University of Chicago vs UPenn for Anes/CCM

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wickedskillz

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any thoughts, advice or opinions on which place to rank higher for CCM fellowship? Please feel free to PM. Thanks.
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I would rank based on your preferred location. Both are small programs at prestigious research heavy institutions. FYI, Penn's CVICU experience is pretty weak. Surgeons run everything.

Definitely rank UTHouston over both. You won't find a better program.
 
I think they are fairly comparable so I'd go with your own personal feeling, location preference, and where you may want to end up practicing. Also, work life balance preferences. Remember that CCM in particular is a tough year because you are learning an entirely different specialty out of the OR , the ICU is demanding, and still need to make time to prep for both the written and oral boards. Also I think both those programs have more national recognition than UTHouston so that should be considered
 
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wickedskillz said:
Thanks for your advice. Also recently being told to consider Pitt above Chicago and Penn. Any thoughts?
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Look at the setup, and see which one is closer to your style. AFAIK, Pitt fellows are almost like residents. And 2 weeks of vacation, seriously? Bye.
 
Upenn, because I know a few of their attendings very well. Dr Fender, Dr Mahlhotra, Dr Bonavia, Dr Kunal, all very dynamic young vibrant physicians. Excellent group there.
 
Thanks for your help everyone. Those of you who did CCM fellowships, did you find the MICU rotations to be especially useful? Did you learn a lot about ARDS and stuff from the medicine guys? Or do you think more neuro / CVICU experience seems more useful in your career?
 
I honestly learned more in the MICU than in the SICU. That's probably because the MICU patients are sicker, and one can see enough SICU pathology during residency. Once you see the bad COPD patient turn blue, get intubated emergently, and survive without brain damage, you'll get a new tolerance level for respiratory emergencies. Once you get a severe pulmonary edema with rising bloody tide in the ETT under control with PEEP of 20, once you get to save a patient with toxic shock syndrome running on four pressors, or a fulminant liver failure, or just even a combined septic and cardiogenic shock, you'll appreciate your time in the MICU. I personally can't have enough of it. Plus there is just one cook and it shows.

ARDS? What's that? Just kidding. You will see so many patients with ARDS levels of oxygenation, at some point in their course of illness, that you will become as immune to the word as to the constant alarms you hear while rounding.

Neuro is useless. They are beginning to kick out non-neurology/neurosurgery-trained intensivists from the neuroICUs. I know FCCM level people, with decades in neuro, who were kicked out. It's not worth it, in my opinion; there is no future in it for anesthesiologists. It won't make you a better neuroanesthesiologist either; you probably know enough for that already, after any decent residency. Unless they teach you at least how to put in an EVD, how to measure MCA velocities, how to properly read a brain CT/MRI etc.

CVICU is a different story. There are many anesthesia departments with CVICU presence, because the darn cardiac surgeons need lackeys, and it's probably lucrative for the departments. But usually the minimum you need for that are TEE skills, if not a cardiac anesthesia fellowship on top of CCM, depending on the place. If you get the chance, I would rather take a month of TEE in the OR than CVICU. The other thing you'll want to learn during your fellowship, and especially in the CVICU, is TTE.

These are just my perceptions as a fellow, so I might be wrong about the market.
 
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Thanks for the input. I see there are a few neuro icu fellowships opening up, which is another year on top. I think likely if you're going to staff a dedicated neuro icu people will start requiring that, which I have no intention of doing.

What did you make if your elective time? I heard people are doing ID and renal elective rotations, which sounds appropriate since we barely do any of that as anesthesiology residents. Did you think that seemed more useful than say an extra month in the micu?
 
It looks like some programs are encouraging research time, which sounds like good hours but I really don't feel too excited about necessarily publishing during fellowship. Really want to focus on locking down clinical skills.

Also, it seems trauma and burns are hit or miss at some programs. Some have it and some don't. I saw a lot of trauma during residency, so not necessarily looking to necessarily do a bunch more. Never did burns during residency though, surprisingly didn't even have a lot of burns patients come to or prior to resuscitation. It seems like initial rescuication is the key, then short term complications, then they stay in the burn unit forever as you manage pain and rehab.

