Anesthesia - Critical Care: recommended programs

[ABCfib]

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Hello!

I would be interested in hearing your opinions/ experiences in regards to Critical Care.

I will be applying for an anesthesia residency with the ultimate goal of ending up as a Critical Care physician. Do you guys know of any places that have reportedly very good Critical Care departments? In addition, in what places is anesthesiology really running the units (no open-unit policy, anesthesiologists are NOT the surgeon's secretaries etc.). And last but not least, which anesthesia programs are known to have Critical Care departments that conduct high-quality research?

I would appreciate your input on those questions! Thanks a lot!

 

[G0S2]

Hello!

I would be interested in hearing your opinions/ experiences in regards to Critical Care.

I will be applying for an anesthesia residency with the ultimate goal of ending up as a Critical Care physician. Do you guys know of any places that have reportedly very good Critical Care departments? In addition, in what places is anesthesiology really running the units (no open-unit policy, anesthesiologists are NOT the surgeon's secretaries etc.). And last but not least, which anesthesia programs are known to have Critical Care departments that conduct high-quality research?

I would appreciate your input on those questions! Thanks a lot!

Two I interviewed with: UCSF and Vanderbilt

 

[Lurch]

mass general, stanford, brigham, iowa all deserve mention.

 

[Spandex]

ccf?

 

[aredoubleyou]

All these threads are is people rattling off the first few notable names that comes to mind. More or less everything is pretty much the same. Pick the city more than the program.

Oh yea, add Hopkins, U of Chicago, and Yale on the list.

 

[cchoukal]

I did residency at U of Chicago and fellowship at UCSF, so I might have some insight. At U of C, they don't typically have fellows, although they have for the last 2-3 years. They only take 1-2 per year, so you're not really engrained into the culture of the institution, which I think is a negative. The Pulm/CC fellowship has always been REALLY strong and the site of some noteworthy papers in critical care (a FACTT site, and the seminal paper in daily sedation interruption). I think that maybe overshadows the anesthesia fellowship. This might be somewhat different now that the IM dept is in a shambles (the chair, a prominent pulm guy stepped down in protest of hospital politics).

On the plus side, the anesthesiologist-intensivists are outstanding clinicians and educators, and I'm still in touch with and collaborating with several. The units are called closed, but no one is fooled; the cardiac and burn surgeons are very involved (and I would say in the case of the cardiac surgeons, engaged in active subterfuge; it's a drag. You'd be in the middle of rounds with the team, the surgeon would show up, and the gensurg resident would literally break off from the team and go huddle in the corner with the surgeon and make all the decisions). Anesthesia recently "took over" the general surgery unit, whatever that means. Sounds like it's going pretty well, although, again, I would hesitate to call it closed.

That said, if you want to be in Chicago, it's the only real fellowship. Northwestern has one, but as long back as I can remember, the experience was limited to neuro and trauma (not counting observational rotations through the other units).

UCSF is largely an open shop as well, with the exception of heme/onc and surgical subspecialty patients, which are closed (but again, it's not like the surgeon is just going to be hands-off; they're always involved and often overbearing). That said, you cover every type of patient except cardiac surgical.

I would say, in general, there are very few places (Columbia maybe, or Vanderbilt, so I've heard) where the anesthesiologists are truly left alone to take care of patients. It's just the reality that surgeons don't think anyone knows medicine or their patients as well as they do. Within that context, then, a good fellowship will give you broad exposure to lots of types of patients and the opportunities for autonomy in management and navigation of the often complex collaboration between services that defines our work.

In that regard, I think UCSF was an outstanding place to train. I'll have a better sense for that as I progress through my first year as an attending, which will be partly at UCSF in that open model, and partly in a closed medical unit.

 

[seinfeld]

Michigan is a great program, if you are seriously considering CCM i would defiantly interview there.

