Pediatric Critical Care Fellowship Program

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					                                    The Children’s Hospital/
                             University of Colorado Health
                                   Sciences Center

        Pediatric Critical Care Fellowship Program

        Section of Critical Care Medicine Department of Pediatrics

                                     General information

        The Children’s Hospital (TCH) in Denver, Colorado is a 233-bed, free-standing children's
hospital affiliated with the University of Colorado Health Sciences Center (UCHSC). The Pediatric
Intensive Care Unit at The Children’s Hospital has recently been remodeled and expanded to
become a 28 bed, multidisciplinary intensive care unit which admits approximately 1200 patients
per year from Denver and the surrounding Rocky Mountain region. The Section of Pediatric
Critical Care Medicine and the Department of Pediatrics at TCH offer a fully accredited pediatric
critical care fellowship designed for board eligible pediatricians planning a career devoted to the
care of the critically ill child.
        The fellowship program offers broad-based training in both the practice of pediatric
critical care medicine and the conduct of biomedical research related to pediatric critical care.
Emphasis is placed on the stabilization and management of the critically ill child with acute single
or multi-system organ failure due to cardiac, pulmonary, infectious, neurologic, or traumatic
illness. The PICU serves active programs in pediatric cardiac surgery, general surgery, trauma
surgery, and bone marrow and solid organ transplantation. Critical care fellows participate
actively in the multidisciplinary teams responsible for the care of those patients, including the
medical PICU team and a dedicated cardiac ICU team.
        Research training is continued throughout all years of fellowship training even though
clinical training is emphasized during the first year. Research is supervised by one or more of our
faculty members. NIH-funded research programs are available in pulmonary vascular disease,
oxygen radical induced organ injury, mechanisms of airway reactivity, interstitial lung disease,
and perinatal metabolism.



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       The critical care faculty consists of 6 physicians, all board-certified or board-eligible in
pediatric critical care medicine and/or pediatric pulmonology, as well as 4 full-time Ph.D.
investigators. In addition, several members of the Departments of Pediatric Pulmonary Medicine,
Cardiology, and Anesthesiology provide key roles in the education and training of the fellows.



                         The training program in detail

     The first year
            The first year is designed to provide the fellow trainee with the necessary
     experience to become an excellent clinician and teacher in the field of critical care
     medicine. The year is fully structured and almost entirely clinical. Responsibilities
     include:


            •   Eight months of clinical service in the PICU, on both the medical ICU (6
                months) and cardiac ICU (2 months) services. Fellows are primarily
                responsible for all medical and cardiac patients in the PICU, and they co-
                manage all surgical patients.

            •   Two months of pediatric anesthesiology in the first half of the year, which is
                designed to teach airway management, intubation skills, and vascular access
                skills.

            •   One month on the pediatric pulmonary medicine service at TCH. Fellows gain
                bronchoscopy experience during this month, as well as a broader view of
                pediatric pulmonary disease.

            •   One month of research time, to be used to begin to develop a project for the
                remainder of the fellowship program.
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            •   Night call is taken in-house, and averages every 4 night when on-service
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                and every 7 night when off-service.


            Fellows participate in The Children's Hospital Emergency Transport Service.
     Fellows go out on transports from referring institutions back to The Children's Hospital in
     those instances where the acuity of illness is such that the presence of a physician is
     deemed necessary (< 5% of transports). All fellows are expected to participate in the
     transport system and to fly on transport when necessary.
            The fellows participate in the weekly Critical Care educational conferences and




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Journal Clubs. All other pediatric, anesthesia, pulmonary and other specialty conferences
are open to fellows. In addition, the fellows review assigned charts for complications
and/or deaths, present the cases for an ICU Morbidity and Mortality Review Team, and
participate in the monthly M&M Conference.



