
Speech therapist
Ethicist
Bioengineer
Statistician/epidemiologist
Site #1
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Site #2
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Site #3
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Site #4
☐
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2. For categories of personnel that are unavailable, describe how that function will be addressed in the
program.
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Facilities and Services
1. Support Services Available 24 Hours Per Day
Site #1
(Yes/No)
Micro-chemistry and hematology laboratory
[PR VIII.C.2.a)]
Blood gas laboratory
[PR VIII.C.2.b)]
Diagnostic bacteriology and virology
laboratories
[PR VIII.C.2.c)]
Blood bank
[PR VIII.C.2.d)]
Facilities for special radiographic imaging
including computerized axial tomography,
radionuclide scanning, angiography, magnetic
resonance imaging, ultrasonography. If any of
these are not available, indicate.
[PR VIII.C.2.e)]
Cardiac catheterization facility
[PR VIII.C.2.f)]
Choose an item.
Site #2
Site #3
(Yes/No)
(Yes/No)
Choose an item. Choose an item.
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Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Capabilities for portable studies, including
radiology, echocardiography, and
electroencephalography
[PR VIII.C.2.g)]
Acute hemodialysis capability
[PR VIII.C.2.h)]
Other Available Support Services
Clinical toxicology laboratory
[PR VIII.C.3.a)]
Nuclear medicine facilities
[PR VIII.C.3.b)]
Pulmonary function testing laboratory
[PR VIII.C.3.c)]
Screening laboratory for inborn errors of
metabolism
[PR VIII.C.3.d)]
Site #1
Site #2
Site #3
(Yes/No)
(Yes/No)
(Yes/No)
Choose an item. Choose an item. Choose an item.
Choose an item. Choose an item. Choose an item.
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2. Will fellows provide care in other settings beside the PICU? [PR IX.A.4] ...................... ☐ YES ☐ NO
3. If yes, use a bulleted list to identify the site(s) and their role (e.g., cardiac ICU – primary provider;
burn unit – consultant)
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Pediatric Intensive Care Units [PR VIII.C.4]
1. Provide the following information for the pediatric intensive care unit (or its equivalent used by the
program) in each site. Provide the requested information for the most recent 12 month period.
If a single site has more than one intensive care unit used by the training program, copy this table
as necessary. Site numbers should be consistent with ADS.
Inclusive Dates:
From (mm/dd/yy):
Pediatric Intensive Care Unit
Number of beds
Average daily census
[PR VIII.C.4.b)]
Average length of stay
Annual number of admissions
To (mm/dd/yy):
Site #1
Site #2
Site #3
PGY1 PGY2 PGY3 PGY1 PGY2 PGY3 PGY1 PGY2 PGY3
Planned number of fellows
assigned to the PICU (do not
include those fellows covering
only nights and weekends with
no daytime responsibilities)
Planned average number of
patients per fellow per week
Planned average number of
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Pediatric Intensive Care Unit
consultations outside the ICU
provided by each fellow per
week
Site #1
Site #2
Site #3
2. Provide the following information for the most recent 12-month academic or calendar year for each
site used to provide a specific required experience, such as transplant, cardiology, intensive care,
etc. Note the same timeframe should be used throughout the forms. Duplicate the table for
each required experience, as necessary. [PR VIII.C.4.a).(1)]
Site #1
Site #2
Site #3
Name of service
Total number of fellows and residents on the
service
Total number of admissions to the service
Number of new patients admitted each year
(“new” refers to those who are seen by
members of the service for the first time.)
Average length of stay of patients on the
service
Average daily census of patients on the
service, including consultations
12-Month Summary-Inpatient Service
1. Summarize how many pediatric patients in the following categories were admitted to or consulted
on by the critical care service at the primary site. This should include patients in the same 12-month
period used on the previous page.
