Anesthesia Critical Care Fellowship

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

drmed

New Member
10+ Year Member
15+ Year Member
Joined
Sep 1, 2008
Messages
3
Reaction score
0
I am interviewing for 2009 Anesthesia CCM fellowships. I really couldn't figure out which program is the best, or even better than the other. Every program I've visited seems to be really nice. Fellows are all happy, staff is very nice. I am having a really hard time to decide where to go. Does anyone have any recommendations or suggestions?
Members don't see this ad.
 
Also taking more of an interest in critical care and developing a desire for critical care fellowship as I begin my CA-3.

Part that hurts is:

1. not taking that starting job @ 300K +
2. even after having completed the Critical Care fellowship to be offered something shy of 250 K.

is this far from reality?
 
Members don't see this ad :)
militarymd said:
go with big names....like UCSF
Click to expand...

Mil,

Why do you recommend big names? I guess I was under the impression that it really doesn't matter where you go so much. Thanks for any advice in advance.

Ender

PS Who are the big names in critical care?
 
Ender said:
Mil,

Why do you recommend big names? I guess I was under the impression that it really doesn't matter where you go so much. Thanks for any advice in advance.

Ender

PS Who are the big names in critical care?
Click to expand...

More opportunities for
1) research
2) clinical experience
3) contacts for both PP and academics
4) etc.

I didn't choose a big name because I wanted to stay closer to home....didn't hurt me, but I'm saying that after the fact.

If given the choice, why not stack the deck in your favor for your future.
 
militarymd said:
More opportunities for
1) research
2) clinical experience
3) contacts for both PP and academics
4) etc.

I didn't choose a big name because I wanted to stay closer to home....didn't hurt me, but I'm saying that after the fact.

If given the choice, why not stack the deck in your favor for your future.
Click to expand...

Thanks for the response. Are there any big names down south you would recommend. I am tired of long michigan winters (I have lived here for many years), and I think Cali would be too cost prohibitive considering I have a family. Thanks.

Ender
 
Ender said:
Thanks for the response. Are there any big names down south you would recommend. I am tired of long michigan winters (I have lived here for many years), and I think Cali would be too cost prohibitive considering I have a family. Thanks.

Ender
Click to expand...


I would ask your program director.

I'm out of touch with the academic world.
 
columbia fills every year. hopkins is very impressive. ucsf, ideal (that's where I'm going). michigan, penn, pitt are also players.
 
Ender said:
Thanks,
Click to expand...

There are others, though. OHSU is supposed to be strong. Wash U. Stanford. Interestingly, MGH seemed kind of weak. A friend interviewed there and they seem to have a very limited preactice. Very few beds, no cardiac surgery ICU (the surgeons staff it).

I think my own place (U of Chicago) could have a very good fellowship for the right person. Some exceptionally strong and dedicated teachers whose names show up a lot in the national organizations (if not in the journals...), but it's time for me to move on. Across town, at northwestern, they seem to focus on just Neuro ICU, if that's your thing.
 
There are several questions you should consider before choosing between different anesthesia cc fellowships. The first question is which intensive care units you will be in. Some programs concentrate training in the SICU, others in the CT-ICU and others in the Neuro-ICU. Also do you have the ability to rotate in units under the direction of other departments such as the MICU or PICU. If you know you like neuro physiology pick a program that rotates in that unit. The next question is the training background of your attendings and other fellows. Some programs are strictly under the control of the anesthesia department while other fellowships are shared between surgery and anesthesia and even others are joint departments between surgery, anesthesia, medicine, cardiology, and pulmonology.

Hope this helps,

Glp1
 
The CC fellowship at Wash U is very strong. The CTICU in particular is staffed by all Anesthesiologist trained CC docs. They are some of the best docs on staff that I've worked with. I learned more in my two months in that ICU (about medicine and surgery in general) then all of residency and med school combined. Would strongly reccomend checking it out if you can stand St Louis for a year. Also many changes have been made to make the fellowship more attractive in terms of hours benefits etc.

