Overview of the Fellowship

    The Pediatric Emergency Medicine (PEM) fellowship program at Stanford University will offer fellows from both Pediatrics and Emergency Medicine backgrounds a rigorous and diverse training experience. The primary goal of the fellowship program is to develop physicians who are clinically excellent in the practice of Pediatric Emergency Medicine, especially in the management of the acutely ill and injured child. In addition, fellows are given the opportunity to become accomplished teachers, knowledgeable investigators and skilled administrators. With the unique resources of the Stanford University network, we are able to offer a fellowship of the highest caliber and train outstanding academic leaders in the field Pediatric Emergency Medicine.

    Our fellowship in Pediatric Emergency Medicine was established in 2016 and is an ACGME accredited, threeyear program focusing on education and experience in patient care, research, teaching, and administrative responsibilities. In addition, there is the option to extend the fellowship by one year to pursue more in-depth research and training in ultrasound, pre-hospital medicine, simulation, wilderness medicine, social emergency medicine and global health.

Clinical Curriculum

    The Pediatric Emergency Service (PEM) is the primary clinical component of the fellowship. During 3-4 months of each year, each fellow delivers emergency care to children and provides supervision for pediatric and emergency medicine residents and third and fourth year medical students. While in the PEM, the fellow is paired with a faculty member. This setting provides ample opportunity for one-to-one teaching and learning with frequent discussions of case management. Other responsibilities include managing patient flow in a busy pediatric emergency department, ensuring follow-up of ill and injured patients, and participating in quality improvement issues.

    Clinical rotations in related acute care specialties comprise another major component of the program. These include: Pediatric Critical Care (PICU), Adult Emergency Services (AES), Anesthesiology, Toxicology and Emergency Medical Services. In addition to the trauma seen at Stanford University Hospital, each fellow gains exposure to the management of trauma as a member of the Emergency Medicine Service at Valley Medical Center in Santa Clara, CA.

    Elective months are available in all pediatric and surgical subspecialties including: plastic and hand surgery, child protection, orthopedics, ultrasonography and others. The Department of Emergency Medicine has existing emergency medicine fellowships in Wilderness Medicine, Academic Medicine, Simulation Medicine, EMS and Disaster Medicine, International Medicine, Cardiovascular among others. This allows for the Pediatric Emergency Medicine to be exposed to a variety of academic subspecialties in the broader field of Emergency Medicine.

    The remainder of the fellowship program is devoted to research, teaching and administrative responsibilities. 

Research Curriculum

    Research experience and education occurs throughout the 3 years of training. The research curriculum consists of two components.

    The first is the development and completion of an individual scholarly activities project under the supervision of a faculty mentor and oversight by the fellowship director, research director and scholarly activity committee. The schedule includes eleven months of research time with additional time available if needed.

    The second component of the research curriculum is participation in a variety of didactic experiences designed to develop skills in research design, biostatistics and critical appraisal of the medical literature. The basic principles of statistics, study design, evidence based medicine and microcomputer applications in clinical research are taught by our faculty.

    The Department of Emergency Medicine is currently involved in research in pediatric prehospital care, clinical effectiveness and informatics, trauma, medical education, global health, simulation, and a variety of other projects. The Pediatric Emergency Medicine Fellow has the opportunity to further their fellowship research in an optional fourth year of fellowship where the fellow will function as an attending in the Pediatric Emergency Medicine Department for 16 hours per week. The remainder of the fellows’ time will be dedicated to furthering their fellowship research or working more closely with the specialized programs in the Department of Emergency Medicine (Ultrasound, International EM, Simulation, Disaster Medicine, Wilderness and Biosecurity).

Teaching Curriculum

    Throughout the year, the fellow is actively involved in the teaching activities of the division of pediatric emergency medicine under the mentorship of the faculty.

    As a supervisor in the pediatric emergency service, the fellow has the opportunity to provide bedside teaching to the pediatric and emergency medicine residents and medical students.

    During Emergency Medicine morning conferences, the fellow leads small group case-based discussions on a variety of topics and learns to provide consultation to their colleagues. The fellows lead the pediatric residents in noon conference pediatric emergency lecture series. The fellows have the opportunity to provide mock codes in our state of the art simulation center to pediatric and emergency medicine residents.

    The fellows contribute to division of Pediatric Emergency Medicine's monthly educational conferences, which include case presentations, lectures, and journal club presentations. In addition, there are also joint Emergency Medicine-Pediatrics journal club evenings as well as dedicated simulation teaching. There are also joint Pediatric Emergency Medicine and PICU conferences. The second-year teaching fellows are responsible for developing the curriculum for the division’s conferences.

    In addition, the fellows produce a number of written educational materials such as the Pediatric Emergency Medicine Nuggets (Critical Analysis Reviews) and the Stanford Pediatric Emergency Medicine Handbook and simulation cases.