 

[sunset823]

I'm interested in anesthesia-critical care as well, and I would echo both Michigan and Vanderbilt. I'm at Vandy for the summer in an anesthesia fellowship, and the critical care units here are beyond amazing, beyond just the vast number of beds they have, there's also a great team. And the anesthesia residency is great here as well, very happy residents. I don't know Michigan's anesthesia dept as well, but I know they have a well-respected critical care fellowship and the hospital is just great.

I've looked into integrated programs that shave off a year, and they are the following:
Oregon Health and Science (3 positions, I believe)
University of Washington (1 position)
UCSF (1 position)

All of them seem to have great critical care programs, though I've not experienced any in person.

 

[bigdan]

Let me put in a vote for Cleveland Clinic Foundation, where I did a medical student rotation in Critical Care Anesthesiology. Simply amazing - pathology that you cannot believe, incredible resources, great anesthesiology attendings. There are CCF residents on this board that can give more specific info, I'm sure, but I remember it being a closed unit where the anesthesiologists really did call the shots.

I've looked into integrated programs that shave off a year, and they are the following:
Oregon Health and Science (3 positions, I believe)
University of Washington (1 position)
UCSF (1 position)

Sunset -

Be sure to look into these closely; I too had considered these combined programs. I strongly believe that these programs BLEND the time but do not decrease the time required to complete anesthesiology residency & critical care training (i.e.: the OHSU combined program for anesthesia/critical care is five years of total training, just like standard anesthesia residency + critical care fellowship would be).

dc

 

[sunset823]

Let me put in a vote for Cleveland Clinic Foundation, where I did a medical student rotation in Critical Care Anesthesiology. Simply amazing - pathology that you cannot believe, incredible resources, great anesthesiology attendings. There are CCF residents on this board that can give more specific info, I'm sure, but I remember it being a closed unit where the anesthesiologists really did call the shots.



Sunset -

Be sure to look into these closely; I too had considered these combined programs. I strongly believe that these programs BLEND the time but do not decrease the time required to complete anesthesiology residency & critical care training (i.e.: the OHSU combined program for anesthesia/critical care is five years of total training, just like standard anesthesia residency + critical care fellowship would be).

dc

thanks for the clarification, bigdan, admittedly I haven't looked closely into these since I have a ways to go yet. But I think the integration and extra time they allow for research still appeals to me. And I'm a Cleveland native and the CCF rotation sounds excellent, definitely something I'll consider in a couple of years (though admittedly it's not a top residency choice, I want to break out of the rust belt after 20 years).

 

[Gern Blansten]

Michigan is a great program, if you are seriously considering CCM i would defiantly interview there.

I would interview there, but I would leave off the "defiantly" part. You may leave them with a bad impression.🙂

 

[yasawa]

delete

 

[seinfeld]

I would interview there, but I would leave off the "defiantly" part. You may leave them with a bad impression.🙂

Damn automatic spell correction

 

[tucker27705]

Stanford. Look at the head of the anesthesia dept. Look at how the icus are run. Look at what the fellows do. If you don't want to do research, go somewhere else.
By the way, if you still want to do cc after doing your residency, including all those months in the icu, I'll be surprised.

 

[chocomorsel]

Can anyone comment on any of the Texas programs? Dallas, San Antonio or Houston. Don't think Galveston still has a program. I will be applying this year and I need to go back home. Been away far too long and get homesick too frequently.

 

[Mista Suprane]

I am going to Columbia for CCM fellowship in July 2011, so needless to say I was very impressed with their program.

However, I also interviewed at Penn, and if you are intersted in the east coast, I think their program is very strong as well.

Additionally, I am a current CA-3 at Hopkins, and although they have an excellent reputation, I had my reasons for not staying.

PM me for more details on any of the programs.

 

[Gern Blansten]

.

 

[PMPMD]

I'll be one of the CCF critical care fellows next year; definitely worth checking this program out. Case Western/UH also has a great CC fellowship.

 

[Intensivist]

Does it ever happens that anaesthesia CCM does both MICU and SICU in academic settings?

