Critical Care Fellowship - Advice

[BiCO25]

Longtime lurker, CA-1 planning on applying CC next year wanting some advice on programs, what to look for in a program while interviewing. Looking for the overall best training, really don't care about location. Made in the 90th+ percentile on my ITE if that matters.

Thoughts on Duke, Vanderbilt, University of Washington, Stanford, Michigan, Columbia, St. Louis, UPenn, JHU, Northwestern? Any great programs I'm missing?

Thanks for the time.

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[TheLoneWolf]

One of my colleagues went to Brigham and seemed overall happy. Not a surprise.

Cant go wrong with the above programs.

 

[CUBR]

It depends on what you mean by "overall best training". Several of the programs you listed are cardiac heavy, while the rest are more medicine heavy. So kinda depends on what you're looking to do after the fellowship.

Duke, you're going to do a lot of echos and be able to test after you finish the fellowship.
Stanford, my co-resident went there and was happy with his training before coming back to the east coast.
Michigan, Go blue! I had an amazing time there, but obviously completely biased.
Vandy, it's an amazing program and was my second choice only because of proximity to family.
UW, more medicine heavy with time on pulmonology service and BMT.
Upenn, cardiac heavy and ANES has a piece of the VV ECMO program there...cool
I think an up and coming program is Emory, worth a look too.

 

[Ezekiel2517]

You will work your ass off in the fellowship at Stanford. But you will be really good when you get out. I heard similar things w Hopkins. BID is a very strong program I'd take a look at if you want great training.

 

[Remxed]

You will work your ass off in the fellowship at Stanford. But you will be really good when you get out. I heard similar things w Hopkins. BID is a very strong program I'd take a look at if you want great training.

Can you elaborate on Stanford a bit more? I'm applying this year and Stanford is near the top of my rank list. Their new hospital is really nice, and they sold it a lot on the interview day including the increase in CT ICU numbers.

 

[Steege305]

Love Vanderbilt. Chose it and never looked back.

 

[Ezekiel2517]

Can you elaborate on Stanford a bit more? I'm applying this year and Stanford is near the top of my rank list. Their new hospital is really nice, and they sold it a lot on the interview day including the increase in CT ICU numbers.

There's a pretty in depth review of their program in here: https://socca.org/newsletters/Vol-23-No-2.pdf
I don't know if it's different now, but this is a program where fellows took quite a bit of call and therefore put in a lot of hours. But, like I said, the training is excellent and you will be really good when you get out.

 

[GasMan4425]

If you’re planning on staying in academics and maybe working half time in the OR, what should I be looking for in a program? I hear the boards are MICU heavy so should I look to have a few months experience there? How many programs can you realistically interview at during CA-2 year (Residency specific likely)?

 

[deleted171991]

The boards are not MICU-heavy. They are critical care medicine-heavy. Critical care medicine is the one that's "MICU-heavy".

Most ICU patients in the US are not post-op. The sickest patients are usually not post-op. It's not surprising that medical intensivists think about SICUs as MICU-lite. If one wants to be a thoughtful well-educated intensivist, one shouldn't even consider a program that doesn't include 2-3 months in the MICU, at least, at 100% fellow not special guest level.

To me, SICU fellows not doing MICU rotations is as absurd as MICU fellows not covering the SICU. It's artificial (based on turf wars, not good medicine) and it's dumb. It's also pretty unique to the US, the same genius healthcare system that invented that internists and surgeons make the best intensivists, not anesthesiologists (or EM docs).

If one wants to learn how to think, one should surround oneself with thinkers (i.e. internists). If one wants to learn how to do (knee jerk, if this then that), one should go in a place with doers (i.e. surgeons). Some internists are doers, and some surgeons thinkers, but people tend to select their base specialties according to what they like the most. The fellowship is just the beginning of lifelong learning, the place where one gets wide exposure to the subspecialty and forms good habits for life.

In my book, sight unseen, Stanford (as described in that SOCCA article) sounds as good as one could get. Just as an example of what to look for in a program; there are many other good ones. Keyword: multidisciplinary. Multidisciplinary faculty, multidisciplinary fellows, multidisciplinary ICUs. Another keyword is junior attending. You want to be the one running the show, during the day and during the night. The attendings should be there to guide you, to prevent harm to patients, to push and challenge you, not to run the ICU. You should be a leader, not an observer.

