CCM Fellowship

[deleted547339]

---

Members do not see this ad.

Hi all.

If an EM resident goes through a multidisciplinary CC fellowship through anesthesia, could he or she work in a MICU if he or she so desires? Obviously, I understand that it ultimately depends on the person doing the hiring, but is this something that occurs regularly? Is this entirely unheard of in academics? I know IM-CCM folks who trained at multidisciplinary programs that work in surgical ICUs, but didn't know if it went the other way.

It seems anesthesia is a bit more forward thinking than medicine and seems to embrace the multidisciplinary nature of CCM, which I appreciate. And the locations of the anesthesia CCM fellowships would be better for my family.

I ask because I know I want to staff an ICU, but do not yet have the experience to conclusively say that I prefer SICU to MICU or NICU, etc.

Thanks.

 

[Ezekiel2517]

Yah

 

[deleted171991]

Not in an academic place. You need to be IM-boarded to be allowed to teach IM trainees. Otherwise, they consider you stu-pid. 😛

It works the other way round, though, because we are nice people, unlike the IM RRC arses. It has nothing to do with our training (we pass similar CCM boards and can otherwise work in any MICU in the country), just with academic turd turf protection.

 

[deleted547339]

Not in an academic place. You need to be IM-boarded to be allowed to teach IM trainees. Otherwise, they consider you stu-pid. 😛

It works the other way round, though, because we are nice people, unlike the IM RRC arses. It has nothing to do with our training (we pass similar CCM boards and can otherwise work in any MICU in the country), just with academic turd turf protection.

Thanks, FFP! Do you see this changing anytime in the future, or do you think the fleas will hold on to what they know?

 

[G-Man82]

I had a conversation with my future Chair and apparently there's some work in progress to change the fact that you have to be IM-boarded to work in the MICU of an academic center. I think they're starting to realize the multi-disciplinary nature of CCM and how a lot of places are developing a critical care center to make critical care practice a bit more standard, which also breaks down certain barriers. If the pulm guys are gonna round in the sicu, then I can round in the micu, too. I can guarantee that I won't wait until a patient is on 100 mcg of Norepinephrine through a 22g before lining the patient up. They'll come around.

The problem you'll face in going to a strictly anesthesia fellowship based out of sicu and cticu is that you may have a lack of medical patients. You can make the argument that you're still trained to manage medical patients because surgical patients are just medical patients who require surgery, but the reality is that in the sicu you won't always see things like onc crises, copd and asthma exacerbations, or crazy idiopathic pancytopenias in a sarcoidosis patient with myocardial infiltrates and a constrictive pericarditis.

But I think the core concepts are similar. I can also go head to head with the pulm fellows regarding ventilator management in various situations. I'd just make sure that your fellowship is truly multidisciplinary and that when you're on MICU, you are the fellow on micu or are at least treated more like a welcome guest vs an observer.

 

[Ezekiel2517]

Much more common to see intensivists staffing ICUs outside of their specialty in non-academic settings. But just keep in mind that the IM trained people overwhelmingly outnumber those from all other specialties . In my experience, the training background is not that significant. Regardless of specialty, the best intensivists I've worked with were not the ones who were most knowledgable. They were the ones who were best at coordinating care and managing and utilizing personnel/resources.

 

[deleted547339]

I had a conversation with my future Chair and apparently there's some work in progress to change the fact that you have to be IM-boarded to work in the MICU of an academic center. I think they're starting to realize the multi-disciplinary nature of CCM and how a lot of places are developing a critical care center to make critical care practice a bit more standard, which also breaks down certain barriers. If the pulm guys are gonna round in the sicu, then I can round in the micu, too. I can guarantee that I won't wait until a patient is on 100 mcg of Norepinephrine through a 22g before lining the patient up. They'll come around.

The problem you'll face in going to a strictly anesthesia fellowship based out of sicu and cticu is that you may have a lack of medical patients. You can make the argument that you're still trained to manage medical patients because surgical patients are just medical patients who require surgery, but the reality is that in the sicu you won't always see things like onc crises, copd and asthma exacerbations, or crazy idiopathic pancytopenias in a sarcoidosis patient with myocardial infiltrates and a constrictive pericarditis.

But I think the core concepts are similar. I can also go head to head with the pulm fellows regarding ventilator management in various situations. I'd just make sure that your fellowship is truly multidisciplinary and that when you're on MICU, you are the fellow on micu or are at least treated more like a welcome guest vs an observer.

Thanks. Super helpful. The nice thing about EM->CCM is that the fellowship is 2 years hopefully allowing me ample time to do both MICU and SICUs.