Although pediatric resident graduates are well prepared to care for many ill children who require hospitalization, there are clinical, academic, and administrative skills that aren’t a standard part of residency, but are necessary for long-term academic success. The Children’s National Medical Center (CNMC) Hospitalist Fellowship program is structured over three years, through a combination of formal course work, seminars, clinical work, and mentored independent study.
Fellows work under the supervision of faculty in our 20-member Hospitalist Division, with inpatient pediatric services at five hospitals in Washington D.C., and suburban Maryland. A faculty appointment as a clinical instructor of the George Washington University (GWU) School of Medicine and Health Sciences qualifies the fellow to complete a Masters in Public Health, taking 15-18 credits per year. In addition to specific clinical, research, and didactic learning objectives, participation in committees and quality improvement and epidemiologic projects will facilitate study of hospital administration, budget, epidemiology and infection control.
The fellow must be a successful graduate of an American Council of Graduate Medical Education approved pediatric residency.
Fellows spend approximately three months during the three year fellowship in the pediatric intensive care unit, two weeks in anesthesia, and two months in the emergency department to gain increased confidence, knowledge, and skill in airway management, placement of central lines, evaluation and management of the severely ill/injured child (respiratory failure and shock), conscious sedation, and pain management.
In addition, fellows spend 12 weeks per year on the CNMC hospitalist service. They co-attend with a CNMC hospitalist and lead a team of residents and students to practice an evidence-based approach to the acute evaluation and management of common inpatient problems such as bronchiolitis; asthma; gastroenteritis and dehydration; pneumonia; UTI; ALTE; common head, neck, skin and musculoskeletal infections; metabolic disorders; HIV infection; rheumatologic disease; and child abuse. Fellows also devote eight weeks per year to studying the process of providing coordinated care for the medically complex/technology dependent patients at CNMC and at rehab/subacute care hospital units that focus on improving care for children with multiorgan system disease. They also learn about complications associated with use of technology. Fellows’ elective clinical time may focus on delivery room management skills and well-baby teaching and management issues at one of our community hospital sites with 8,000 deliveries annually.
CNMC fellows learn to plan, implement, analyze, and present results of a research study to answer a question relevant to hospitalists. By the end of the fellowship the fellows have an article accepted for publication in a peer-reviewed journal and present findings at a national meeting. To gain knowledge and skill needed to conduct an independent research project the fellows complete coursework in the School of Public Health at GWU and work under faculty mentors at CNMC.
Four faculty members of our Hospitalist Division have completed the CNMC Master Teacher Certificate program with the GWU School of Education. In seminars taught by master teachers, fellows learn to lead, teach, and develop educational programs effectively. Faculty observe the fellow’s teaching skills in a variety of settings and provide feedback. Fellows have the opportunity to participate and develop computerized and standardized patient simulations to assess residents’ and students’ ability to care for pediatric inpatients.
PEDIATRIC SPECIAL SECTION
In the Literature
Formula Supplementation Prophylaxis for Jaundice in Breastfed Newborns
Gourley GR, Li Z, Kreamer BL, et al. A controlled, randomized, double-blind trial of prophylaxis against jaundice among breastfed newborns. Pediatrics. 2005;116(2):385-391.
Question: In breastfed newborns does oral beta-glucuronidase inhibitors during the first week after birth increase fecal bilirubin excretion and reduce jaundice without affecting breastfeeding deleteriously?