 

[cchoukal]

Does it ever happens that anaesthesia CCM does both MICU and SICU in academic settings?

yes.

 

[seinfeld]

Does it ever happens that anaesthesia CCM does both MICU and SICU in academic settings?

i do it in private practice.

 

[ett]

Can anyone give me more details about Stanford CCM program in anesthesia department?

 

[halflife94]

Can anyone tell me about UH CCM? Work hrs? Experience?

 

[NRAI2001]

As an anesth-CC doc would you basically be doing the same work as a pulm-CCM doc? Would your anesthesia training give you any added skills/benefits?

Do people ever get double fellowships in cardiac + CC? Sounds like it would be a really good combo?

 

[PMPMD]

Can anyone tell me about UH CCM? Work hrs? Experience?

well if you're talking about UH/Case then I can - current CA-3. I think our critical care experience is excellent. We do 6 months of ICU: 2 intern year, then 4 between ca-2 and 3. There is 1 fellowship spot.

What makes our critical care program great is the people: the attendings are all very approachable and most are very laid back. Our department chairman and 1 of our 2 program directors are intensivists; which gives the residents some major role models in the ICU.

WE have a 20 bed unit which has 2 separate services, SICU and CTICU. CTICU has cardiac, thoracic and vascular; SICU has everything else. Each team has an attending, 2-3 residents and 1-2 interns. There are also 2 nurse managers who help out tremendously; they float between teams.

We have great acuity and pathology. Pretty much all kinds of cases: livers, complex cardiac including VADs and transplants, thoracic, and all the usual gen surg, ortho, GU, vascular, etc. No trauma however. The fellow can do a trauma ICU month at Metro (another Cleveland hospital and a Level 1 trauma center)

Resident hours - get here at 7, leave usu 4-5. We try to get the precall resident out first, and some attendings let the on call resident come in in the afternoon. Calls: 7-9 per month, but residents get paid $75/hr for anything over 6 calls.

Can't give you exact #s on fellow hours - I think they're very reasonable. Fellows can moonlight in the ICU, in the main campus ORs and one of the remote site ORs. The latter is home call.

 

[pd4emergence]

I know this is an old thread but does anybody have any comments they can make about any of the critical care programs in the southeast?

 

[SexPanther]

I know this is an old thread but does anybody have any comments they can make about any of the critical care programs in the southeast?

Vandy http://www.vandydreamteam.com/critical_care_anesthesia_fellowshipgreat place. I would be doing a CCM fellowship here if I knew I wasn't going back to a private practice gig in the midwest, thus I'm doing CT.

 

[Idiopathic]

very good fellowship at vandy. education based, not malignant, calls are reasonable, truly you seem to be an extra person on the service and not someone that the service cant exist without

 

[imfrankie]

Brigham has a two year combined cardiac critical care medicine anesthesia fellowship

 

[nycitygas]

Brigham has a two year combined cardiac critical care medicine anesthesia fellowship

Really?? Ive been debating between the two. How is the fellowship organized, do you do like a month of cardiac, then of ICU ect or is it more one year of this one year of that?

 

[imfrankie]

I believe the latter. Talk to Doug Shook at BWH. He's a nice guy and answers emails.
Good luck. Super training if you've got the horsepower for two years.

 

[nycitygas]

I believe the latter. Talk to Doug Shook at BWH. He's a nice guy and answers emails.
Good luck. Super training if you've got the horsepower for two years.

That would be pretty badass. One of my cousins is actually a anesthesia critical care fellow there this year and he seems extremely happy. I'll try to get into touch after I decompress from my ITE.

 

[CardiacIntensivist]

Brigham has a two year combined cardiac critical care medicine anesthesia fellowship

Mmm forgive the student ignorance but does it allow one to be board certified in both?

 

[imfrankie]

It sure does allow you to be boarded in both.

