Complex Care Fellowship | Overview
Goals of the training program
The goal of the two-year Complex Care Fellowship is to provide learners with valuable clinical training and experience for a career in caring for children with medical complexity. The fellowship equips learners with the skills to be effective clinicians, scholars, and leaders in complex care. The curriculum can be individualized to accommodate a fellow’s learning needs and career goals while providing standard complex care training. All fellows will engage in clinical care and completion of a scholarly project, with opportunities for teaching and advocacy.
The Complex Care Fellowship provides training in the care of children with medical complexity over a period of two years.
The first year of fellowship is primary clinical. Fellows have the opportunity to participate in complex care activities enabled by the Division of General Pediatrics at Boston Children’s Hospital and in community sites.
Opportunities for deep clinical exposure will occur in the following areas:
- primary care medical home
- consultative care coordination
- multidisciplinary clinic care
- perioperative care
- inpatient care
- palliative care
- urgent care
- home care
- post-acute facility care
- skilled nursing facility care
Complex Care fellows will also provide longitudinal care throughout the fellowship to their own cohort of children with medical complexity. Fellows will be the primary manager of the children’s health, working to fulfill all of the children’s healthcare needs, including chronic medications, durable medical equipment, acute illness treatment, specialty co-management of coexisting conditions, etc. Fellows are expected to fully integrate with nurses, social workers, case managers, therapists, schedulers, and other healthcare professionals in these efforts. Fellows also participate in various multidisciplinary clinical programs, with the potential for other clinical experiences based on individual interests.
- Rainbow Program: Primary care medical home for children and youth with special healthcare needs.
- Complex Care Service (CCS): Consultative health home for children with an existing community-based primary care provider. CCS offers outpatient clinic visits, dedicated inpatient hospitalist service, and home visits.
- Cerebral Palsy and Spasticity Center: Care of children and youth with cerebral palsy and abnormal muscle tone, through collaboration with Orthopedics, Physiatry, Neurology, Neurosurgery, Augmentative Communication, physical and occupational therapy, social work, and CCS.
- Spina Bifida and Spinal Cord Conditions Center: Care of children and youth with spina bifida, through collaboration with Neurosurgery, Urology, Nephrology, Gastroenterology, Plastic Surgery, Orthopedics, Physiatry, Endocrinology, physical therapy, social work, and CCS.
- Aerodigestive Center: Care of children and youth who have dysphagia, feeding problems, respiratory symptoms, and related gastrointestinal issues, through collaboration with Gastroenterology, Pulmonology, Feeding Team, Nutrition, social work, and CCS.
- Craniofacial Program: Care of children and youth with a craniofacial condition, through collaboration with Plastic Surgery, Oral Surgery, Neurosurgery, Dentistry, Genetics, social work, and CCS.
During the second year of fellowship, fellows’ clinical responsibilities will decrease, and they will actively work on a scholarly project with an assigned complex care mentor. Fellows will acquire research skills in design, methods, and analysis through monthly seminars and journal clubs. Fellows will conduct a scholarly project during the course of their fellowship. The project may be clinical, educational, or advocacy-related. They will have access to local, regional, and national data on children with medical complexity. Fellows will be mentored by accomplished faculty with expertise in healthcare administration, finance, medical education, medical informatics, quality improvement, systems engineering, and health services research. They will present their scholarly work at biannual Works in Progress sessions with faculty advisors.
Fellows will be asked to complete research and career development courses through the Clinical Research Center and the Offices of Fellowship Training and Graduate Medical Education.
Medical education training
Medical education is an important focus of the clinical training program. The fellowship curriculum is based on a framework of entrustable professional activities (EPAs) that define essential clinical activities in the care of a child with medical complexity. Curricular components developed by a national team of complex care clinicians, educators, and family leaders are used to structure training and assessment. Activities include the following:
- evaluate and manage common clinical issues in children with medical complexity (including pain/irritability, aspiration, feeding difficulties, and abnormal muscle tone)
- provide routine care and troubleshoot common issues for children with medical complexity who use medical technology
- provide comprehensive perioperative assessment and management for children with medical complexity
- develop and implement safety and emergency plans for children with medical complexity
- perform effective, team-based, patient-, and family-centered care coordination
- advocate for children with medical complexity and their families
Fellows receive formal training through clinic seminars and hospital-wide curricula, and have opportunities to engage in career development sessions, dedicated clinical teaching, and journal clubs in complex care. Fellows will also teach residents about caring for children with medical complexity. Fellows have the opportunity to participate in educational projects 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.
Alexander Strzalkowski, MD, completed his pediatric residency at the University of Rochester. He did his undergraduate education at Villanova University, earning a bachelor of science in biology, and went to Thomas Jefferson University (SKMC) for medical school. His prior scholarly work was focused on optimizing infant formula nutrition (published in Clinical and Experimental Allergy) and quality improvement efforts to reduce pulse oximetry use for pediatric patients with asthma. Dr. Strzalkowski has a passion for caring for children with medical complexity, particularly in the outpatient setting. His fellowship scholarly project involves assessing the types of surgeries that have a higher propensity to leading to post-operative pneumonia in children with neuromuscular disorders. His specific clinical interests include contingency planning for medical technology care, emergency planning in the outpatient setting, improving medication reconciliation practices, and coordination of care across the hospital-to-home transition, particularly for infants discharging from the NICU.
Anjum Ahmed, MD, completed her pediatric residency at New York Presbyterian (NYP) Brooklyn Methodist Hospital. She completed Medical School at Aga Khan University, Pakistan. Dr. Ahmed is eager to delve deeper into the world of complex care and explore scholarly interests related to pain in non-verbal children, social determinants of health, and advocacy for children and youth with special healthcare needs.
For further information and to apply
Kathleen Huth, MD, MMSc, FRCPC