Also, food for thought: some of the best blogs and video conferences in American critical care education belong to internists and EM docs, not anesthesiologists or surgeons (although anesthesiologists dominate the non-US free online critical care education). And these internists and EM docs are not at the big names; they are at places like UVermont and Stony Brook (for Emcrit/Pulmcrit), or VA hospitals (for two of the authors of some of the best ICU handbooks). And it's UMaryland that has amazing critical care lectures online, not JHU. And so on. It's not the brand that matters; it's the people.

 

[psychbender]

Every year someone comes on here wanting to know what the "best" programs are, and every year, we post the same responses. There is no absolute best place (except Michigan, apparently), as every applicant's goals and needs are going to be different.

Apply widely, to both "big" and not so big named programs. There are some smaller programs that will surprise you. Back when I sent out my application, I had in mind where I wanted to go, and included a few other places that looked interesting. I was a nontrad, had some more money and vacation time built up, and so could go on a few extra interviews to places about which I did not feel strongly when I sent out my applications. I ended up being pleasantly surprised by a few, and put one of them into my top spot. Now, I did make that decision also based on family reasons, and were I childless, single, and straight out of residency, I probably would have ranked my programs a little differently. As it was, the prospect of working 80+ hours a week as someone's bitch for the privilege of attaching a big name to my own, and not seeing my wife and young kids for a year was not appealing.

For better overall training, I agree with the above general principle, though. Look for training at places that advertise multidisciplinary departments and training. If all of the fellows from all of the specialties are in one big pool, and treated the same regardless of base specialty, that is usually a good sign. No training outside of surgical ICUs is a red flag, as is the presence of another fellow in those outside units while you are rotating through (Pulm fellow running the MICU team, while you are the guest/observer). If, however, you only want to work in an academic CVICU doing academic CVICU stuff, then look for a place that includes several months there. You will just have to realize that there will be gaps in your training and knowledge going forward, as you pigeonhole yourself into one practice setting.

 

[ToKingdomCome]

Love Vanderbilt. Chose it and never looked back.

Not a lot of elective time or OR time though?

 

[Nivens]

I have a ton of respect for the internists at my hospital- I did a IM internship and have always been awed by the depth of their knowledge and systematic approach to breaking down a patient. Makes it all the more confusing when then routinely do such boneheaded things, like send me a patient on 15 of norepi 24 hours after a PCI for a fairly large MI with no arterial line. And I’m 100% certain they have equivalent complaints about mistakes we routinely make that are obvious to them. It’s just so interesting how our base training influences these things.

This is an oversimplification, but in my experience surgical/anesthesia/EM intensivists are much better when a patient is acutely trying to die- they can’t necessarily recite the textbook chapter on the relevant disease, but they know how to manage the immediatelife-threatening effects. IM trained CC docs really seem to shine in more chronic critical illness where the picture is complex and there problem is more diagnostic in nature. I’m thinking obscure presentations of certain cancers, for example.

I’m just musing out loud here. At the end of the day, FFP is 100% correct: the more multidisciplinary your training, the better.

 

[MoMoGesiologist]

I have a ton of respect for the internists at my hospital- I did a IM internship and have always been awed by the depth of their knowledge and systematic approach to breaking down a patient. Makes it all the more confusing when then routinely do such boneheaded things, like send me a patient on 15 of norepi 24 hours after a PCI for a fairly large MI with no arterial line. And I’m 100% certain they have equivalent complaints about mistakes we routinely make that are obvious to them. It’s just so interesting how our base training influences these things.

This is an oversimplification, but in my experience surgical/anesthesia/EM intensivists are much better when a patient is acutely trying to die- they can’t necessarily recite the textbook chapter on the relevant disease, but they know how to manage the immediatelife-threatening effects. IM trained CC docs really seem to shine in more chronic critical illness where the picture is complex and there problem is more diagnostic in nature. I’m thinking obscure presentations of certain cancers, for example.

I’m just musing out loud here. At the end of the day, FFP is 100% correct: the more multidisciplinary your training, the better.

I honestly find it annoying how quick anesthesia/surgery are to place aline and central line. Where I am, if a pt is on one low dose pressor, they get lined up, even if you know it’s temporary and they’ll leave icu in a day or two. If you don’t line them up, you get snide remarks about how the other icu docs are so good and always place lines, as though somehow more lines is a therapeutic intervention. Just offering a differing perspective (coming from someone who loves placing lines, just doesn’t see the point when it’s not changing my management)

 

[deleted547339]

I honestly find it annoying how quick anesthesia/surgery are to place aline and central line. Where I am, if a pt is on one low dose pressor, they get lined up, even if you know it’s temporary and they’ll leave icu in a day or two. If you don’t like them up, you get snide remarks about how the other icu docs are so good and always place lines, as though somehow more lines is a therapeutic intervention. Just offering a differing perspective (coming from someone who loves placing lines, just doesn’t see the point when it’s not changing my management)

As a resident, I felt like I needed a CVL and A-line on anyone sort of sick. Now, as faculty, I almost never place (or have my fellows place) a-lines. You just don’t see the rapid hemodynamics swings in the MICU that you do in the OR.