Second and third years
       The second and third years are primarily devoted to a research experience with
the assistance of a specific mentor. Research work can be performed at The Children's
Hospital, the Pediatric Critical Care/Developmental Lung Biology Laboratory at the
University of Colorado Health Sciences Center, the Cardiovascular-Pulmonary Research
Laboratory (UCHSC), or the National Jewish Center for Immunology and Respiratory
Medicine. Research mentors are experienced principal investigators with ongoing studies
in either clinical or basic science research. Experience is also available in physiology, cell
and molecular biology, biochemistry, immunology, and pharmacology.
       Although most applicants complete their fellowship training in three years, an
optional fourth year of training is available to those interested in seriously pursuing a
career as a physician-scientist or those who desire dual board certification, such as in
both Critical Care and Pulmonary medicine.



                            Research Facilities
Developmental Lung Biology Laboratory

Director: Kurt R. Stenmark, M.D.
       The Developmental Lung Biology Laboratory is located at the University of
Colorado Health Sciences Center (UCHSC). Presently, the group consists of three
physicians and three full-time Ph.D. researchers as well as four doctoral and post-
doctoral research fellows, including pediatric critical care fellows. Current areas of
investigation include both normal and pathologic mechanisms involved in lung cell
growth and development, factors controlling vascular tone and structure in the
pulmonary circulation, and responses of the vasculature to injury.


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Cardiovascular Pulmonary (CVP) Research Laboratory
Director: Ivan McMurtry, Ph.D.
       Located at the UCHSC, the Cardiovascular Pulmonary Research Laboratory offers
research opportunities in cardiovascular-pulmonary physiology and cell biology. Topics
of research include the pulmonary circulation, acute lung injury, endothelial cell damage,
as well as high altitude physiology. Drs. John Weil, Ivan McMurtry, David Rodman, Lorna
Moore, and Jack Dempsey offer an outstanding research experience for fellows in a
collaborative relationship with the UCHSC Department of Medicine.


National Jewish Center for Immunology and Respiratory Medicine (NJCIRM)
Pediatric Pulmonary Section Head: Gary Larson, M.D.
       On a separate campus near TCH and UCHSC, the NJCIRM has major
investigative programs in basic immunology as well as physiological disturbances in
pulmonary disease, with emphasis on airway smooth muscle function, exercise-induced
bronchospasm, respiratory muscle strength and lung mechanics.



                                       Faculty
Mark Banks, MD
       Instructor of Pediatrics. Dr. Banks recently completed his pediatric
intensive care fellowship at The Children’s Hospital. His research is in discerning the role
of the transcription factor Egr-1 in the pulmonary vascular remodeling seen with chronic
hypoxia.

Todd C. Carpenter, M.D.
       Assistant Professor of Pediatrics Dr. Carpenter is a board-certified pediatric
intensivist. He is also an investigator in the Developmental Lung Biology Laboratory at
the University of Colorado Health Sciences Center. His research interests include
altitude-related illness in children and the effects of viral infections on the pulmonary
vasculature and lung fluid balance.




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Mita Das, Ph.D.
        Assistant Professor of Pediatrics Dr. Das is an investigator in the
Developmental Lung Biology Laboratory at the University of Colorado Health Sciences
Center. Her current research interests include investigating the mechanisms by which
hypoxia alters proliferative responses and signaling mechanisms present in the vascular
adventitial fibroblasts.



Emily L. Dobyns, M.D.
        Associate Professor of Pediatrics Dr. Dobyns is a board-certified pediatric
intensivist. She is the director of the PICU fellowship training program. Her research
efforts are primarily directed towards clinical studies of novel therapies for pediatric
acute respiratory failure.


Maria Frid, Ph.D.
        Instructor Dr. Frid works in the Developmental Lung Biology Laboratory at the
University of Colorado Health Sciences Center. Her research centers on the cellular and
molecular mechanisms of pulmonary remodeling in hypoxia-induced pulmonary
hypertension.


Evgenia V. Gerasimovskaya, Ph.D.

        Instructor of Pediatrics Dr.Gerasimovskaya is an investigator in the
Developmental Lung Biology Laboratory at the University of Colorado Health Sciences
Center. Her research interest include purinergic signaling pathways in vascular cells,
molecular mechanisms of hypoxia-induced ATP release, and metabolism of extracellular
ATP by ecto-nucleotidases. Her research interests also involves investigating the
mechanisms of hypoxic activation of heterotrimeric G protein, intracellular kinases, as
well as Egr-1 transcription factor.


