Clinical Shifts
Pediatric emergency medicine fellows perform 14 clinical shifts per month; each shift is nine hours in duration. Pediatric emergency medicine fellows exclusively work in the octopus/dolphin pod (trauma area) where all of the sickest medical, surgical and poisoned patients are cared for. Pediatric emergency medicine fellows are directly supervised by pediatric emergency medicine staff who are fellowship trained. The shift times are 7 a.m. to 4 p.m., 3 p.m. to midnight, and 11 p.m to 8 a.m.

Children’s Hospital of Michigan is an American College of Surgeons designated Level 1 Pediatric Trauma Center, offering a regional Poison Control Center and a very busy pediatric burn unit. The Hospital is a tertiary referral center with a compete spectrum of pediatric subspecialists and facilities. Children’s offers active cardiothoracic and neurosurgery services and the ED routinely manage those patients.

During clinical shifts, pediatric emergency medicine fellows supervise and teach patient management and procedural skills to medical students and  residents from many different programs. Nearly all of the emergency medicine residency programs in the region send their residents to Children’s for the pediatric emergency medicine experience.

Below is the curriculum for pediatric emergency medicine fellows who have completed a pediatric residency program. The curriculum for emergency medicine graduates is two years in duration and some of the rotations are different.

1^st YEAR
5 months ED 14 shifts/9 hour shifts

1 month Trauma Detroit Receiving Hospital - Adult

1 month Anesthesia CHM

1 month Orthopedics CHM

1 month Toxicology CHM/Harper - Adult

1 month PICU CHM

2 months Research CHM

2^nd YEAR
5 months ED CHM

4 months Research CHM

1 month Elective CHM

1 month Adult ED Huron Valley Hospital

½ month Risk Management Beaumont Hospital

½ month EMS

3^rd YEAR
6 months ED CHM

5 months Research CHM

1 months Elective CHM

EDUCATION

Outside of clinical shifts in the emergency department, the main source of education for fellows is Wednesday morning conference. During this conference, core topics covered include toxicology, journal club, and a mock code on a monthly basis. Pediatric emergency medicine board review occurs twice per month. The material is based upon the content specifications published by the American Board of Pediatrics for Pediatric Emergency Medicine. The curriculum is based upon an 18-month block, allowing each fellow to be exposed to content specifications two times during the fellowship. Below you can find an example of the monthly ED conference schedule:

March 4
Meeting Location – Classroom 1
7:00 am Mock Code (Trauma Bay) – Dr. Radtke
7:45 am Case Presentation – Dr. Garg
8:30 am Dental Trauma – Dr. Stenger
9:15 am Board Rev, Ortho Trauma – Dr. Lagisetty

March 11
Meeting Location – Boardroom A
7:00 am Malpractice Case Series – Michael Rinkel
7:45 am Use of Hypertonic Saline in CHI – Dr. Arora
8:30 am Congenital Heart Disease – Dr. Mastropietro
9:15 am Septic Arthritis, Dr. Abdel-haq

March 18
Meeting Location – Boardroom A
7:00 am Resident Presentations
7:45 am Resident Presentations
8:30 am Bites and Stings, Dr. Qureshi
9:15 am Pediatric Cardiac Emergencies – Dr. Singh

March 25
Meeting Location – Classroom 1
7:00 am Resident Presentations
7:45 am Resident Presentations
8:30 am Journal Club – Dr. El Chami
9:15 am Board Rev. Thoracic Trauma – Dr. Stankovic

March 31
Meeting Location – Boardroom C
4 pm Monthly Staff

In addition to educational support from the program director and associate program director, Dr. Earl Hartwig is the director of pediatric emergency medicine education. Dr. Hartwig’s involvement in fellow education is invaluable. Various other conferences supplement the knowledge pediatric emergency medicine fellows acquire from activities within the division. Some of these conferences are:
 

• Pediatric Grand Rounds
• Emergency Medicine Grand Rounds
• Toxicology Grand Rounds
• Trauma Conference
• Radiology Conference
• Business Meeting

 TEACHING OPPORTUNITIES

Pediatric emergency medicine fellows at Children’s Hospital of Michigan have vast opportunities to teach. Teaching is part of pediactric emergency medicine fellowship and the performance of each fellow is critiqued and feedback is given. Fellows regularly teach at:

• Wednesday Pediatric Emergency Medicine Fellows Conference
• Noon Fellows Conference
• Regional presentations at various emergency medicine residency programs
• APLS
• PALS
• Grand Rounds at other programs (Dental, Emergency Medicine)

NATIONAL CONFERENCES

pediatric emergency medicine fellows attend and participate in national conferences such as:

•  AAP Annual Meeting
• ACEP Annual Meeting
• PAS Annual Meeting
• SAEM Annual Meeting
• Advanced pediatric emergency medicine Assembly

 RESEARCH

A structured research program for pediatric emergency medicine fellows begins the 1^st month of fellowship. Each July, the program provides fellows with a list of potential research ideas and a list of abstracts that were published at the previous years national meetings. Each fellow either accepts an idea or develops their own original research question. A literature search is performed to ensure that the study is both feasible and that the question has not already been answered.

