Emergency Medicine

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Pediatric Emergency Medicine

Pediatric emergency medicine-trained physicians care for the wide range of acute injuries and illnesses that affect the pediatric population, as these conditions are often serious and potentially life threatening. The pediatric emergency medicine (PEM) fellowship at IU School of Medicine is the only ACGME-accredited PEM program in Indiana, and it provides a challenging and diverse training experience. PEM fellows gain the skills necessary to become outstanding leaders in clinical and academic medicine.

Clinical training is based at Riley Hospital for Children at IU Health in Indianapolis, the only level 1 pediatric trauma center and pediatric burn center in Indiana and the state’s major pediatric referral center. Fellows in this division become skilled, efficient, competent and compassionate PEM physicians who represent and contribute to this specialty and their communities.

The PEM Fellowship is a three-year program for graduates of pediatric residencies and a two- to three-year program for graduates of emergency medicine residencies. It includes a dynamic clinical rotation that provides ample exposure to a wide range of pediatric patients, complaints and procedures that assists the fellow in developing skills in assessment and management of pediatric medical and surgical emergencies.

Curriculum

The pediatric emergency medicine fellowship curriculum includes comprehensive training goals, objectives, evaluation and feedback mechanisms. Fellows can individualize training to meet their future goals while participating in quality-improvement initiatives, advocacy work, out-of-hospital training and ultrasound training.

Sample Rotation Schedules for Pediatrics-Trained Fellows

First-year PEM fellows who are pediatrics-trained complete five blocks of emergency medicine; one block each of research, anesthesia, trauma (adult), emergency department (adult) and PICU; two blocks of elective, three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

Second-year PEM fellows who are pediatrics-trained complete five blocks of emergency medicine; two blocks of research; one block each of emergency department (adult), child abuse/legal, toxicology, ultrasound, and an elective; three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

Third-year PEM fellows who are pediatrics-trained complete five blocks of emergency medicine; five blocks of research; one block elective; one block EMS; three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

Sample Rotation Schedules for Emergency Medicine-Trained Fellows

First-year PEM fellows who are emergency medicine-trained complete five blocks of emergency medicine; one block each of research, anesthesia, pediatric inpatient, pediatric outpatient, neonatal medicine, PICU and elective; three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

Second-year PEM fellows who are emergency medicine-trained complete seven blocks of emergency medicine; one block each of research and child abuse/ legal; three blocks of electives; three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

PEM fellows who are emergency medicine-trained and choose to train for a third year complete six blocks of emergency medicine; four blocks of research; two blocks of electives; three weeks of elective/one week vacation; and three additional weeks of vacation during emergency department blocks.

Electives

Electives for PEM fellowship training include ophthalmology, OMFS, dermatology, radiology, cardiology, sports medicine / orthopedics, plastic surgery, EMS, ultrasound and toxicology as well as other options per fellow interests and needs—with program director approval.

During elective and research months, fellows do 4-6 shifts in the Emergency Department at Riley Hospital for Children, depending on rotation. During elective months, fellows have time for research. First-year fellows complete 14 shifts per month; those pursuing the two-year fellowship complete 16 shifts per month. Second-year fellows do 12 shifts per month; those pursuing the two-year fellowship complete 14 shifts per month. Third-year fellows complete 10 shifts per month.

Clinical Training

Pediatric Emergency Medicine fellows complete clinical work at Riley Hospital for Children at IU Health in Indianapolis, which treats more than 1500 trauma patients each year and expects to see more than 50,000 patients in the emergency department this year. With a high patient acuity, this represents one of the largest admission rates of any pediatric ED in the United States. With one to two pediatric sedations per day in the Riley emergency department, PEM fellows are exposed to all major drugs used for pediatric sedations, including Ketamine, Propofol, Nitrous and a variety of intranasal medications. Adult trauma and general emergency medicine rotations take place at IU Health Methodist Hospital, the region’s largest Level 1 adult trauma center and busiest emergency department.

While IU School of Medicine pediatric emergency medicine faculty members serve as role models and mentors for PEM fellows throughout their clinical development, fellows have mentors who are members of the Department of Emergency Medicine and the Department of Pediatrics and have the opportunity for mentorship outside these departments.

Didactic Learning

Each week, Pediatric Emergency Medicine fellows are exposed to core PEM curriculum during four-hour division education, which is variable; topics may include current treatment of certain diseases, discussions of new pathways and hospital-specific topics. Subjects often involve outside speakers but may involve current division or departmental faculty. Quarterly multidisciplinary lectures and best practice sessions/consensus conferences are under development.

Fellows also participate interdisciplinary conferences, simulations, quarterly journal club, procedure sessions, EM and pediatrics Grand Rounds, research conferences and research project development as well as a weekly Board Review with faculty and fellows, starting in the first year. Board Review uses questions from the Wang et al Pediatric Emergency Medicine Question Review Book. Pediatric Emergency Medicine fellows are required to attend the Pediatric Fellows Workshop/ Conference, an event for all pediatric subspecialty fellows.

They are expected to attend EM and pediatrics Grand Rounds when topics are pediatrics-related and also attend appropriate EM weekly education topics. Fellows present Grand Rounds, EM education didactics on pediatric topics, didactics for pediatric noon conferences when appropriate, and assist with PEM simulations and workshops when appropriate.

Fellows attend the National PEM Fellow’s Conference, as well as other regional and national meetings to present their research.

Research Experience

Fellows develop an individual research project under the guidance of their Scholarly Oversight Committee (SOC), which begins meeting with the fellow early in the first year of training. The division provides research support through PResNet, the Pediatric Research Network, which is part of the Children’s Health Services Research Institute in the Department of Pediatrics. Opportunities for collaboration are also available outside of the division.

This program develops fellows’ academic skill in critical assessment of PEM medical literature through the completion of an individual scholarly project supervised by a qualified mentor as well as participation in a comprehensive research curriculum.

Evaluation

Pediatric Emergency Medicine fellows are provided ongoing, timely 360-degree-style evaluation processes that allow tracking of progress in the Six Core Competencies set forth by the ACGME. The goal is to maintain a program of training that emphasizes patient safety and the well-being of trainees. This fellowship benefits from ongoing programmatic assessment and improvement through monthly check-in sessions with the program director and associate program director as well as regular evaluation and input by faculty and fellows.