 

[FuzzyBK]

There isn't a board certification for cardiac, per se. There's TEE certification, but you don't necessarily need the cardiac fellowship for that though.

 

[1984]

Actually it is difficult to become TEE certified now without a fellowship. Basic certification requires supervised interperetation of 150 exams and performance of 50 exams. And these have to be in a training program. For most, it is difficult to achieve these numbers without a fellowship.

To become certified in Advanced perioperative TEE cardiac anesthesiology fellowship training is REQUIRED.
From the Nation Board of Echocardiography application for Advanced Periop TEE:

Applicants must have a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with car­diovascular disease. Training obtained during the core residency (anesthesiology, internal medicine, or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with an ACGME or other national accrediting agency accredited fellowship in cardiothoracic anesthesiology.

 

[FuzzyBK]

Do you need a fellowship - yes
Do you need a CT anesthesia fellowship - no
Could you only go to a CCM program and be certified in Advanced PTE - yes
If you use a CT fellowship to get your TEE numbers, it must be accredited by the ACGME - yes

That pretty much summarizes the guidelines you posted. I'm just saying that there are CCM programs that can give you that opportunity without the need for a CT anesthesia fellowship.

 

[PMPMD]

.

 

[G0S2]

For current fellows or graduates, what is the interview day like? Is it like residency where they essentially sell the program or do they assess your clinical competence with questions?

 

[PMPMD]

For current fellows or graduates, what is the interview day like? Is it like residency where they essentially sell the program or do they assess your clinical competence with questions?

In my n = 1 experience, most of it was selling the program. If I went to an interview and they started pimping me, I would probably look elsewhere. They can assess my clinical experience by talking to the attendings I worked with for 4 years.

 

[MTGas2B]

n=4 two years ago. All selling the program, letting you meet current fellows. No one pimped me or tried to size me up, at least not that I caught on to.

 

[cchoukal]

N=4, 2008. One had a dinner the night before to meet the fellows (none showed; same program had zero unsupervised time with fellows during the interview day).

Most were interested in what my goals were and telling me how they could meet them. Some had lunch with fellow(s). All had some component of observing rounds along with several individual interviews. All were generally casual, collegial.

 

[cfdavid]

As an anesth-CC doc would you basically be doing the same work as a pulm-CCM doc? Would your anesthesia training give you any added skills/benefits?

Do people ever get double fellowships in cardiac + CC? Sounds like it would be a really good combo?

Two of our faculty are double fellowship trained in Cardiac and CC.

 

[G0S2]

Two of our faculty are double fellowship trained in Cardiac and CC.

One of my attendings who wrote one of my letters is CCM/CT trained and told me today that he is seeing more and more double-fellowship trained people at conferences.

 

[deleted171991]

What lesser-known/smaller CCM fellowship programs would you guys recommend?

 

[Random Anesthesiologist]

A surgery resident was telling me that some surgical critical care fellowships take anesthesiologists as fellows.

1. Is this true?

2. Would it be worth it to explore this option?

 

[Dwindlin]

A surgery resident was telling me that some surgical critical care fellowships take anesthesiologists as fellows.

1. Is this true?

2. Would it be worth it to explore this option?

I know where I'm heading (tomorrow!) has taken Anesthesia residents into their SCC program.

 

[Random Anesthesiologist]

I know where I'm heading (tomorrow!) has taken Anesthesia residents into their SCC program.

Hey congrats!

 

[deleted171991]

A surgery resident was telling me that some surgical critical care fellowships take anesthesiologists as fellows.

1. Is this true?

2. Would it be worth it to explore this option?

1. Yes. Same way surgeons are board-eligible even if they do an anesthesia CCM fellowship.

2. Depends on the program. One would want to be trained by a more diversified faculty than just trauma surgeons, who (in my very limited experience) usually suck both at CCM and surgery (regardless where they trained). Plus SICU patients are generally not as sick as MICU ones.

 

[Random Anesthesiologist]

Interesting. Thanks!