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Pediatric emergency medicine combines the family-centered, diagnostic expertise of the skilled pediatrician and the efficient and decisive resuscitative abilities of the emergency physician. Pediatric emergency physicians expertly manage the emergent aspects of disease across all medical and surgical subspecialties with a kind, reassuring presence in a busy environment. Residency training in either pediatrics or emergency medicine provides the fundamental ground work for this transition to pediatric emergency practice. At Carolinas Medical Center of Atrium Health, in Charlotte, NC, our fellowship builds on the unique baseline skill set of physicians from either background. It is our mission to create leaders that will continue to advance pediatric emergency care in both academic and community practice settings.

Clinical Environment

Fellows practice in a busy 35,000 , patient visit per year urban emergency department dedicated to the care of children 0-17 years. During clinical shifts in the dedicated Children's Emergency Department (CED), fellows also participate in the resuscitation of 1,000 pediatric trauma activations per year at our Level I Pediatric Trauma Center. Carolinas Medical Center, an urban 874 bed tertiary care center, is the flagship hospital of the Carolinas HealthCare System, now known as Atrium Health.  Atrium Health  is the third largest non-profit public system in the nation with 33 affiliate referring hospitals. Our medical center provides graduate medical education for more than 250 physicians in 18 specialties.

Core subspecialty rotations occur at the attached Levine Children's Hospital, a 234 bed state-of-the-art facility, recognized as one of "America's Best Hospitals" by U.S. News & World Report. Ancillary support services maximize the fellows' time with patients and their family. These providers include child life specialists, bedside interpreters, a fast-track appointment scheduler, 24-hour social work services and dedicated sexual assault nurses for forensic evidence collection. Fellows maintain the highest standard of care while advancing their leadership role across the clinical training experience in a busy, but efficient tertiary care training environment.

Research Program

Fellows complete independent, prospective clinical or bench research projects during fellowship. Our department provides a team of research expertise to support fellow productivity including a research manager, research coordinators, a research nurse, and a scientific writer.

Research didactics include statistics, epidemiology, technical writing and research design. Fellows present their research to faculty and receive feedback on content, delivery, and the use of computer presentation software. Fellows are expected to complete a project of publishable quality, and present their research at a national scientific meeting. The emergency medicine faculty includes federally funded researchers who are available to provide mentorship to fellows interested in a career as a clinician-researcher.

Teaching

Fellows actively teach medical students, emergency medicine residents, pediatric residents, nurses, and the faculty during their fellowship. They develop proficiency in various teaching formats including lectures, small group exercises, low- and high-fidelity simulation, education boards, and bedside teaching. Through these myriad experiences, our fellows compile a substantial teaching portfolio over the course of their training. At Carolinas Medical Center, dedicated staff can mentor fellows in the development of curricula, learning assessment tools, portfolio design, and educational research projects. Other supplementary activities are also available for fellows interested in a career as a clinician-educator.

Administration

Fellows have the option to do an elective in administration during their fellowship. Fellows also receive didactic education in documentation, risk management, billing/coding, and clinical policy implementation. Fellows actively participate in the quality assurance program that is part of the Division of Pediatric Emergency Medicine here at Carolinas Medical Center. Fellows interested in a career in administration or medical direction may participate in additional skill building opportunities including Lean process improvement projects, quality improvement initiatives, service excellence training, and information technology systems management.

International Emergency Medicine

In a multi-institutional collaboration, our faculty has developed the first emergency medicine residency in East Africa at Muhimbili National Hospital in Dar es Salaam, Tanzania. Fellows may choose to participate in this project by assisting in on-site clinical care, teaching, and research or may contribute to the project remotely from Charlotte by assisting with curriculum development and revision.  Our program also has an affiliation with Hospital de Pediatría Prof. Dr. Juan P. Garrahan in Buenos Aires, Argentina.  Fellows may spend an elective month gaining experience in emergency care of children here as well.