    All fellows become providers in Pediatric Advanced Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, Advanced Pediatric Life Support (APLS) and instructors in PALS. Faculty in our division are actively involved in the administrative aspects of APLS training through the APLS steering committee at the American Academy of Pediatrics.

Administrative Curriculum

    Administrative responsibilities include participation in continuous quality improvement issues, risk management, policymaking, and especially, the day-to-day operations of the PEM. Administrative topics related to the pediatric emergency department are also covered in a seminar series.

Program Staff

Kajal Khanna, M.D. J.D
Program Director 

900 Welch – Suite 350
MC 5768 Stanford University
Stanford, CA 94305
kajalk@stanford.edu
650-721-3695

Brenda Roth
Program Coordinator 

900 Welch – Suite 350
MC 5768 Stanford University
Stanford, CA 94305
broth2@stanford.edu
650-721-3695

Program Facilities

Stanford University Medical Center
    The Stanford University Medical Center is comprised of the Stanford Hospital and Clinics, the Stanford University School of Medicine and the Lucile Packard Children’s Hospital at Stanford. The Emergency Department serves as the joint emergency care facility for both the Stanford Hospital and the Lucile Packard Children's Hospital, and is a Level I Trauma Center for both adults and pediatrics. The Stanford ED currently treats greater than 50,000 patients annually, including 2,400 traumas (many of which are brought by aeromedical transport from around the Bay Area and northern and central California).

    The Pediatric Emergency Service (PEM) at Stanford University Medical Center cares for more than 25,000 children and young adults each year and provides 24 hour attending coverage. All ill and injured children and young adults less than 21 years, including those who require acute resuscitation due to dehydration, sepsis, meningitis, trauma, or toxic exposure, are managed in the PEM. As a Level 1 Trauma Center, Stanford receives acutely injured children who require prompt stabilization and management.

    Additional rotations at Stanford Medical Center include: emergency medicine, ultrasonography and a variety of elective opportunities. As part of the emergency medicine rotation, the fellow will have opportunity to be involved in trauma care presenting to the adult emergency medicine trauma bay

Lucile Packard Children’s Hospital (LPCH)
    LPCH has become an internationally-renown children’s hospital. US News and World Report consistently honors LPCH as one of the nation’s best children’s hospitals. LPCH provides highly specialized pediatric care while continuing to serve as a community hospital for the children of Palo Alto, East Palo Alto, Menlo Park, Mountain View, Los Altos, Atherton, and Redwood City. It is a busy children’s hospital with 13,800 annual admissions. Its 272 beds, including 87 medical-surgical beds, 24 PICU, 20 CVICU and 40 NICU beds, are grouped into units to serve patients and families' special health care needs. These units include General Pediatrics, Pediatric Subspecialties, Hematology-Oncology, Bone Marrow Transplantation, Pediatric Surgery and Transplantation, Neonatal Intensive Care, Intermediate Intensive Care (for Newborns), Pediatric Intensive Care and Cardiovascular Intensive Care. In 1997, the obstetrical and neonatal services were merged and the Johnson Center was created to provide mothers and babies a comprehensive, family-centered approach to their care. There are over 5,100 infants born at LPCH each year.

    LPCH’s growth in clinical services has been dramatic in the outpatient clinics. The Ambulatory Care Center has over 134,000 annual clinic visits and provides primary and specialty care in a wide variety of medical, obstetrical and surgical clinics. Additionally, our Short Stay Unit provides an outpatient treatment center for children needing special infusions, transfusions, or other procedures. LPCH has also established six interdisciplinary clinical Centers of Excellence to shape nationally pre-eminent programs in areas essential to children’s health. These include the centers for Brain and Behavior, Cancer and Blood Diseases, the Children’s Heart Center, Mothers and Babies, Pulmonary Care and Cystic Fibrosis, and the Transplant Program.

    Currently, LPCH is tackling a large hospital remodeling project which will increase patient capacity and enhance the overall experience at the hospital. The major Phase 1 projects have recently been completed, including the addition of more labor and delivery suites and the opening of new treatment areas. With the construction of a separate 20-bed cardiovascular intensive care unit (CVICU) to care for pre- and post-operation cardiac patients, the 6 pediatric intensive care unit was able to expand to 24 beds. The Ford Family Surgery Center, a dedicated pediatric center with seven state-of-the-art operating suites opened in December 2008. Additionally, the Bass Center, a pediatric cancer center, has recently opened which provides a separate day treatment area for oncology patients requiring chemotherapy or transfusions and a dedicated pharmacy for the oncology patients. It is located next to the new 15-bed Hematology-Oncology Unit and 12-bed Stem Cell Transplant Unit.