From what you heard, how valuable is the burns and trauma experience? Worth chasing after with elective time if you don't see much at your fellowship program?
 
wickedskillz said:
Thanks for the input. I see there are a few neuro icu fellowships opening up, which is another year on top. I think likely if you're going to staff a dedicated neuro icu people will start requiring that, which I have no intention of doing.

What did you make if your elective time? I heard people are doing ID and renal elective rotations, which sounds appropriate since we barely do any of that as anesthesiology residents. Did you think that seemed more useful than say an extra month in the micu?
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Probably not. I would spend my time on imaging rotations with radiology and cardiology (TTE/TEE). But that's me.
 
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I specifically stayed away from research-heavy places. While it helps to add stuff to your resume, it should be optional. One year will fly away in a blink, and the last thing you need is to waste your time on their research. This is not a mini-fellowship, which could be done in just 6 months (such as regional, neuro, OB, "ambulatory", "periop" etc.). For CCM, even 12 months (with 3 of electives) may seem not enough for the passionate.

I would do another 6 months of IM-CCM in a heartbeat, if it existed.
 
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FFP said:
Probably not. I would spend my time on imaging rotations with radiology and cardiology (TTE/TEE). But that's me.
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I selected TEE, TTE, and coronary care unit for my electives this upcoming year...but I'm reconsidering the third one. I was thinking CCU might be interesting considering most of the folks have significant comorbidities that need to be managed in addition to whatever heart problem brought them in. Thoughts?
 
vector2 said:
I selected TEE, TTE, and coronary care unit for my electives this upcoming year...but I'm reconsidering the third one. I was thinking CCU might be interesting considering most of the folks have significant comorbidities that need to be managed in addition to whatever heart problem brought them in. Thoughts?
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I would take another 1.5 month of (OR) TEE, and 0.5 of CCU, especially if not trained at basic PTEexam level during residency. You can learn how to do TTEs in the ICU, and the views are similar to TEE (just from a different angle), so reading them is a similar skill.
 
Get as much micu training as possible. You may end up in a place like mine where the ICUs don't have true borders and we get medical overflow all the time. Plus with ECMO owned by our department and unit, I get a lot of sick ARDS patients that we may or may not place on ecmo. During H1N1 season I even had one proned and on VV-ECMO at the same time.

I agree with FFP. Though my main unit is a CVICU, I like my medical overflow patients more because it's just the CCM team running the show. Regardless of how well you know your stuff, CT Surgery is still primary and will bump your decision with their own, even if it's insanely stupid. Like giving fluid to a patient with a cvp of 25, who's prior cvp was 18, and after 250 ml went to 25. RV failure. Fluid is not a pressor.

You don't need an IM residency to be able to do CCM. It's something I try and tell my residents when I get them, but sadly, I think they feel that way because they are severely lacking medical knowledge.


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I'm considering looking into critical care but it's hard for me to consider a year in AAA ball after being in the majors for 5 years with experience CV fellowship and TEE cert. The thing that has me considering is that i could find myself in a career i enjoy more than my current situation (which ironically may NOT be the reason to add a fellowship) Did any CC trained peeps on here go back after being an attending for a few years and what was that experience like?
 
Thanks for the advice regarding electives. Chicago's new PD is very big on echo, and said he wants you to be able to read TTE so well by the end of the year, you should be able to sit cardiology boards (Don't remember the name he mentioned). That sounded awesome, but I was wondering as to the need for such depth of study in Echo for ICU. For most units (outside CVICU) I figures it's probably enough to have basic echo skills: Assess EF, check RV Dilation, Make sure valves are not blown open, look for effusions and titrate in your fluids. Is there really much benefit of taking two months to learn beyond that?
 
Also, @FFP what radiology skills do you wish you had honed in more on? How would you ideally structure a radiology elective for it to be he high yield for you in the ICU.
 
wickedskillz said:
Also, @FFP what radiology skills do you wish you had honed in more on? How would you ideally structure a radiology elective for it to be he high yield for you in the ICU.
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You should definitely be taught some CT reading skills (chest, abdomen, pelvis, brain). You should be taught how to diagnose a DVT by ultrasound. Some abdominal ultrasound wouldn't hurt either.

One-two months of TEE should be enough for basic knowledge (non-cardiac surgery). You won't get to do TEE as an intensivist, but you should use the opportunity to get the manual skills, because you are an anesthesiologist. You can learn most of the advanced theory from books, later, if interested, but you should know the views and how to get them, including 3D.
 
