Pediatric Emergency Medicine
Fellowship Director: Dr. Ambreen Khan
The Division of Pediatric Emergency Medicine at SUNY Downstate fellowship curriculum consists of clinical rotations in the pediatric emergency department and areas related to pediatric emergency medicine, including anesthesia, critical care, orthopedics, trauma, simulation, ultrasound, radiology, child abuse, EMS, and research
Established in 2009, the program is led by an energetic and dynamic group of dedicated faculty determined to provide excellent clinical and academic training to our fellows. The PEM program is part of SUNY Downstate Health Sciences University, a large tertiary medical center. Located in the heart of Brooklyn, the health system serves its roughly 2.5 million population (the most populous of NYC’s five boroughs).
The Division of Pediatric Emergency Medicine cares for over 50,000 visits per year, below the age of 19 years between Kings County Hospital Center (KCHC) and University Hospital at Downstate (UHD). At KCHC, the pediatric ED has 14 beds (6 monitored, a large asthma room, and 2 trauma/resuscitation bays). Kings County is a New York City Health and Hospitals Corporation facility and a level 1-trauma center. Across the road at UHD, the pediatric area has a total of 5 beds, 4 of which are monitored and an asthma area. UHB is the official teaching hospital of SUNY Downstate.
Curriculum
The duration of the fellowship is 3 years for pediatric residency graduates and 2 years for emergency medicine graduates. Block rotations are detailed in the tables below. Under the 3-year Pediatrics trained track, fellows rotate in the pediatric ED for 14 blocks (4 weeks/block) and have 10 blocks of dedicated research time.
The first year is aimed at developing clinical emergency medicine skills and the fellow is given priority for procedures and responsibility for complex presentations. For the first 6 months, fellows function as direct PEM providers, taking first –hand ownership of patient care and staffing it with an attending. After this time, their responsibility includes overseeing other residents rotating in the pediatric ED.
In the second year, the curriculum focuses on the continued development of clinical skills in the pediatric ED and the niches of PEM, including Toxicology, Ultrasound, Child Abuse and Simulation.
During third year, the emphasis is on the completion of the research project and developing clinical independence in the pediatric emergency department. This year also allows opportunities for electives and administrative duties to encourage the fellow to explore and further develop their areas of professional interest.
Under the 2-year EM trained track, fellows rotate in the pediatric ED for 11 blocks (4 weeks/block) and have 3.5 blocks of research time. The focus for the emergency medicine trained fellow in the first year is to be exposed to the “pediatrics” side of emergency medicine. The second year allows the fellow to develop clinical independence as well as opportunities to develop their professional interests. Time is allotted for “research” with the expectation that the fellow is able to produce at least 1 scholarly product during fellowship.
Educational Highlights
Trauma
Kings County Hospital was named the first level 1 Trauma Center in the US and continues to be integral to caring for the severely injured in Brooklyn. Unfortunately, children and adolescents experience significant trauma in our locale. In addition to what is seen during PEM shifts, pediatrics trained fellows spend their trauma block in the adult Critical Care Trauma (CCT) area, and have additional exposure throughout the 2nd and 3rd year via additional CCT shifts.
Emergency Ultrasound
The curriculum has integrated ultrasound into the fellows training. Fellows benefit directly from the ultrasound fellowship program that is run in-house. This gives the opportunity to have easy access to ultrasound machines, attend weekly ultrasound lectures run by the ultrasound division, obtain direct feedback on tape review days by RDMS certified physicians, participate in ultrasound conferences/training workshops and conduct research in the field.
International Medicine
Working in the heart of Brooklyn can often feel like an international experience with our many recent immigrants! Although we see malaria, dengue and typhoid in our own ED… the department is supportive of fellows having an international experience if desired. There is 1 block in the final year of training that is allotted as “call free” to encourage this. We have established elective opportunities in El Salvador, Jamaica, Lesotho, Haiti, Brazil, Turkey and India. The department of also has an established International Emergency Medicine Fellowship, with faculty that can help promote an interest in humanitarian work, education, training and research in global health.
Simulation
Fellows participate in simulation at all levels. They participate in mock codes and simulation sessions as learners. They also spend time at the Health and Hospitals Corporation, Institute for Medical Simulation and Advanced Learning (IMSAL). IMSAL is a unique setting that not only offers simulation courses on topics such as advanced airway and central line placement, but also provides fellows with instruction on adult learning theory and how to formulate and run simulation cases. With this foundation, fellows are transitioned into the role of instructor. They generate and run mock codes for the emergency medicine and pediatric residents. The department also offers a formal simulation fellowship.
Disaster
The Emergency Preparedness division is committed to pediatric specific preparedness and research. Opportunities that are available for pediatric emergency medicine fellows include elective rotations, disaster research training & clinical work, writing & implementing protocols specific to pediatric disaster management and attending conferences specific to disaster medicine. The department also offers a Disaster Preparedness Fellowship.
Teaching
As SUNY Downstate is a large teaching center, fellows work closely with and help mentor medical students, Physician Assistant students, EM, Pediatric and Family Practice residents when they rotate through the Pediatric ED. Throughout the year, fellows are also scheduled to help with PALS teaching, (before graduation they are credentialed as a PALS instructor) and present lectures to medical students and the pediatric residency program of SUNY Downstate. We pride ourselves in producing excellent educators.
Research and Scholarly Activity
Fellows have support from the PEM and EM research divisions where a robust academic faculty is interested in teaming with trainees to publish original research. During the first year fellows attend a “Principles of Research Methodology” course. Fellows at SUNY Downstate, have ample opportunity to collaborate with our keen faculty to write fascinating case reports, PEM Practice articles, help with text-book chapters, and be involved in other scholarly activities. With all the resources of the medical school on campus, a Masters in Public Health and other course offerings are at your fingertips.