CCM Fellowships

[Seba]

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I posted this in the CCM forum but not surprisingly there have no responses in 2 days so I thought I would try the busiest forum on SDN. MERRY CHRISTMAS!!!!!!!!!!!!!!

I am a current CA-1 and am strongly considering a fellowship in CCM. Can anyone comment on the fellowships at Wake Forest, Emory, Duke, Michigan, and any others. Specifically, I am looking for a program that has true CLOSED units, adheres to evidence based practices and has either mandatory or substantial elective opportunities to do MICU time.

I am interested in a either an academic or private practice career that will allow me to attend in a mixed med/surg icu and also do at least 50% anesthesia. Does anyone know of folks doing this type of career in either private practice or academic? I know academics split time in between the OR and the SICU but anyone also attending in the MICU?

Thanks!!

 

[2win]

I posted this in the CCM forum but not surprisingly there have no responses in 2 days so I thought I would try the busiest forum on SDN. MERRY CHRISTMAS!!!!!!!!!!!!!!

I am a current CA-1 and am strongly considering a fellowship in CCM. Can anyone comment on the fellowships at Wake Forest, Emory, Duke, Michigan, and any others. Specifically, I am looking for a program that has true CLOSED units, adheres to evidence based practices and has either mandatory or substantial elective opportunities to do MICU time.

I am interested in a either an academic or private practice career that will allow me to attend in a mixed med/surg icu and also do at least 50% anesthesia. Does anyone know of folks doing this type of career in either private practice or academic? I know academics split time in between the OR and the SICU but anyone also attending in the MICU?

Thanks!!

To early for you to decide IMO. Also in 3 years things can change a lot (regarding the quality of the program and so on...). Stay tuned on this forum and you'll find a lot of useful info.

 

[aredoubleyou]

Pound for pound, I'd say the Wash U CCM fellowship is the best. MICU in a tertiary institution is a waste of time in my humble oppinion, only in the community are you gunna attend MICU, and the crazy zebras will be shipped out in that setting, the run of the mill medical stuff youll have exposure to in a sicu.

 

[narcusprince]

At CCF we have a closed unit. Which is anesthesia run completely. The fellows rotate through the CICU, MICU, PICU, and NICU, CVICU. The attendings are very knowledgeable. I would say its a gem.

 

[seinfeld]

Short version- I went to michigan, top notch program- currently doing PP CCM and anesthesia, easily passed my CCM boards. I mainly cover MICU, Cardiac ICU with some occasional vascular and Gen surg pts.

i have posted numerous times on this subject. Please do a search for those threads, and then PM with specific questions, as others know i am more than willing to answer ?'s.

 

[seinfeld]

http://forums.studentdoctor.net/showthread.php?t=682871&highlight=critical+care

http://forums.studentdoctor.net/showthread.php?t=560146&highlight=critical+care

 

[Seba]

Thanks Seifeld. Does anyone else out there have any info on my questions/concerns? Anybody else in anesthesia considering CCM?

 

[cchoukal]

Stanford has true closed units. A buddy of mine is a fellow there and he's pretty happy. His attendings are anesthesiologists, pulmonologists, and I think a handful of surgeons.

I interpreted from your posts that "closed" units and medical patients are important to you (as they were for me early in my training). I had the sense that the tertiary medical patients were sicker and more challenging and that anesthesia intensivists who "merely consulted" in open units were somehow "less than" the "real" doctors who took care of patients in closed units.

As I progressed in my training, I saw that, open or closed, the people who sent the patients to the unit were still pretty heavily involved, and critical care was less about having control over every aspect of patient care than it was about lots of different teams with competing goals and limitations (and ZERO understanding of each other team's goals and limitations) coming together to do the right thing for the patient.

Let's face it: it is a rare surgeon that will totally relinquish a patient's care to an anesthesiologist (who they typically don't see as peers anyway), no matter where they trained. That could sound defeatist, I suppose, but it's just meant to reflect reality so that you can make the best decision possible, based on the factors that truly matter. That is, some factors might affect your training/competence WAY more than open or closed units, if you allow yourself to get past that one variable that seems so important at the outset.

Of course, I am biased. I am a fellow at UCSF where most of the patients are co-managed in an open service. For me, most of the anesthesiology CCM fellowships were centered around surgery and CT surgery, with little emphasis on medical patients, save for the month-long elective where you're not really the real MICU fellow anyway, but rather an observer, thereby really limiting what you get out of the rotation. At the same time, knowing what I know about surgeons, I wasn't certain that the surgery-heavy fellowships were going to give me what I wanted anyway, since, again, even closed units have input/sabotage from surgeons anyway.

So for me, the trade off was to go to UCSF where the open model predominates, but where I'd be the fellow for every type of ICU patient in the hospital. To me, being the consultant for ICU care for ALL the patients seemed like a better opportunity than being the sort of pseudo-primary for a very circumscribed set of patients.

Anyway, long story short, there's a lot more to picking an ICU fellowship than merely open vs closed and some illusion of control, so ask around where your mentors trained, go to the ASCCA conference and participate in the mentorship sessions, and good luck!

 

[Seba]

CC, thanks for the post! I am very new to this side of CCM as most of my experience has been in the MICU. I am thinking I would like to work in a combined med/surg ICU in a medium sized private practice hospital but possibly academic if it were the right job. Do you feel that your training will prepare you to care for all varities of medical in addition to the surgical pts?

Also, most medical pts, at least where I have trained thus far, are admitted by the ICU team directly to the ICU from the ER. Is this how it works in most PP hospitals? If so, the only docs taking care of these pts would be the ICU docs and then discharge them to a floor team. Do you plan to do PP or academics? In regards to OR/ICU time how do you plan to structure your time?