Directors of Neurocritical care fellowship: Critical Care Medicine

• Jennifer Blumenthal, MD (Director Senior Fellowships, Critical Care Medicine, Boston Children’s Hospital)
• Traci Wolbrink, MD, MPH (Program Director, Critical Care Medicine, Boston Children’s Hospital)
• Sally Vitali, MD (Medical Director, Critical Care Medicine, Boston Children’s Hospital)
• Nilesh Mehta, MD (Division Chief, Critical Care Medicine, Boston Children’s Hospital)

Directors of Neurocritical care fellowship: Neurology

• Mustafa Sahin, MD, PhD (Neurologist-in-Chief, Chair, Department of Neurology, Boston Children’s Hospital)
• Kerri LaRovere, MD, RPNI, MMSc (Chief, Neurocritical Care Program in Neurology, Boston Children’s Hospital)
• Agnieszka Kielian, MD (Director, Critical Care Epilepsy Service, Boston Children’s Hospital)
• Michael J. Rivkin, MD (Co-Director, Stroke and Cerebrovascular Center, Boston Children’s Hospital)
• David K. Urion, MD, FAAN (Co-chair, Ethics Advisory Committee and Director of Education, Department of Neurology, Boston Children’s Hospital)

Objectives:

The goal of this clinical training program is to provide senior fellows with the skills to become experts in the recognition, evaluation, and management of critically ill children with acute and severe injuries involving the nervous system. The core components of the clinical education consist of:

1. Evaluating patients with acute neurological and neurosurgical complications who are admitted to the medical, surgical, and cardiac intensive care units at Boston Children’s Hospital, comprising around 150 ICU beds
2. Developing advanced expertise in neuroimaging and neuromonitoring, including point-of-care neuroultrasound (transcranial Doppler and carotid studies), conventional and quantitative EEG, pupillometry, near infrared spectroscopy, and surface electromyography
3. Select rotations in adult neurocritical care (at Massachusetts General Hospital and Brigham and Women’s Hospital), Stroke and Cerebrovascular Disorders Center, ICU EEG, epilepsy surgery, neuroradiology, neurointerventional radiology, neurosurgery, and rehabilitation medicine.

Specific learning objectives:

• Physical examination skills to elicit the diagnosis and rapid changes in neurological emergency
• Knowledge of the differential diagnoses for the various clinical presentations of acute and severe disorders involving the nervous system
• Knowledge of the appropriate investigations and management of neurological emergencies (including cerebrovascular accidents, and refractory and super-refractory status epilepticus), and other acute and severe disorders involving the nervous system
• Knowledge of basic principles and practices of cerebral resuscitation, and appropriate and timely treatment of neurocritical care conditions
• Pharmacology of commonly used medications for the treatment of acute disorders involving the nervous system
• Expertise in the interpretation of various neuromonitoring modalities with exposure to technology, development, and regulatory and safety aspects
• Expertise in counseling patients and families regarding neuroprognostication and outcomes
• Pre-operative and post-operative care of patients undergoing cardiac surgery, epilepsy surgery, and management of implanted devices (vagal nerve stimulation, deep brain stimulation, etc.)
• Skills to evaluate the clinical literature relevant to pediatric neurocritical care and clinical trial design
• Skills in the didactic teaching of neurocritical care conditions and neuromonitoring tools
• Skills to pursue an academic career in the field of pediatric neurocritical care

Clinical Expectations/Experiences:

Clinical skills will be accomplished through a combination of direct clinical care, educational conferences, and self-directed learning. Trainees will spend time in the fellow role in the MSICU where they will be exposed to a variety of critically ill neurocritical care patients. Trainees will be expected to keep a log of their procedural and clinical exposure (case logs). Trainees will work directly with Neurocritical care leadership to ensure they are gaining sufficient exposure throughout the year. Trainees will help coordinate and lead Neurocritical Care Conferences throughout the year.

Sample Year:

*Sample curriculum, will be catered to needs of fellow as indicated with leadership team

In addition to the clinical components, applicants are expected to participate in academic and research opportunities while in the program.

A faculty advisor will be assigned to help guide clinical training, research, and overall career development. This assignment should be completed within one month of initiation of fellowship

Trainees are expected to participate in academic lectures and conferences in the Department of Neurology and Division of Critical Care Medicine offered at Boston Children’s Hospital relating to pediatric neurocritical care.

Didactic sessions include weekly case conferences, monthly neurocritical care core topic conferences, a quarterly Multidisciplinary Neurocritical Care Conference, and a quarterly Neurocritical Care Neuroradiology Conference.

Participation in educational activities offered through Boston Children’s Hospital and the Neurocritical Care Society are encouraged.

Trainees will be expected to meet with chosen mentors monthly and present one works in progress to division throughout the year. All sessions to be presented at local, regional, or national conferences are to be presented to the division prior to presentation elsewhere.

Research

Research opportunities and scientific training will be provided through the faculty of the Boston Children’s Neurocritical Care Program. Fellows are expected to complete a research project at the intersection of critical care and neurology this can be but is not limited to a research project and/or manuscript, a quality improvement project, or an educational intervention/curriculum. This will be a mentored experience

Prerequisites

Applicants must:

• hold a MD or DO degree
• have verification of good standing from the candidate’s institution
• be board certified or eligible in pediatric critical care medicine (equivalent certification for physicians trained outside of the United States will be considered on a case-by-case basis)
• be eligible for a medical license in Massachusetts

A strong interest in clinical and basic science research and prior publications are encouraged.

Application process

The application should consist of:

• cover letter
• personal statement (1 page)
• curriculum vitae
• list of publications
• three letters of recommendation
• copies of USMLE parts 1, 2, and 3; LMCC (if applicable); ECFMG certification (if applicable)
• visa status (if not a citizen/permanent resident of the U.S.)

Applications should be submitted as a single PDF document to jennifer.blumenthal@childrens.harvard.edu, traci.wolbrink@childrens.harvard.edu, and mary.mcavoy@childrens.harvard.edu by April 30 the year prior to starting (e.g., April 30, 2024, for the July 1, 2025, start date). After submitting the application, candidates may be invited to meet in person or via remote interviews with members of the selection committee in the spring/early summer.

Location of the fellowship activities

• Boston Children’s Hospital (primary affiliation)
• Massachusetts General Brigham (for adult neurointensive care)

Accreditation

This is a non-ACGME accredited training program.

Duration 12 months