Nov 18, 2014
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Hello all,
A current anesthesia resident looking to see if I could obtain valuable advice from peers and colleagues...
Interested in anes CCM fellowships for 2017(applying in nov ) .I have reasonably good scores on my ITE and AKT's.
What do you look for in terms of desirability(other than geography and job prospects)
1. Open vs closed unit
2. CT ICU/ burn experience
3. TEE/TTE certification
4. Workload (i.e availability of residents )/ call schedule
5. Research(not a big factor for me)
6. Morale of fellows
Any advice would be appreciated.
 

RussianJoo

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Yep you look for all those things and for me a big one was name recognition, I wanted to be at a place with a big name.
 

psychbender

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Sevodex, I'm also applying this year, and some of the biggest things that I am looking for are programs with excellent TEE/TTE training (preferably with the ability to obtain Advanced PTE certification), good CT ICU exposure (CT cases are still my favorite), a wide range of periop pathology and interventions, and happy fellows that can find good jobs as intensivists. There are still a lot of open units in the real world, so having some exposure to how to function as only a consultant, and not the primary, during fellowship may be useful (or maybe not). I like to work, not write papers, so research opportunities are not a priority for me. As for workload, fellowship is only a year. I have had several conversations with my wife about workload, and she's supportive of my plan to go back to training after being staff for a few years, and said that she's alright with going back to residency hours and salary. At least we're debt-free, and I can have some GI Bill money to supplement income for that year. Finally, I value quality of training over name recognition (although, they often do go hand-in-hand), particularly since I am not gunning for a career in academia at a big-name place.
 
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Ezekiel2517

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I'm pretty sure the rules have changed so that advanced TEE certification is only attainable to those who do cardiac fellowship. Where I trained, the cardiac anesthesia dept were extremely protective of their TEE's and it was a pain in the ass for me to get my numbers. TEE cert. is useful for you only if you plan on doing cardiac cases after fellowship. TTE is what you want in the ICU
 
OP
S
Nov 18, 2014
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What is your opinion of open vs closed units? In my hospital currently, we have surgery managing the trauma and surgical ICU where we rotate , with just one anesthesia attending .... and the unit is so open you rarely get to do any decision making... the primary service /attending calls the shots
 

Doctor Bob

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What is your opinion of open vs closed units? In my hospital currently, we have surgery managing the trauma and surgical ICU where we rotate , with just one anesthesia attending .... and the unit is so open you rarely get to do any decision making... the primary service /attending calls the shots
I hate open units.
Makes me feel like a scribe when I have to run all my decisions past another service. Either they're my patients or not. I get that surgeons want to have control over what happens to their post op patients (and they should), but then they should do the management and leave me out of it.
 
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Random Anesthesiologist

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Another one here throwing my hat in the ring.
 
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Stank811

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minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease. Does not state it has to be a cardiac fellowship. Many AnesCC fellowships meet this requirement.
 

bigdan

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You guys looking for CCM fellowship need to at least look at University of Michigan if it is anywhere on your radar. I'm deeply biased, but man, it's a fantastic place to do an anesthesiology critical care fellowship.
 

psychbender

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I've been called by the intensivist and/or surgeon to put a probe down patients in the unit, and my ICU is rather small. The situations were placement of ECMO cannulas in the unit, and examining a the heart of a fresh CABG pt that was decompensating (the intensivist couldn't get good TTE images due to chest tubes, and whatnot). Still, not common scenarios ( maybe five times in two years have I made the field trip), and restricted to CT. It would be interesting to hear from anyone familiar with Duke how often and for what indications they get TEEs in the unit, and how often they do TTE.
 
OP
S
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@bigdan -Could you tell us more about U mich CCM ... looking to start an anes ccm fellowship in 2017?
 

