Critical Care

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Ricardo L. Garcia-De Jesus, MD

Pediatric Critical Care

Pediatric Critical Care Medicine Fellowship Program
Department of Pediatrics
University of Puerto Rico – School of Medicine

Ricardo L. Garcia-De Jesus
Program Director
Assistant Professor
Department of Pediatrics
tel: 787-777-3535 xt. 7186

Email: ricardo.garcia@upr.edu

The Pediatric Critical Care Fellowship Program

The Pediatric Critical Care Fellowship Program was accredited in 1996 by ACGME with the objective of providing excellent training in Pediatric Critical Care Medicine and preparing individuals to become future leaders in the field.

The fellowship was developed using guidelines of the Society for Critical Care Medicine, the American Board of Pediatrics Subspecialty Board of Critical Care Medicine, and the Accreditation Council for Graduate Medical Education. The program was initially created under the direction on Dr. Felicita Gotay.

Our fellows have an excellent success rate on the American Board of Pediatrics Critical Care Sub-board examination.

Mission and Overview

The Pediatric Critical Care Medicine (PCCM) Program is a 3 year accredited program through ACGME, and sponsored by the University Of Puerto Rico School Of Medicine through its Department of Pediatrics at the University Pediatric Hospital, which serves as its main clinical site. Dr. Ricardo L. García-De Jesus directs the program and the associate director is Dr. Alicia Fernandez Seín.

The goal of the program is to graduate a competent pediatric critical care specialist capable of delivering optimum patient care as a skilled clinician, competent teacher, and knowledgeable investigator, capable of administering a pediatric critical care unit. The PCCM program main objective is to promote in its fellow residents a commitment to lifelong learning, emphasize scholarship, self-instruction, development of critical analysis of clinical problems, and the ability to make appropriate decisions.

A schedule of three (3) years is available to the fellow resident at the beginning of the training program. The trainee will attain clinical excellence in applying acquired knowledge in identifying, diagnosing and managing the critically ill pediatric patient. The faculty has meetings every three months to evaluate ongoing curriculum and produce changes based on evidence based medicine and inputs related to practice based learning that occurs in the program’s yearly retreat. We receive the input of the fellows, so they are empowered to change the program curriculum.

Program Goals

On completion of the PCCM program, each physician will have developed a measurable quantity of advanced knowledge, performed and taught a set of observable skills, demonstrated advanced decision-making capability, demonstrated the ability to be the leader of the multiple-professional team model, and possessed an attitude of caring for patients who are critically ill. The overall goals of the training program are to provide an environment that permits each trainee to:

1. Patient Care:

• develop expertise in the complex care of all critically ill children,
• develop skills in the design, understanding and performance of clinical and/or laboratory research that will result in a better understanding of mechanisms of disease, physiology and pathology and the completion of at least one mentored research or scholarship project under the supervision of a scholarship oversight committee;
• develop expertise at organization, analysis, preparation, and presentation of data.
• develop knowledge on physiology and evidenced-based approaches to therapy;
• develop expertise in all 6 core ACGME competencies;
• be prepared for a successful academic or clinical career.
• fulfill all the requirements to obtain certification in Pediatric Critical Care Medicine by the American Board of Pediatrics; and develop the self-discipline required for life-long learning, maintenance of certification and compliance with regulations.

2. Research:

• Analyze current and novel clinical practices by identifying relevant scientific publications and evaluating them using evidence-based medicine techniques.
• Support ongoing basic science or clinical studies designed to evaluate and improve the understanding of critical illness and the care of the critically ill.

3. Administrative:

• Evaluate current ICU hospital policies and suggest improvements.
• Triage critically ill patients to optimize care delivery within the institution.
• Improve resource utilization and maintain patient care quality by facilitating triage of patients to limited institutional critical care beds and caregivers.
• Develop programs and change unit practice to improve care of critically ill patients.
• Develop programs for patient safety monitoring and error reduction.
• Actively participate in quality assurance processes, including mortality and morbidity conferences, process improvement teams, and Joint Commission on Accreditation of Healthcare Organizations preparation.
• Support the process of assessing patient and family satisfaction.
• Encourage and enhance good relationships with other healthcare providers.
• Provide the opportunity to pursue her/his own development in a research, clinical scholar, or clinical educator academic track, or to develop all skills required for a private career in pediatric critical care medicine.

The PCCM program will provide the appropriate level of supervised exposure to an adequate number of critically ill patients, participates in an organized didactic program, develops and executes a guided research project, and is allowed to develop leadership and management skills in caring for the critically ill in the PICU. A graduated progression during the subspecialty training should lead the physician to increasing responsibility and independent decision-making.

