The Medical College of Wisconsin Pediatric Critical Care Advanced Practice Provider Fellowship Program

Our Critical Care Advanced Practice Provider (CCAPP) fellows receive all of their training at Children's Wisconsin. The 12-month curriculum is divided between roughly 10 months of CICU/PICU clinical work, 1-2 weeks each of Anesthesia and Neuro Critical Care time, and 6 weeks of elective rotations.

Each week the CCAPP fellow will work an average of 50 hours. Of this, 40 hours will be clinical, and 10 hours will be allocated for a variety of educational activities.

CCAPP Fellowship

• CICU, Trauma/Surgical/Medical/Oncology PICUs – 10 months
• Mandatory Elective Rotations with Anesthesiology and Neuro Critical Care – 1-2 weeks each
• Elective Rotations of your choosing as available (Max 3) – 6 weeks total
• Research/Educational time – approximately 10 hours/week
• Clinical training – approximately 40 hours/week

We consider mentorship during fellowship very important. Mentors offer unique guidance because they have been in your position and are using their experience for your benefit. Throughout the CCAPP fellowship training, you will work closely with the program directors, your preceptors, and faculty members who will offer advice, guidance and feedback along the way.

Throughout the 12-month fellowship, you will have reviews with the APP Fellowship Directors, and your primary and secondary preceptors. These will be both formal and informal. Formal evaluations will occur regularly at pre-identified intervals, and feedback from other APPs, Critical Care intensivists, medical fellows, and RNs will also be obtained to assist you with making progress toward program and your own individual goals.

Each fellow is expected to complete a QI or research project during their fellowship. Based on your interests, you will be encouraged to meet up with several CCAPPs and faculty at MCW who have common academic goals/interests – ultimately you will identify an advisor and team, who will help guide you throughout your project. You will use allocated academic time to meet with your project advisor(s) and team members, who will help guide you throughout your project. Your advisor will attend research meetings with you as needed, and is dedicated to knowing specific details of your project and long term goals.

In addition to practical clinical experience, we provide other structured opportunities for learning, including:

• RESCQ Conference (Research, Ethics, Safety, Career Development and Quality Improvement)
  Weekly presentations/discussions on Research (such as: study design, statistics, databases, organization and interpretation of literature, manuscript writing and editing, oral and poster presentations, evidence-based medicine, journal club, and research in progress updates), Ethics (including: clinical, professional and research), Patient Safety Science, Career Development for Fellows (such as: work-life balance, career longevity, resiliency, how to choose a mentor, career selection panels) and Quality Improvement (including project updates, QI methodology, etc.)
• Code Conference
  A monthly multidisciplinary, faculty mentored/fellow- and advanced practice provider-led objective data-driven review and discussion of the previous month’s Code Blue Activations within the Pediatric Critical Care Unit.
• Neuro-Critical Care Conference
  A monthly multidisciplinary (critical care, neonatology, neurology, neurosurgery, neuroradiology, infectious disease and physical medicine and rehabilitation) case-based discussion focused on highlighted our shared Neuro-Critical Care patient population.
• Systems Improvement Conference
  A monthly, faculty mentored/fellow-led discussion focused on practice-based medicine, quality improvement, patient safety science and system-wide improvement opportunities within Pediatric Critical Care.

Additional Conferences:

• “Tuesday Conference” - A rotating schedule comprised of:
  • PICU Bedside Rounds
    Case-based discussions with fellows and local "experts," occurs in the medical/surgical ICU twice per month
  • CICU Bedside Rounds Lecture Series
    Case-based discussions with fellows and local "experts," occurs in the Cardiac ICU twice per month
• Cardiac Cath Conference
  Weekly multidisciplinary review of upcoming cardiothoracic surgery procedures, presented by cardiologists and surgeons.
• Multidisciplinary Surgical Conference
  Bi-monthly fellow-led conference for critical care, general surgery, and anesthesiology.
• Pediatric Grand Rounds
  Weekly lecture for staff physicians, trainees, and students.
• Professor Rounds
  A weekly, interactive hospital-wide clinical case presentation conference presented by a senior pediatric resident. A beloved tradition at the Children’s Wisconsin!
• Trauma Grand Rounds
  Monthly lecture on trauma-related topics.

Our CCAPP fellows will meet the hospital’s Centralized APP fellows at the beginning of their orientation week, and will form a small cohort of CW APP fellows. This cohort will meet regularly throughout the year for a variety of educational activities and camaraderie.

CW APP Fellow Bootcamp
At the end of orientation week, our CCAPP fellows participate in several days of bootcamp with their Centralized fellow colleagues. Bootcamp consists of simulations and hands on skill stations to get fellows up and running as they transition to the units. During bootcamp, our CCAPP fellows will participate in airway stations, learn the various respiratory therapy modalities and support available at CW, practice placing CVLs, arterial lines, endotracheal tubes, and PIVs, as well as perfecting their LP and ultrasound technique. They will also participate in brief simulations to understand their new role as the provider responding to the hospital’s Rapid Responses.

APP Personal, Professional, and Leadership Development Training
A full curriculum designed for novice APPs with curriculum including an introduction to personal, professional and leadership development, wellness and emotional intelligence, DiSC behavioral styles, career development, crucial conversations, communication, accountability, transition to practice, career development, mentorship and scholarly work. Our CW APP fellow cohort participates in the full series throughout their fellowship year.

APP Fellow Simulation
Several times throughout the year, the CW APP fellow cohort will meet up to participate in a variety of mutually applicable simulations. The simulations will focus on a variety of topics encountered throughout the hospital, such as an infant with bronchiolitis initially admitted to an acute care bed, who progressively worsens with RRT activation, and ultimate transfer to the PICU prior to needing to be intubated. These simulations allow our fellows to solidify core critical care concepts, while also working on direct communication skills and hospital handoffs.