Santa Clara Valley Medical Center (SCVMC)
    SCVMC, founded in 1876, is the oldest and only publicly-operated hospital in Santa Clara County, as well as being the major provider of health care for San Jose. The hospital is located in San Jose, a 30-minute drive south from Stanford. Its affiliation with the Stanford University School of Medicine provides a key and integral part of our pediatrics residency training program. As a large public hospital with many specialized and regional services, SCMVC serves a high proportion of low-income patients from many different cultural backgrounds including patients of Hispanic, Cambodian and Vietnamese backgrounds. The SCVMC outpatient facility, Valley Health Center- Bascom, is located across the street from the hospital and offers more than 60 primary care and specialty clinics.

Kaiser Permanente Medical Center – Santa Clara
    Kaiser Permanente Medical Center is located in Santa Clara, approximately a 20-minute drive from Stanford Hospital. It boasts a new state-of-the-art hospital building which opened its doors in 2007. The brand new 46 bed Emergency Department sees approximately 70,000 high acuity patients a year. Pediatrics accounts for more than 15% of the population. The ED consists of a 26 main treatment beds, a 10 bed Minor Injury Area, and a 14 bed Clinical Decision Unit. Kaiser Santa Clara is a busy receiving site for Santa Clara paramedic units and is a designated STEMI receiving center, acute stroke center, and referral center for pediatrics. Of note, Kaiser Santa Clara has garnered national recognition from U.S News and World Report for excellence in acute stroke and STEMI care. At Kaiser Permanente, unique learning opportunities exist for the EM resident; these include a 1:1 faculty to resident teaching ratio in the Kaiser ED. There is graduated responsibility as R3’s are expected to act almost independently as attendings and lead daily 4 PM teaching rounds with the other residents in the department. The hospital has 327 beds and serves over 250,000 Kaiser Foundation Health Plan (KFHP) members in Santa Clara County and is a major affiliated hospital of the Stanford University School of Medicine. Kaiser Permanente Medical Center has independent residency programs in Internal Medicine, Obstetrics and Gynecology, and Podiatry. These are complemented by residents in other specialties from Stanford University including pediatric and general surgery residents.

    Health Management Organizations are an integral part of health care delivery in California. Approximately one out of every three Northern Californians is a member of the Kaiser system; this number continues to grow. Kaiser’s integrated delivery system has been a model for national health care reform and quality improvement. Numerous opportunities exist for research and quality improvement projects within the organization.

    There are a number of other facilities that provide additional training experiences to the fellows. Fellows complete a one-month rotation in toxicology as an elective in a Poison Control Center. They spend two weeks with the San Mateo County bureau of emergency medical services. 

ROTATION YEAR LOCATION
Pediatric Emergency Medicine F1, F2, F3 Stanford University (PEM)
Emergency Medicine F1, F2, F3 Stanford University (AES)
Emergency Medicine F2 Santa Clara Valley Medical Center
Emergency Medicine F3 Optional Kaiser Rotation
Anesthesiology F1 Lucile Packard
Pediatric Critical Care Medicine F1 Lucile Packard
Emergency Medicine Services F2 San Mateo EMS
Toxicology F2 Elective Location/San Francisco General Hospital, UCSF

Core Faculty

Bernard Dannenberg, MD            Director, Pediatric Emergency Medicine
Jim Quinn, MD                                   Director of Research, Department of Emergency Medicine
Ewen Wang, MD                                 Assistant Medical Director, Pediatric Emergency Medicine
Kajal Khanna, MD, JD                     Director, Medical Education, Director, Pediatric Emergency Fellowship
Daniel Imler, MD                                Assistant Medical Director, Pediatric Emergency Medicine
Moon Lee, MD, MPH                         Director of Quality Improvement, Pediatric Emergency Medicine
Jason Lowe, DO                                 Full-time Pediatric Emergency Medicine Academic Faculty
Andrea Fang, MD                               Full-time Pediatric Emergency Medicine Academic Faculty
Angela Lumba-Brown, MD            Full-time Pediatric Emergency Medicine Academic Faculty
Marjan Askar, MD                              Part-time Pediatric Emergency Medicine Academic Faculty
Ram Duriseti, MD                              Part-time Pediatric Emergency Medicine Faculty
Phillip Harter, MD                             Director of Continuing Medical Education, Adult Emergency Medicine Faculty
Don Schreiber, MD                           Director of Quality, Adult Emergency Medicine Faculty
Sam Shen, MD, MBA                        Department Chair, Emergency Medicine
Ian Brown, MD                                    Assistant Director of Emergency Medicine, Adult Emergency Medicine Faculty (Informatics) 
Sarah Williams, MD                         Program Director, Adult Emergency Medicine
Viveta Lobo, MD                                Director of Ultrasound, Department of Emergency Medicine 

Contact information – All faculty and fellows can be contacted using their Stanford email addresses available on Stanford Who