Our program offers an official Global Health Track that offers the opportunity for certification in caring for pediatric patients in a global setting.  As part of this track, fellows may complete their research and scholarly project at international hospital sites.  Dedicated research months may be used to develop experience in international settings if the fellow chooses to do their scholarly work abroad.  Support for international enrollment occurs in collaboration with our international partners’ research teams.  In collaboration with the Carolinas Heart Institute and the World Affairs Council of Charlotte, fellows may pursue international experiences in other locations.

Emergency Medical Services and Disaster Preparedness

Carolinas Medical Center has a nationally and internationally respected program in emergency medical services (EMS) and disaster medicine. At the forefront is Carolinas MED-1, a mobile hospital designed, equipped, and staffed to manage minor to severe emergency medical conditions, including operative trauma surgery and intensive medical care.

Our medical transport service, MedCenter Air, provides comprehensive pediatric critical care transport services with ground teams as well as fixed wing and helicopter transport of patients from medical facilities or injury scenes from 11 neighboring counties. Our department also works closely with the National Disaster Medical System.  We also are part of the CHaMP EMS Reseach Node Center through the Pediatric Emergency Care Applied Research Network (PECARN).  Fellows with a primary residency in pediatrics complete a four week EMS rotation, with the opportunity to ride along with Mecklenburg County’s MEDIC trucks, and with MedCenter Air’s transport teams. Fellows interested in a career in Pediatric EMS and Disaster Preparedness will have numerous opportunities to develop this career interest.

Injury Prevention

The injury prevention division provides information and resources, promotes injury prevention research, and provides community and faculty education programs in injury prevention. Fellows may elect to engage in injury prevention research or write educational materials for this division to develop expertise and advocacy in this area.  We work closely with the Carolinas Center for Injury Prevention.

Toxicology

Fellows complete a one-month rotation in toxicology working with the toxicologists on ED and inpatient consultations and participating in daily teaching rounds with emergency medicine residents, toxicology fellows, and pharmacy doctoral students. In addition to toxicology consults at CMC and LCH, fellows receive exposure to the diverse cases reported to the Carolinas Poison Center, part of the Division of Toxicology.

Simulation

Carolinas Medical Center Emergency Medicine has a Level I accredited simulation center. Monthly simulation exercises promote the practice of high stakes/low frequency and high frequency/low stakes diagnostic and procedural skills. Fellows participate in these exercises, low fidelity and high fidelity mock codes in the department, and hands-on skill building in the annual Wound Care Management Course and Difficult Airway Management Course.

Ultrasound

During the ultrasound rotation, all fellows will learn ultrasound guided line placement, master the pediatric FAST exam, and utilize ultrasound to assist in the decision to terminate pediatric resuscitation efforts.  Fellows work alongside our ultrasound fellowship trained faculty to develop competency in cardiac, renal, gallbladder, soft tissue, musculoskeletal, and lung ultrasound, and ultrasound-guided regional nerve blocks. Fellows will also learn to complete evaluations for ectopic pregnancy for patients with complications during the first trimester of pregnancy. There are two dedicated ultrasound machines used during all clinical shifts in the Children's Emergency Department, and fellows are encouraged to utilize ultrasound routinely in the evaluation and workup of patients. All fellows participate in a mandatory two day introduction to ultrasound workshop at the start of their training, and are offered the opportunity to teach during subsequent years.

Specialized Fellowship Curriculum (INSPIRE)
Another of the many benefits of training at Carolinas Medical Center through the Department of Emergency Medicine is the opportunity to build relationships with the other fellows in the department- Ultrasound, Toxicology, EMS, Disaster Medicine, and Global Health.  Our program has developed a specialized curriculum specifically for fellows in our department to guide their growth and development into well-prepared academic or community clinicians.  This unique and novel curriculum gives targeted training in Scholarship, Research, Mentorship, Education and Bedside Teaching, Manuscript Development, and Professional Presentation Skills. 

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