Ever wonder what a day in the life of a CCAPP Fellow is like at Children's Wisconsin?

CCAPP Fellowship
As a CCAPP fellow, you will spend approximately 40 hours per week on service with direct supervision of your preceptors. You are also given approximately 10 hours per week for an approved academic activity, either a QI type project or research activity. The purpose of the one-year fellowship is to allow you to get comfortable in the PICU with the ability to incrementally increase the number and complexity of patients you will be caring for across all 3 of our Pediatric ICUs, with the ultimate goal of autonomy and independent practice. Our PICUs are divided into a Cardiac ICU (CICU), Trauma/Surgical ICU, and a Medical/Hem-Onc ICU, for a total of 72 ICU beds.

In addition, you are given dedicated time to spend with our Anesthesia and Neuro Critical Care colleagues, where they will help you develop your airway skills and neuro exams. You will also have several weeks dedicated to elective rotations of your choosing (pending availability) for in-depth post-graduate training with a specific population of patients (available electives will be discussed during interview process). Some electives rotations previous fellows have completed include: cardiac transplant, infectious disease, pulmonary, palliative, complex care, transport, general surgery, and CV surgery.

You will spend significant time in our CICU. We have a thriving cardiac program at Children's, and perform a large volume of cardiac surgery, with 3 active surgeons on staff. It is here that you will gain valuable experience taking care of a variety of both pre and post-operative patients with congenital heart disease, cardiac transplant patients, patients requiring ECMO support, and patients supported with various forms of mechanical circulatory support. As with the other floors, this is a true-multidisciplinary team as we round and discuss patients with the cardiologists and the cardiothoracic surgeons daily.

You will also spend significant time in both of our PICUs. The Trauma/Surgical ICU, where you will learn post-operative management of a variety of patient populations, including post-operative neurosurgery, general surgery and solid-organ transplant (predominately liver and kidney) patients. The Trauma/Surgical PICU provides you with quick turnover and intensive exposure to very sick traumatic brain injury and transplant patients. You will work collaboratively with house staff and fellows of the various surgical specialties, as together you are a team co-managing the patients.

On our Medical/Oncology PICU, you will see a wide variety of patients, but specifically gain expertise in management of sepsis, critically ill bone-marrow transplant (BMT)/hematopoietic stem cell transplant (HSCT) patients and oncology patients. You will also work with various subspecialists who will frequently be present on rounds providing a true multidisciplinary approach to patient care.

Our fellows work a variety of shifts, including days, nights (call), and weekends. While on call, you will be responsible for covering one of the three ICU floors. Nights on call provide increasing amounts of autonomy. It is reassuring to know that there is always one of your attendings in-house and readily available for patient care and educational opportunities. As a fellow you are given priority for procedures as this is a time for you to begin learning and mastering routine procedural skills necessary in the PICU. Your clinical service generally accounts for 40 hours/week. You will also be given ~10 hours/week to work on your academic project, complete an educational curriculum, and for independent study, as needed.

Overall your CCAPP fellowship is an extremely busy time filled with a clinical service and immense educational opportunities.

“The Pediatric Critical Care APP fellowship has provided me with a well-rounded opportunity for development of my clinical skills, critical thinking, and continued education. As a new graduate with limited ICU experience, it allowed dedicated time to broaden my knowledge base, while learning from a large group of providers with a variety of approaches. The Critical Care APPs set an incredible example as to what it means to be leaders in our field.”

“I loved getting to work with the PICU/CICU team; I learned so many things! I also really appreciated the mentorship provided in this program; it helped me to build confidence as a new provider, and gave me a place to talk about frustrations or challenges.”

Quotes from APP Preceptors/Mentors
“The fellowship is ideal for the candidate that wants to hone their decision-making skills while easing into the transition of being a provider.”

“Fellowship provides for a structured transition to the provider role with the flexibility to experience areas not traditionally found as a student such as anesthesia and interfacility transport.”

"Fellowship participants are motivated individuals that want to enrich their knowledge of the care of complex patients within a large academic facility. Being at a tertiary facility allows for clinical and rotational opportunities that are among the best in the country.”

As a nurse practitioner candidate, must be a recent graduate of accredited acute care pediatric nurse practitioner program

• Minimum of 2 years RN experience in a pediatric setting
• Ability to obtain PNCB acute care PNP certification within 6 months of entering CCAPP fellowship program
• Current RN license through state of Wisconsin

As a physician assistant candidate, must be a recent graduate of an accredited PA program

• Prior pediatric experience and exposure will be prioritized
• Ability to obtain PA-C certification within 6 months of entering the CCAPP fellowship program

For both PNP & PA candidates:

• Eligibility for credentialing through Children's Wisconsin medical/dental staff
• Eligibility for credentialing through MCW credentialing department
• Current PALS certification
• 12 month commitment

• Comprehensive clinical training in all areas of pediatric critical care (medical, surgical, cardiac)
• Didactic educational curriculum designed to solidify core critical care concepts
• Formal and informal educational opportunities in an academic medical setting
• Elective Rotations
• Completion of a QI or research project
• Formal APP Personal, Professional and Leadership Development Training curriculum
• Simulation & Critical Care APP Bootcamp

Designed to optimize educational experience including:

• Protected time for weekly didactic educational sessions
• Protected time for completion of an academic research or QI type project
• Protected time for participation in APP Personal, Professional, and Leadership Development Training