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.