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Matched at my first choice on the west coast .....
 
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Any thoughts on the unfilled program listing on SFmatch? Surprised by a few names on there and I see some familiar ones from last year and the year prior.
 
secants said:
Any thoughts on the unfilled program listing on SFmatch? Surprised by a few names on there and I see some familiar ones from last year and the year prior.
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Some good names on that list. Still worth applying, if that's what you are thinking about. But you should always wonder why they didn't fill: was it bad education, was it geographical location, was it exploitation, was it the lack of a name, or human quality of PD/faculty?

Like I can see Mayo or MUSC not filling, because I have seen them not even answering their emails. Columbia is probably first-class education, with some very smart people, but used to be intense. UMass is not really what I would call a fellowship. UF Gainesville just went through a serious restructuring and faculty hemorrhaging, and the hospital sucks (if I recall Blade correctly). CCF and Johns Hopkins have the name, but I have never met (for the former) or been impressed by one of their grads (for the latter). Dartmouth is a small name in snow country; most people couldn't tell even the state, or that it's Ivy. Cannot really comment on the rest.
 
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secants said:
Any thoughts on the unfilled program listing on SFmatch? Surprised by a few names on there and I see some familiar ones from last year and the year prior.
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I liked both OHSU and OSU when I interviewed there, and everyone was super friendly.
 
I liked CCF, they just didn't have enough autonomy outside of the SICU, and only spent a month in their massive CVICU. I'm also not a fan of old fashioned open-bay units.

I was not surprised that OHSU didn't fill either of their traditional fellow spots. Portland is awesome, but the program fell short of my expectations.

UAB had a nice program, with good transplant exposure, good hours (although, some overnight call may be nice), and nice moonlighting, so I'm surprised they didn't fill.

I wonder what this year's statistics will show regarding applicant number?

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FFP said:
Why? Do they have such a great CCM program? (I am being curious, not sarcastic.)
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I'm a dumb CA1, so I don't know first hand. I feel like I've had conversations with some folks who spoke highly of UCSF's CCM program. Maybe I was mistaken. But up higher in the thread there was a discussion of "branding" of a program. I'd have imagined just for branding alone (from the applicants perspective) they'd have filled.

FWIW, anybody have anything to add about WashU's CCM or ACTA programs?
 
This number of open spots looks like it used to 5 years ago. Do you guys know if the number of applicants is down overall? Or are there always this many open spots?

Congrats to all who matched - I'm biased toward CCM, but I think you're all making a great choice.

Wickedskillz...are you a UPMC resident by chance? Congrats on matching there. You'll be very busy, and have an important CCM name on your resume after the year!
 
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To me CCM would be much more popular if there was more certainty in the job market. To do an extra year and pretty much corner yourself to only doing academics is not attractive for many people.

Is Cornell weak for ccm? It looks like they didn't fill two years in a row.
 
Bigdan, we don't have the stats from SF match yet for this year to see how many applicants there were. I count 38 unfilled spots this year (30 and 23 for 2015 and 2014). There were 189 and 196 initial applicants (148 and 147 submitted rank lists) for 2015 and 2014, respectively (for 167 and 150 spots). Also, several programs either opened (Arizona, Colorado), or expanded (Vanderbilt, Nebraska, MUSC), so the number of positions offered this year was probably more than the pool of submitted rank lists.

I'll jump on the bandwagon. I, too, matched to my #1 choice.
 
GravelRider said:
To me CCM would be much more popular if there was more certainty in the job market. To do an extra year and pretty much corner yourself to only doing academics is not attractive for many people.
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Who knows what the market has in store? When I was searching for jobs, all the PP places I interviewed at for anesthesia/CCM were AMCs. Perhaps they see a certain value to having a foothold in the hospital's ICU that traditional PP groups don't see?

I ended up in academics more for the certainty, better CCM practice, sicker patients, and I like having residents. Hours aren't awful. CCM has the most hours for me potentially but that's also where my call and weekend responsibilities lie and I get extra time off. I have none of that in the OR. OR for me is 7-3 scheduled. Anything past that is extra money, but I'm capable of having early outs etc.

Regardless of what you do, it's so much better than being a resident.


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