Eva Nozik Grayck, MD
        Associate Professor Dr. Grayck is board-certified in pediatrics and pediatric
critical care. She has a particular clinical interest in the care of critically ill infants and



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children with acute lung injury, septic shock or multisystem organ dysfunction. Dr.
Grayck is also an investigator in the Developmental Lung Biology Group at the University
of Colorado Health Science Center. Dr. Grayck’s research focuses on new mechanisms
by which reactive oxygen and nitrogen species regulate pulmonary vascular function in
developing and mature lungs.




Peter Jones, PhD
          Assistant Professor of Pediatrics Dr. Jones is a Principal Investigator in the
Developmental Lung Biology Laboratory at the University of Colorado Health Sciences
Center. He earned his Ph.D. in Pathology at Cambridge University in the UK, and
completed his training at UC Berkeley and The Hospital for Sick Children in Toronto. His
laboratory's research interests include the roles of cell adhesion and homeobox
transcription factors in lung vascular development and disease, as well as in breast
cancer.


Peter Mourani, MD
          Instructor of Pediatrics Dr. Mourani is fellowship-trained in both pediatric
intensive care medicine and pediatric pulmonology. He is board-certified in pediatric
intensive care medicine. His research work is directed towards clinical studies identifying
molecular mechanisms and genetic risk factors for the development of
bronchopulmonary dysplasia and pulmonary hypertension.


Kurt R. Stenmark, M.D.
          Professor of Pediatrics Dr. Stenmark is the head of the Section of Pediatric
Critical Care and Director of the Developmental Lung Biology Laboratory at the
University of Colorado Health Sciences Center. As the principal investigator of a
Specialized Center of Research (SCOR) Grant from the National Institutes of Health, Dr.
Stenmark leads a group investigating the basic cellular and molecular mechanisms
involved in pulmonary vascular remodeling and the response of the lung vasculature to
hypoxia and other injuries.




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Mary Weiser-Evans, Ph.D.
       Assistant Professor of Pediatrics Dr. Weiser-Evans is an investigator in the
Developmental Lung Biology Laboratory at the University of Colorado Health Sciences
Center. She directs research investigating the roles of basement membrane matrix
proteins in modulating the growth of vascular cells during development and in
pathologic states, as well as the contribution of re-expressed embryonic genes to
vascular injury.



                          The application process

       For positions beginning July 2006, fellowship selection will begin in the summer
of 2005. Materials required to apply are: 1) a completed application form (available
upon request or from our website:
www.uchsc.edu/peds/subs/critcare/educat/fellows.htm), 2) a current CV, and 3) three
letters of reference. All application materials and letters of reference must be received
by June 15, 2005. The completed applications are screened and selected applicants are
invited to travel to Denver to meet with faculty and fellows and tour the facilities. Final
fellow selection is accomplished by participation in the National Residency Matching
Program Match (www.nrmp.org/) for critical care fellows, which occurs in the fall each
year. Applicants must be eligible for a Colorado medical license.




International Medical Graduates

       In order for International Medical Graduates to be eligible to enter our program,
you must meet the following criteria:

   •   Have a valid ECFMG Certificate (www.ecfmg.org/cert/index.html)

   •   Be able to legally work in the United States. This is defined as:

           o   Being a United States citizen; OR

           o   Holding a valid resident/alien registration card ("green card", which is
               actually pink) OR



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          o    Be willing to train with a J-1 Clinical visa. Once you are accepted into the
               program we will sponsor you on a J-1 Clinical Training Visa.

          o    Having any other documentation that allows you to legally work in the
               U.S.

   •   Minimum selection criteria of the University of Colorado Health. Visit
       www.uchsc.edu/gme/PolicyProcedure/Selection_P&P.pdf to view criteria.

   •   Any other criteria as determined by the program

Thanks again for your interest in our program and best wishes in your future endeavors.



                                    Contact Person:
                                        Jacki Main
                             Pediatric Critical Care, Box B530
                                 The Children’s Hospital
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                       1056 East 19 Avenue Denver, CO 80218
                      phone: (303) 861-6211 fax: (303) 764-8074
                               main.jacklyn@tchden.org




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