MC
 
Hockeyguy said:
The CC fellowship at Wash U is very strong. The CTICU in particular is staffed by all Anesthesiologist trained CC docs. They are some of the best docs on staff that I've worked with. I learned more in my two months in that ICU (about medicine and surgery in general) then all of residency and med school combined. Would strongly reccomend checking it out if you can stand St Louis for a year. Also many changes have been made to make the fellowship more attractive in terms of hours benefits etc.

MC
Click to expand...

I actually interviewed at Wash U for residency and I really liked the place. I was just put off a bit by the some of the residents complaining about the work hours, etc. One of them told us that the place was malignant, but I try to take that stuff with a grain of salt because I know there are complainers in every program. Interestingly though you have mentioned past problems with hours and benefits (pertaining to the ccm fellowship). Do you know what these are and what sort of change has taken place? Thanks.

Ender
 
Members don't see this ad :)
I actually interviewed with UCSF. I did like the place except the fact that it is a totally open unit where you only leave recommendations in most units. And considering the fact that I cannot affford to live in SF even for a year, I decided against UCSF.

I am kind of torn between Mayo Clinic in Rochester, MN , Vanderbilt in Nashville, TN and Pittsburgh. They all have similar programs with Pittsburgh having the longest hours for fellows.

Any recommendations about which might be better than the other? Anybody who heard anything about these programs?
 
drmed said:
I actually interviewed with UCSF. I did like the place except the fact that it is a totally open unit where you only leave recommendations in most units. And considering the fact that I cannot affford to live in SF even for a year, I decided against UCSF.

I am kind of torn between Mayo Clinic in Rochester, MN , Vanderbilt in Nashville, TN and Pittsburgh. They all have similar programs with Pittsburgh having the longest hours for fellows.

Any recommendations about which might be better than the other? Anybody who heard anything about these programs?
Click to expand...


I interviewed at Pitt also and I was really conflicted. On the one hand, they had a huge program, all closed (a stand-alone CCM department with anesthesiologists, pulmonologists, surgeons, and EM), millions of dollars, a "center" for just about anything you could think of. On the other hand, with all that going for it, it wasn't really on the radar for any of the people I asked about programs. Anesthesia people almost never go there, and the majority of the fellows are from places I'd never heard of. That and as a fellow you basically function as an intern, resident, and fellow on most of the services (i.e., most services are a fellow, attending, and maybe a PA/NP, so YOU are doing the scut, calling consults, writing notes, pushing gastrograffin at the bedside, etc.).

As for UCSF, they have some open and some closed patients, but when I rounded, I couldn't tell which were which. I got the sense they treated most of their patients as if they were closed. They are also supposedly making the CTICU closed and building a closed unit at the new hospital in the Mission. Also, I'm not all that convinced that closed units really make that much difference. Surgeons are going to influence the care regardless, so for me it was more about diverse clinical substrate, lots of medical patients, and world-class mentorship.

Agreed that SF is a tough place to live. I'm single, which helps, and they have a couple programs to make the fellow year a little more affordable. Of course, nothing comes for free...
 
Ender said:
I actually interviewed at Wash U for residency and I really liked the place. I was just put off a bit by the some of the residents complaining about the work hours, etc. One of them told us that the place was malignant, but I try to take that stuff with a grain of salt because I know there are complainers in every program. Interestingly though you have mentioned past problems with hours and benefits (pertaining to the ccm fellowship). Do you know what these are and what sort of change has taken place? Thanks.

Ender
Click to expand...

The following is based on reliable secondhand information: In the past, call was q2- q3. It was "home call," in order to comply with ACGME guidelines, but fellows rarely were able to go home, and wound up having to stay in-house. Now, this has now changed to a nightfloat system.
 
Well, I also heard Pitt is really hard on you because of the scoutwork. However, I did meet a lot of anesthesiologist who did their fellowship in Pitt and are now running programs throughout the country.

Does anybody know anything about Mayo or Vanderbilt?
 