Faculty:

Ricardo L. Garcia-De Jesus
Director Fellowship Program
Assistant Professor
Department of Pediatrics

Alicia Fernandez-Seín, MD
Associate Program Director
PICU Medical Director
Professor
Department of Pediatrics

Erskin Bezares-Casiano, MD
Assistant Professor

Nitza Lugo-Figueroa MD
Assistant Professor

Gilberto Puig-Ramos MD
Associate Professor

Jose Rodriguez-Santana MD
Associate Professor

Sunsiree Santana MD
Assistant Professor

Sandra Somohano MD
Assistant Professor

Maria B. Villar-Prados MD
Assistant Professor

Anabel Puig-Ramos, PhD
Research Coordinator

Fellows

Current Fellows (2011-2012)

Carlos Ocasio MD First Year

Hilda Diaz-Escalera, MD Second Year

Manuel Iglesias-Garcia, MD Second Year

Facilities and Support Services

University Pediatric Hospital

The Pediatric Intensive Care Unit (PICU) is the only 12 beds Level I multidisciplinary ICU located at San Juan, Puerto Rico, and is the referral center for all the trauma and neurosurgical patients. It has 12 pediatric suites with state of the art monitoring and the latest technology. A Pediatric Intensivist directs the PICU, and the care team is composed by graduated nurses, respiratory therapist, social worker, nutritionist, pediatric residents (PL2, PL3), rotating residents (Emergency Medicine, Anesthesia) and Medical Students (MS IV). The PICU have an average of 725 admissions per year. The hospital provides 24hrs microchemistry and hematology laboratory, blood gas laboratory, blood bank, x-ray and bacteriology services. There are also Internet access, access to operating rooms, hemodyalisis service, echocardiography and electroencephalography. There is also access to nuclear medicine studies and screening laboratory for inborn errors of metabolism. During this rotation the Intensivist in charge of the service supervises the fellow.

Centro Cardiovascular de PR y del Caribe

This is the only pediatric cardiovascular intensive care unit (CICU) in Puerto Rico. The Centro cardiovascular de PR y Del Caribe performs more than 250 pediatric cases per year. The CICU is a 10 bed ICU with the latest on invasive and non-invasive monitoring equipment for the pediatric patient after cardiovascular surgery. The CICU is directed by a Cardiothoracic Surgeon and staffed by pediatric hospitalist and pediatric Intensivist. The facility provides 24 hrs laboratory, x-ray and bacteriology services. In addition, it has a catheterism laboratory, pulmonary function test laboratory, and operating rooms. Also the CICU has ECMO (extra corporeal membrane oxygenation) available, and is the only place where heart transplant is performed in Puerto Rico. During this rotation the Intensive Care faculty member assigned to the service, Dr. Ricardo L. García, Program Director and Dr. Enrique Marquez, Pediatric Surgeon; supervise the fellow resident.

Rotations

Clinical Training

Trainees spend around twelve months on the clinical PICU service and four months in the cardiothoracic post-operative care unit; with electives in trauma surgery, anesthesia, nephrology and pulmonary. In-house call averages every fourth to fifth night during the first two years and every 6-7 night in the last year.

Research Opportunities

In our fellowship program, each fellow receives sufficient research experience to enable him/her to perform successfully in a research-oriented, academic medical center at the completion of training. The patient population and broad clinical exposure provide ample opportunity for research. The fellows present commentaries at the research and journal club and are encouraged to participate in the process of writing and submitting a grant application for research project funding.

Educational activities include Pediatric Critical Care Fellow’s Conferences & Rounds, Journal Club, and Morbidity & Mortality Conference among others.

Stipend

Salary is based on the UPR School of Medicine GME Office contract guidelines for level of training year.

Supervision Policy

Pediatric Critical Care Medicine complies with The University of Puerto Rico School of Medicine Graduate Medical Education supervision policy. To view the policy, please click here.

Eligibility and Selection

To request a brochure, please contact us.

How to Apply

Thank you for your interest in the University of Puerto Rico School of Medicine Pediatric Critical Care Fellowship Program. Applications are accepted through ERAS.

More Information

If you have questions pertaining to the Pediatric Critical Care Fellowship program, please contact:

University Pediatric Hospital
Department of Pediatrics
Section of Pediatric Critical Care Medicine
ATT: Ricardo L. Garcia
PO BOX 191079
San Juan, PR 00919-1079
Phone: 787-777-3535 ext. 7186
Fax: 787-728-5136

Email: ricardo.garcia@upr.edu

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