ICU Patients
Multi-system Trauma
[PR VIII.C.4.b)]
Cardiovascular Surgery
[PR VIII.C.4.d)]
Neurologic or neurosurgical
problems [PR VIII.C.4.c)]
Solid organ transplantation
[PR VIII.C.4.c)]
Number of patients available to fellows
Number on critical care Number seen in consultation or
medicine service
on a shared service
#
#
#
#
#
#
#
#
2. If the program does not meet the minimum number of patients as specified in the program
requirements, provide an explanation as to how fellows will become competent in those areas. If
participating institutions are used to supplement the experience at the primary site, replicate and
complete the table above for each site. [PR VIII.C.4.a).(1).(a)]
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List of Diagnoses
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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List 100 consecutive admissions and consultations by the Pediatric Critical Care service. Identify the
time period during which these admissions/consultations occurred. The date range should occur within
the same 12-month period used in previous sections. The dates must begin on the date the first patient
on the list was admitted and end with the date the 100th patient was admitted, (e.g., July 1, 2014
through October 20, 2014). Submit a separate list for each site that provides required rotations.
Duplicate tables as necessary.
Site Name:
Inclusive Dates:
Patient ID
Number
Age
From (mm/dd/yy):
Length of ICU stay
To (mm/dd/yy):
Primary Critical Care
Diagnosis
Major Procedures
EDUCATIONAL PROGRAM [PR IX]
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Procedures
1. Provide the numbers of each procedure performed in the most recent 12 month period. [PR
IX.A.2.a)]
Inclusive Dates:
From (mm/dd/yy): Click here to enter To (mm/dd/yy): Click here to enter a
a date.
date.
Procedures
AIRWAY
Endotracheal intubation
BREATHING, VENTILATION
Mechanical ventilation (indicate the
number of patients)
Placement of thoracostomy tubes
CIRCULATION
Insertion of arterial catheter
Insertion of central venous catheters
Continuous Infusion of vasoactive agents
RENAL REPLACEMENT THERAPY
(hemodialysis, peritoneal dialysis)
PROCEDURAL SEDATION
EXPOSURE TO INTRACRANIAL PRESSURE
MONITORING (i.e. fellows analyze data and
adjust monitors, etc.)
Site #1
Site #2
Site #3
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
2. Describe how fellows will learn the principles of pulmonary artery catheterization, cardioversion and
pericardiocentesis.
Limit the response to 100 words
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3. Explain how fellows will learn the indications, contraindications, techniques and complications for
the procedures listed above.
Limit the response to 200 words
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4. How will the program document and monitor procedural competence of fellows? [PR II.A.4.s)]
Limit the response to 100 words
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Core Curriculum
Identify the training sites (e.g., sites, clinics, offices, community agencies) and learning activities
(clinical experience, conference series, self-directed learning modules, small group discussions, journal
club, workshops, etc.) used to address the required core knowledge areas.
Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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Core Knowledge
Area
Management of
patients requiring
transport
Fundamental
pharmacologic
management of
patients
[PR IX.B.3]
Instruction in
biomedical
instrumentation
[PR IX.B.4]
List the learning activities used List the corresponding setting
to address the core knowledge
in which these learning
Year(s) of
area
activities take place
Training
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#
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#
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#
Inpatient Experiences
1. Describe the responsibilities that the fellows will have for inpatients when assigned to inpatient
services.
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2. Describe how and by whom the fellows will be supervised. For each site, describe daytime, night
and weekend supervision by attending critical care faculty. Include whether it is on site, by phone,
etc. State the extent to which supervising faculty is readily available at these times.
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3. Explain how fellows will be directly involved in the care of critically ill surgical patients including (a)
general surgery, (b) cardiovascular surgery, (c) neurological surgery, and (d) trauma to acquire the
requisite knowledge and skills to attain competence in evaluation, diagnosis and pre/post operative
management of such patients. Also describe the coordination of care between the pediatric
surgeons and the critical care intensivists concerning the management of medical problems in
these patients. [PR IX.A.3.a)]
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4. State how many hours per week fellows will participate in rounds with faculty. Describe this
experience and the objectives of these rounds.
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5. Describe the experiences, if any, that the fellows will have with anesthesiologists.
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6. For each site, describe how fellows will be involved in patient transport (if applicable).
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Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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IF THERE ARE ANY UNIQUE SCENARIOS OCCURRING IN THE PROGRAM THAT DO NOT FIT WITHIN THE CONFINES
OF THIS FORM, PLEASE EXPLAIN.
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Pediatric Critical Care Medicine
©2015 Accreditation Council for Graduate Medical Education (ACGME)
Updated 4/2015
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