Mayo's CCM fellowship program is pretty cool. You basically spend 6 months on q4 call in the MICU (staffed totally by pulm/CC), SICU (staffed totally by anesthesia) and mixed med/surg ICU (50/50 split b/w the above). Some of the units are open ICU's, but these main units are all closed. The other 6 months are electives which can be anything from ICU-dedicated consulting services (neph ICU, ID ICU, nutrition ICU, etc) to extra call months in any number of ICU's (neuro, neurosurgical, peds, CT surgery, CCU, trauma, etc) to bronchs to echo. For a CCM fellowship, it's really not that bad a lifestyle. Mayo also has pulm/CC and straight medicine CC fellowships, both 1 year and 2 year. You spend a month as a subconsultant where you the service is yours and the actual consultant just basically observes. For anesthesia folks, the staff jobs rock as you generally do about 50% CC and 50% anesthesia (meaning each month is 1 week on, 1 week off, and two weeks OR time), and the CC staff get paid exactly the same as the anesthesia staff. Overall it seems great. The fellows and staff are cool. The town kind of blows, but what can you do? Anyway, I'd consider it if you could stomach the locale.
 
B-Bone said:
Mayo's CCM fellowship program is pretty cool. You basically spend 6 months on q4 call in the MICU (staffed totally by pulm/CC), SICU (staffed totally by anesthesia) and mixed med/surg ICU (50/50 split b/w the above). Some of the units are open ICU's, but these main units are all closed. The other 6 months are electives which can be anything from ICU-dedicated consulting services (neph ICU, ID ICU, nutrition ICU, etc) to extra call months in any number of ICU's (neuro, neurosurgical, peds, CT surgery, CCU, trauma, etc) to bronchs to echo. For a CCM fellowship, it's really not that bad a lifestyle. Mayo also has pulm/CC and straight medicine CC fellowships, both 1 year and 2 year. You spend a month as a subconsultant where you the service is yours and the actual consultant just basically observes. For anesthesia folks, the staff jobs rock as you generally do about 50% CC and 50% anesthesia (meaning each month is 1 week on, 1 week off, and two weeks OR time), and the CC staff get paid exactly the same as the anesthesia staff. Overall it seems great. The fellows and staff are cool. The town kind of blows, but what can you do? Anyway, I'd consider it if you could stomach the locale.
Click to expand...

The electives in Echo and pulm/brochoscopy are very valuable in terms of private practive. Those are skills which will make you stand-out from the crowd.
 
BLADEMDA said:
The electives in Echo and pulm/brochoscopy are very valuable in terms of private practive. Those are skills which will make you stand-out from the crowd.
Click to expand...

Do you mean to imply that there are CC fellowships that DON'T train you to be proficient in these very core medical diagnostic tools? Yikes!
 
cchoukal said:
Do you mean to imply that there are CC fellowships that DON'T train you to be proficient in these very core medical diagnostic tools? Yikes!
Click to expand...

Do you mean to imply that EVERY fellowship program will REALLY teach you these skills well? Some will "say" you get experience but others will really give it to you. That is why you INTERVIEW at the program and ask current Fellows questions.

In the private practice world being VERY proficient with these tools means a lot more than a month with ECHMO kids.
 
bumping this for selfish interests. :D


does anyone have firsthand experience with the CCM fellowships at:

OHSU in Portland
U. Washington in Seattle

CCF
Penn

can PM me or continue this already useful thread.

thanks
 
please excuse the question, but whats the difference between an open and closed ICU unit?

thanks
 
nellinola said:
please excuse the question, but whats the difference between an open and closed ICU unit?

thanks
Click to expand...

in a closed ICU only intensivists can write orders. all others can only make suggestions to what should be done in their progress notes but can't actually write the orders on those patients.
 
