Training Overview 

The Complex Care Fellowship offers comprehensive clinical and academic training in the care of children with medical complexity across inpatient and outpatient settings. The curriculum is designed to provide broad exposure to complex care practice while allowing flexibility to support each fellow’s individual learning needs and career goals. 

Clinical Training 

Clinical training includes exposure to a wide range of care models and settings, including primary care medical home, consultative care coordination, multidisciplinary clinic care, perioperative care, inpatient care, palliative care, urgent care, home care, telehealth, post-acute facility care, and skilled nursing facility care. Through these experiences, fellows develop expertise in the comprehensive, team-based management of children with medical complexity and the systems of care that support them.  

Throughout fellowship, fellows provide longitudinal care to their own panel of children with medical complexity. Fellows serve as primary clinical managers for a cohort of patients, helping address the full spectrum of care needs, including chronic medication management, durable medical equipment, acute illness care, and coordination with subspecialists and community providers. Fellows work closely with an interprofessional team that includes nurses, social workers, case managers, therapists, and schedulers, reflecting the collaborative nature of complex care practice.  

Fellows participate in several core clinical programs: 

• Rainbow Program: A primary care medical home for children and youth with special healthcare needs.  

• Complex Care Service (CCS): A consultative health home for children with an existing community-based primary care provider. CCS includes outpatient clinic visits, a dedicated inpatient hospitalist service, and home visits. 

• Cerebral Palsy and Spasticity Center: A multidisciplinary program focused on the care of children and youth with cerebral palsy and abnormal muscle tone, in collaboration with Orthopedics, Physiatry, Neurology, Neurosurgery, physical and occupational therapy, social work, and complex care.  

• Spina Bifida and Congenital Spinal Anomalies Center: A multidisciplinary program focused on the care of children and youth with spina bifida, in collaboration with Neurosurgery, Urology, Nephrology, Gastroenterology, Plastic Surgery, Orthopedics, Physiatry, Endocrinology, physical therapy, social work, and complex care.  

• Aerodigestive Center: A multidisciplinary program focused on the care of children and youth with dysphagia, feeding difficulties, respiratory symptoms, and related gastrointestinal issues, in collaboration with Gastroenterology, Pulmonology, Feeding Team, Nutrition, social work, and complex care.  

• Craniofacial Program: A multidisciplinary program focused on the care of children and youth with a craniofacial condition, in collaboration with Plastic Surgery, Oral Surgery, Neurosurgery, Dentistry, Genetics, social work, and complex care.  

Curriculum and Educational Approach 

The fellowship curriculum is structured around the knowledge and skills essential to the care of children with medical complexity. Fellows develop expertise in clinical assessment, shared decision-making, care coordination, advocacy, and interprofessional collaboration through a combination of direct patient care, longitudinal mentorship, and formal teaching. 

The curriculum is organized around a framework of entrustable professional activities (EPAs) that define the essential clinical activities involved in caring for children with medical complexity. These curricular components, developed by a national team of complex care clinicians, educators, and family leaders, are used to structure both training and assessment.  

Key curricular areas include: 

• evaluating and managing common clinical issues in children with medical complexity 

• providing routine care and troubleshooting common issues for children who use medical technology 

• performing comprehensive perioperative assessment and management 

• developing and implementing safety and emergency plans 

• facilitating team-based, patient- and family-centered care coordination 

• advocating for children with medical complexity and their families  

Fellows also have opportunities to teach medical students, residents and other learners, and to develop as clinician-educators throughout training. Fellows have the opportunity to participate in educational programming at Harvard Medical School and in the Boston Combined Residency Program, the pediatric residency program based at Boston Children’s Hospital and Boston Medical Center. 

Fellows participate in a structured seminar series that supports clinical development, scholarship, and career growth. As in comparable fellowship models, these seminars include career development, clinical teaching, research discussion, and regular opportunities to present works in progress and receive mentorship and feedback.  

Seminars and conferences may include: 

• Fellowship seminars focused on career development topics 

• Clinical teaching series and case-based discussions addressing important issues in chronic illness, disability, care coordination, and advocacy 

• Journal clubs in which fellows and faculty discuss literature relevant to clinical care and health systems for children with medical complexity