CUBR

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@bigdan- what is the workload/ team dynamic like at UMich? and is there anything in particular that has made your experience so fantastic?
 

bigdan

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CUBR -

Understanding that things may have changed since my graduation, here are my thoughts:
1) Workload: Work hard & play hard (or work long hours and have some pretty generous time off). I spent most of my time (8 of 13 blocks; each block is 4 weeks) in either CVICU or SICU. In each 4 week block, you are "on" for two of them, on a "backup" week for one, and then get "admin time" for one...(that is - one week of non-clinical time!). When you're working, you're working. CVICU sees everything (VA ECMO, VAD, IABP, valves, etc), and your "on" week is 24/7...come in and round, go home when stable, and come back in if new admit or resident is in trouble. SICU is more traditional for your "on" weeks - one week of 12 h/day "day shift" x 7 days and one week of 12h/day "night shift". You work your ass off. Fellow carries the ECMO phone, so you're the gatekeeper for ECMO referrals, gatekeeper for a high-acuity stepdown unit, rounding, etc. As much as you get crushed, you know you have a week off at some point. I read, did research, traveled, or just hung out during that week off. It was great.
2) Team Dynamic: Fantastic. I went to a residency where the ICU fellows were seen sorta like "senior-senior residents"; they always rounded with the attending (prerounded, wrote orders, wrote notes, called consults, etc). At Michigan it seemed the fellows were more like "junior attendings". When a nurse and resident were bickering, "The fellow said so" would end an argument. Obviously, respect is earned over time, but by the last part of the academic year, most attendings were either silent audience (or not there altogether) for rounds. It was the single best year of my adult education, in large part due to the autonomy and responsibility. You have to own your f'ups too, in this model, but your patients are your patients.

What made it so great was the overarching focus on making the fellow an outstanding anesthesiologist-intensivist. It was not so overly heavy in work hours that I couldn't catch up on reading, get a research project done, or study for (and PASS!) my written and oral boards. It was not so easy that it felt like I was doing time for a certificate - my very first week there, I was "on" in the CVICU...128 hours (in the hospital) later, that first week ended. Not a ton of scut - I only wrote notes if I cannulated for ECMO or had some critical event that had to be documented. But I gained respect, got tremendous autonomy, got a month of echo training (spent mornings with cardiac ultrasonographers, then afternoons reading echoes with cardiologists), helicoptered from Ann Arbor to Cincinnati to pick up a VA ECMO transfer as the "flight physician", cannulated ECMO at bedside a few times, learned to do my own CVVHD orders, made some great friends, learned a ton, got to see some terrible college football (at the time), and have a whole bunch of **** with a big yellow M on it. Loved it.
 

secants

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Bigdan, do you think if you worked in the community in a micu or mixed medsurg unit, you'd be comfortable doing it as most CC training seems heavy on CV/Sicu for obvious reasons.
 

bigdan

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Secants -

To answer directly, no, I don't feel I'd be comfortable. My training was heavy in CVICU and SICU, as you'd written. We did "do" a month of MICU (and could do a second elective month if desired), but you had a non-essential role - the residents were medicine residents, the Pulm/CCM fellows were always there, and you weren't assigned patients...I was a paid medical student who didn't have to present patients, to be honest with you. And I did all the Swans. Additionally, I have no trouble admitting that I simply am not trained for/do not know the breadth of medicine that the MICU population required. I would hope I could work myself up-to-snuff, but have still never taken care of a pt with blast crisis, BMT/GvHD, etc.

For me, the CV/SI heavy training was perfect. I did a second year of training at in cardiothoracic anesthesiology, with the plan to do intraop hearts and CVICU as an attending. Mission accomplished, BTW...
 
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CUBR

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Bigdan- is the CVICU staffed by anes? and do you think you would have had the same experience (ECOM cannulations etc) had you not do a previous cardiac fellowship? or does the program train all the fellows?

Thanks for all the great info.
 

bigdan

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C -

It's expected that if bedside cannulations are necessary, the fellow present would help cannulate.

I did the CT year after ICU, at a different institution.
 

Random Anesthesiologist

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Bump, interview season well under way.
 

OldGregg

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Hey gang, long time SDN lurker here also throwing my hat into the CCM ring. Thanks to the insiders for their takes on a few programs.
 

CUBR

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it seems like CC is getting more and more popular...
 

Random Anesthesiologist

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Anyone hear from Michigan?
 

Random Anesthesiologist

Random Anesthesiologist
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Thanks. Well, I guess I wasn't cool enough.
 

Random Anesthesiologist

Random Anesthesiologist
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Not unless they ask.