Finishing my fellowship at Michigan so here is basic stuff on the program

-13, 4 week blocks
- 6 blocks in Surgical ICU (completly closed unit) where besides general post-op complication management and Liver Txps, you get a good volume of outside hospital transfers for ARDS and possible ECMO cannulation. The transfers most often not even surgical patients. Currently, given the Swine Flu, almost half the unit are "ECMO evals" who are either on ecmo or High Frequency Ocillatory ventiilators (HFOV). You also run the CVVHDF, nephrology doesnt write the orders. You act more as an attending than a resident. By mid year you bascially run rounds. Current system has 4 fellows at a time in the SICU, 1 day fellow, 1 night fellow, 1 person on research/administrative week and 1 on Back up to help triage incoming patients during rounds so that rounds dont get interrupted. Over the 4 week block you rotate through all the positions. Staff is alternating b/w surgical and anesthesiology
- 3 blocks of Cardiac/vascular ICU. (semiclosed unit)Heart Txp, Lung txp, LVADs, Acute Thoracic and abdomial Aortic Dissections and repairs, and then the post op Mitrals with EF of 10%. Majority are Anesthesia faculty, 2 CCM trained cardiac surgeons, and 1 acute care surgeon.
- 1 block of Neuro ICU- (Open unit) Neurointensivits and Anesthesia faculty.
- 1 block of TEE (elective)- Cardiac faculty have a course setup. Throughout the year you are welcome to attend teh cardiac Anesthesia Echo lectures.
- 1 block of Medical ICU or as I did, half block of Medical ICU and Half block of acute Renal. can also do ID, Cardiology, research etc.
- Vacation 4 weeks

Did plenty of bronchs, did some Bedside trachs (could have done more just wasnt that interested), chest tubes, pleurocentesis etc. Weekly core lectures and journal club.

Hope this help give insight
 
can anesthesia trained CCM docs work in mixed ICUs? maybe i should ask do they work in mixed ICUs? or do they strictly work in S-ICUs...

thanks in advance for your replies.
 
RussianJoo said:
can anesthesia trained CCM docs work in mixed ICUs? maybe i should ask do they work in mixed ICUs? or do they strictly work in S-ICUs...

thanks in advance for your replies.
Click to expand...

Most don't, but that's more a function of reimbursement and staffing patterns than competency.

An anes trained CCM doc would be perfectly capable of working in a large community MICU. I don't think you'd be well trained to work in an academic MICU full of zebras.
 
Pilot Doc said:
Most don't, but that's more a function of reimbursement and staffing patterns than competency.

An anes trained CCM doc would be perfectly capable of working in a large community MICU. I don't think you'd be well trained to work in an academic MICU full of zebras.
Click to expand...


thank you for your reply.
 
Pilot Doc said:
An anes trained CCM doc would be perfectly capable of working in a large community MICU. I don't think you'd be well trained to work in an academic MICU full of zebras.
Click to expand...

I'm very happy to hear this.

Lemme know if I'm wrong here, but is this because in a community MICU you get alotta sepsis, respiratory insufficiency, renal/lytes issues (things anesthesia training is intrinsically great for) whereas in an academic MICU you get alotta Osler-Weber-Rendu-renal-pt-on-MAOI-O/D-with-new-lymphoma bomb/zebras?
 
I'm going to Columbia 2010- cover a big CTICU and SICU full-time with call 1 in 7 and night float every seven weeks. Very different experience than other programs that have home call. Its a big class of seven fellows. Closed units solely anesthesia run. I was very impressed and I interviewed in Boston and other places. How will it be? I'll let you know in two years, but the outgoing fellows feel like they're isn't a situation in the ICU they can't handle now. You do echo rounds with the CV anesthesia fellows and can spend a month with the cardiologists on TTE. Overall, a high-acuity hospital- very sick patients.
 
Pill -

Is there any way you can get your TEE numbers at Columbia CCM (or at any of the other CCM programs that you interviewed at)? It would be perfect if you could both: do CCM and be able to sit for the TEE exam. My suspicion is that you need to do too many to get them in within a month or two though.

dc
 
Bump to see if anyone else is applying or currently training.
Applying for 2011, interested in an academic OR/ICU career after an MPH or MSCI.

Interested in any info on:

Duke (interesting twist with TEE certification, talked to an '09 grad who felt that went well)
Vanderbilt
Hopkins
Maryland
Pitt (....impresive summary here http://www.ccm.upmc.edu/CCM_Annual_Report_2008.pdf)
Penn
 
I interviewed at Pitt and if you’re interested, I could tell you more offline. It looks very impressive and they clearly have a lot of resources and enormous clinical substrate. They have so many units and services that there aren’t enough housestaff to cover all the beds. The result is that many of the ICU teams consist of an attending, a fellow, and an NP. The result, as I saw it on my interview day, was that the fellow often functioned as the intern, resident, and fellow. There are advantages and disadvantages to this, and I think for the right person, it can be a great fit. But it pays to be aware that the fellow role here was very different than what I saw at my other interviews, and so it stood out.
 
