Critical Care FAQs

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AJM

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Here's the start of the critical care FAQs. Feel free to add your own words of wisdom. (note, since this is a sticky, some posts may be moved or edited to keep this a streamlined and informational thread).



Critical care medicine (CCM) is a multidisciplinary specialty that focuses on the care of critically ill patients in the intensive care unit. Physicians who are trained in CCM are called “intensivists”, and they come from a wide variety of backgrounds, including anesthesia, surgery, internal medicine and the IM subspecialties, pediatrics, and emergency medicine.

There are many different types of ICUs that intensivists work at. Many intensivists will choose to focus on one particular type of ICU, while others will work in several different units. At smaller hospitals, however, there is often only a single ICU, and the intensivist there takes care of a range of patients, both medical and surgical. Because of this, critical care programs train their fellows to take care of patients in a variety of different types of units to broaden their training.

The following are the types of ICU’s in which intensivists work:
MICU – medical ICU
SICU – surgical ICU
NSICU – neuro/neurosurgery ICU
PICU – pediatric ICU (generally staffed by intensivists who trained in PICU)
NICU – neonatal ICU (generally staffed by intensivists who trained in NICU)
CCU – coronary care unit (while technically an intensive care unit, this unit is generally staffed by cardiologists who have not done CCM fellowships)
Cardiac surgery ICU, thoracic ICU – generally only at large hospitals, staffing is typically a combo of intensivists and cardiothoracic surgeons


The following are the routes one can take to become an intensivist:

Internal Medicine
Most IM-trained intensivists work primarily in MICUs, however there are many who work in the SICU. There are several different paths to CCM from Internal Medicine:

The most common path is to do a pulmonary/CCM fellowship after an IM residency. Pulmonary/CCM is a 3-year fellowship with a minimum clinical requirement of 12 months of pulmonary training and 6 months of critical care time. Extra critical care months can often be counted as pulmonary months, so many programs will have the fellows spend extra time in the ICU without necessarily increasing overall training time.
Another route is to combine a CCM fellowship with any other IM subspecialty fellowship, which increases the fellowship training by one additional year. The most common fellowships people do this with are renal and ID, however you can take this path with any subspecialty fellowship.
The last route is to train in CCM directly from IM residency with no additional subspecialty fellowship. This type of fellowship is a 2-year fellowship, and requires a minimum of 12 months of clinical time.

Anesthesia
Most anesthesia-trained intensivists work primarily in the SICU, however there are many who work in the MICU. To get certified in CCM through anesthesia, it’s a 1-year fellowship done after an anesthesia residency.

Surgery
Surgery-trained intensivists in general work in the SICU environment. A surgery CCM fellowship is a one year fellowship that can be done either during or after a surgery residency. Since at many academic surgery programs, residents take time off after their 2nd or 3rd year of residency for research, some will choose to take that time to do their critical care fellowship training. It is generally more common to do this fellowship after surgical residency, however.

Emergency Medicine
While not common, there are a growing number of EM/CCM fellowship positions available, many of which are not actually found through FREIDA. These tend to be in the SICU environment, however EM-trained intensivists can work in both the MICU and the SICU.

Pediatrics
Pediatricians have two different types of critical care units that they can choose to train in, the fellowships of which are done after a pediatrics residency – either a NICU fellowship or PICU fellowship. The NICU is a neonatal ICU, and focuses on the unique needs of neonates (of course). The PICU is the pediatric ICU, and focuses on critically ill children older than the neonates (in general, older than 3 months of age, give or take).

Neurology
Neurologists can train to become neuro-intensivists, and specialize in the unique needs of critcally ill neurology and neurosurgery patients. Neuro-critical care is a developing fellowship, and can be done after a neurology residency. Neuro-intensivists work in neuro- and neurosurgery-ICUs.

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