A research mentor is chosen by each pediatric emergency medicine fellow with the guidance of the director of research, Prashant Mahajan, M.D., the medical director, Stephen Knazik, D.O. and the fellowship director. The mentor and the division’s research coordinator help the fellow at each stage of the research project, from the development of the research question to publication. Fellows are encouraged to actively pursue grant funding for their projects and are required to submit their work prior to graduation. Fellows are also required to submit two case reports/review articles during their fellowship.

A typical timeline for pediatric emergency medicine fellow research:

1^st Year

2^nd Year

 3^rd Year

RESEARCH EDUCATION

Research education is also integrated into the division’s conferences. However, pediatric emergency medicine fellows are also exposed to external research education. Fellows from all of the divisions at Children’s Hospital of Michigan attend a weekly fellow’s conference. The didactic portion of these conferences covers topics such as biostatistics, research design and locating a source of funding. Fellows also present their research ideas at these conferences and feedback is given by faculty with a wealth of research experience. Their advice helps mold the research design of fellow’s projects, guides fellows in the analysis phase of their project, and provide useful counseling regarding presentation skills. Fellows also attend a SPSS course given by the Children’s Research Center of Michigan that is on campus. Fellows have also been sent to national research workshops funded by EMS-C.

Current Research Projects

Current Fellow Projects

1. Is language a barrier to EMS utilization?
2. A retrospective review of resuscitations performed at a Tertiary Children’s Hospital.
3. Pediatric Emergency Literature, Quantity and Quality.
4. Evaluating the cost effectiveness of a pediatric burn protocol.
5. Evaluating the integration of ALTE into the educational curriculum of pediatric emergency medicine fellowship programs.
6. Does ultrasound of cellulitis identify abscesses missed on physical exam?
7. Long term complications of sedation in the radiology suite.
8. Utility of pelvic radiographs in pediatric trauma.
9. Evaluating high flow oxygen utilization in patients with bronchiolitis.

Previous Fellow Publications

 1. Misra S, Mahajan P, Chen X, Kannikeswaran N. Safety of procedural sedation and analgesia in children less than 2 years of age in a pediatric emergency department. Int J Emerg Med 2008 Sep; 1:173.
2. Kundra M, Stankovic C, Gupta N, Thomas R, Hamre M, Mahajan P. Epidemiology of Cancer Detected in a Pediatric Emergency Department.. Clin Pediatr. 2008 Oct 2.
3. Stankovic C, Mahajan P, Ye H, Dunne RB, Knazik SR. Bioterrorism: Evaluating the Preparedness of Pediatricians in Michigan. Pediatric Emergency Care. 25(2):88-92, February 2009.
4. Sarnaik A., Sethuraman U., Jones E. A 3 1/2-Year-Old Child With Bilateral Lower Extremity Pain of 3 Weeks Duration. Clin Pediatr (Phila). 2008 Oct 2.
5. Sarnaik A, Bhaya N, Mahajan P. Approach to a Child with Depressed Level of Consciousness and Coma. Future Medicine. July 2008, Vol. 5, No. 4, Pages 435-449
6. Kalidindi S. Cutaneous Larva Migrans. The AAP’s Atlas of Tropical Medicine. 2008.
7. Stankovic C, Mahajan P: 6-year-old Male with an Unusual Case of Urinary Retention. Pediatr Emerg Care. 23(8):573-575, August 2007.
8. Kundra M, Yousaf S, Maqbool S, Mahajan PV. Boerhaave syndrome—unusal case of chest pain. Pediatr Emerg Care. 2007 Jul;23(7):489-91.
9. Kundra M, Mahajan P. Subconjunctival Hemorrhage in a Teenage Boy. Case in point. Consultant for Pediatricians. Nov 06 Vol.5, No11, 725
10. Kundra M, Mahajan P. Pediatric Chest Pain: Keys to the Diagnosis. Consultant for Pediatricians. August 2006 Vol 5. No. 8.
11. Kundra M, Mahajan P. Eosinophilic Granuloma. Consultant for Pediatricians. (Photoclinic). July 2006. Vol5 No7.
12. Kundra M, Mahajan P. Coronary Artery Fistula. Clinical Pediatrics, Nov/ Dec 2005; Vol 44, No 9, 801-8
13. Kundra M, Mahajan P.Genetic Disorders –Ellis van Creveld Syndrome. Consultant for Pediatricians. September 2005 Vol.4 NO.8 page 382-85
14. Stankovic C, Mahajan P: Healthy Children With Invasive Community-acquired Methicillin-resistant Staphylococcus aureus Infections. Pediatric Emergency Care 2006, 22(5):361-363
15. Stankovic C, Mahajan P: Methicillin-Resistant Staphylococcus aureus as a Cause of Community Acquired Pneumonia. Current Infectious Disease Reports, June 07. Vol.9, No.3. p223-227.
16. Stankovic C, Mahajan P: Spontaneous Pneumothorax. Consultant in Pediatrics 2006, 5(9).
17. Benjamin Y, Mahajan PV, Thomas R: Nebulized Dexamethasone in Acute Bronchiolitis – A Randomized Controlled Trial. American Journal of Emergency Medicine, accepted for publication
8. Joshi S, Mahajan PV, Kamat D: Infantile Hypertrophic Pyloric Stenosis. Consultant for Pediatricians 2006, 1-3

 ADVOCACY

Pediatric emergency medicine fellows advocate for children primarily by educating other heath care professionals and services who care for children. Many of the fellows present conferences at other institutions. Fellows are also required to become PALS and APLS instructors. These courses are given both on the local and state level.