We just got ACGME approved here in San Antonio for an anesthesia CCM fellowship. Its your typical MICU/Trauma/SICU with Brooke Army burns, PICU and 2x months TEE.
 
I must be crazy but I am considering a CCM/CT fellowship which is 2 years at Penn

Anyone have any idea why this would be helpful??? besides being trained exceptionally well (I assume)

I really do enjoy both

anyone do this?

thanks
 
Dryacku, I know where you're coming from. I'm thinking along similar lines (although, as I'm only half way through my CA-1 year things may well change). As mentioned in your post, I know that Penn has such a program. Have you heard of any others (I'd think that most places with both fellowships would be able to offer something similar).
 
lushmd said:
Dryacku, I know where you're coming from. I'm thinking along similar lines (although, as I'm only half way through my CA-1 year things may well change). As mentioned in your post, I know that Penn has such a program. Have you heard of any others (I'd think that most places with both fellowships would be able to offer something similar).
Click to expand...

What is Penn offering? A ton of places will let you do CT and CCM. If either are accredited programs, you have to do a year in each. No way around it, thanks to the ACGME. Now, some places will pay better or allow a tailored moonlighting etc to increase interest. It's an attractive combination but 6 years of training is a long time.
 
Proman, I don't know the particulars of Penn's program, just that they have an established two year combined fellowship track (you're right that now both fellowships are ACGME accredited, its no longer possible to do both fellowships in 18 months at an accredited program). As mentioned in my previous post, I'm sure that many programs with both fellowships would be able to offer something similar to Penn. 6 years is certainly a long time...
 
Here's what I found from Penn's CCM website. I think a similar arrangement would be possible at lot of other programs as well.

Track 4: Combined Critical Care / Cardiac Anesthesia

This track is a 24 month long fellowship that culminates in board eligibility for Critical Care Medicine and Cardiac Anesthesia by the American Board of Anesthesiology. Candidates must be accepted into both the Critical Care fellowship and the Cardiac Anesthesia fellowship. The program consists of the ACGME mandated 9 months of Critical Care, 9 months of Cardiothoracic Anesthesia and 6 months of elective. An individualized curriculum will be constructed by Drs. Kohl and Cheung, along with the fellow, to maximize overlap of the two disciplines over the 24 month period.
 
proman said:
Here's what I found from Penn's CCM website. I think a similar arrangement would be possible at lot of other programs as well.

Track 4: Combined Critical Care / Cardiac Anesthesia

This track is a 24 month long fellowship that culminates in board eligibility for Critical Care Medicine and Cardiac Anesthesia by the American Board of Anesthesiology. Candidates must be accepted into both the Critical Care fellowship and the Cardiac Anesthesia fellowship. The program consists of the ACGME mandated 9 months of Critical Care, 9 months of Cardiothoracic Anesthesia and 6 months of elective. An individualized curriculum will be constructed by Drs. Kohl and Cheung, along with the fellow, to maximize overlap of the two disciplines over the 24 month period.
Click to expand...

Has anyone completed a combined CC/CA fellowship? It seems like a tough road, although if it is a good program, it may not be that bad.
 
You must log in or register to reply here.
Next unread thread

Similar threads

R
ACCM Critical Care Fellowships
Replies
0
Views
371
residentsnooze
R
B
Critical care fellowships
Replies
8
Views
2K
CodeBlu
CodeBlu
B
Cardiac vs Critical care
Replies
22
Views
2K
psychbender
psychbender
B
Critical Care Medicine Fellowship (UK trained anesthesiologist)
Replies
3
Views
509
gtb
G
B
Cardiothoracic anesthesia (ACTA) fellowship 2025
2 3 4 5
Replies
232
Views
28K
martvubo
M
Top