 

[vector2]

I honestly find it annoying how quick anesthesia/surgery are to place aline and central line. Where I am, if a pt is on one low dose pressor, they get lined up, even if you know it’s temporary and they’ll leave icu in a day or two. If you don’t like them up, you get snide remarks about how the other icu docs are so good and always place lines, as though somehow more lines is a therapeutic intervention. Just offering a differing perspective (coming from someone who loves placing lines, just doesn’t see the point when it’s not changing my management)

Agree that lines in general are overused, but I still like a-lines because they're relatively low risk and they prevent the nurse from disbelieving the cuff pressure, trying a different arm, trying the leg, changing cuffs, aka spending an hour farting around while the pt malperfuses brain, heart, kidneys.

Overall, minimalism is the way to go, but we've swung so far that there are pts who go 2 weeks without a repeat CXR even though they've recently deteriorated and have 2-3 days worth of worsening hypoxia, or pts with undifferentiated mixed shock and a heart history who don't get a swan because some guy heard from his guru 5 yrs ago that all swans are bad.

 

[dchz]

pts with undifferentiated mixed shock and a heart history who don't get a swan because some guy heard from his guru 5 yrs ago that all swans are bad.

I agree with pretty much everything yous aid, but what's a swan gonna tell you that a TTE probe won't? I personally like swans too...

 

[MoMoGesiologist]

Agree that lines in general are overused, but I still like a-lines because they're relatively low risk and they prevent the nurse from disbelieving the cuff pressure, trying a different arm, trying the leg, changing cuffs, aka spending an hour farting around while the pt malperfuses brain, heart, kidneys.

Overall, minimalism is the way to go, but we've swung so far that there are pts who go 2 weeks without a repeat CXR even though they've recently deteriorated and have 2-3 days worth of worsening hypoxia, or pts with undifferentiated mixed shock and a heart history who don't get a swan because some guy heard from his guru 5 yrs ago that all swans are bad.

I like PA catheters as well, but issue is I won’t be only person looking at those numbers in SICU. Get ready for surgeon to come by and tell you how to manage patient for mixed shock based on their interpretation...

 

[AdmiralChz]

I like PA catheters as well, but issue is I won’t be only person looking at those numbers in SICU. Get ready for surgeon to come by and tell you how to manage patient for mixed shock based on their interpretation...

“Hmmm urine output is dropping. Let’s start some renal dose dopamine.”

 

[vector2]

I agree with pretty much everything yous aid, but what's a swan gonna tell you that a TTE probe won't? I personally like swans too...

I like PA catheters as well, but issue is I won’t be only person looking at those numbers in SICU. Get ready for surgeon to come by and tell you how to manage patient for mixed shock based on their interpretation...

Like many things in the hospital, it comes down to your staffing model. Open ICU with surgeons and it could get wild when looking at a swan. But other than myself, my SICU has pretty much zero people who have any facility with a TTE probe (other than for a qualitative assessment of whether the pt is at cardiac standstill). Even worse are the few who have taken a basic POCUS course who slap the probe on the chest for 5 seconds and go "oh yea looks good" even though they only looked at one view and have no idea what the depth marker or normal RV/LV dimensions or a VTI or IVC plethora are.

Regardless, say even if I am staff, the swan is still helpful in certain situations. If a pt is borderline hypoperfusing, it is the gold standard for cardiac output. If the pt has concomitant pHTN, cant beat actually knowing the PAs vs derived TR RVSP. And more and more data keeps coming out validating the utility of PAPi and CPO. Above all, it is a continuous monitor, not a spot check, and it doesn't suffer the same interobserver variability as echo.

Furthermore, at some point I gotta go home (I am an anesthesiologist after all) and I'll have to rely on the bedside nurse or a resident. If the pt's UOP has dropped off, I can't exactly go tell the nurse to get me three views of the RV and tell me whether the function is now severely reduced from moderately reduced, can I? OTOH, nurse can tell me over the last 3 hrs the sPAP down 10, dPAP up 10, CI now 1.8, CVP rising, and remotely I have gained the information I need.

 

[deleted547339]

Like many things in the hospital, it comes down to your staffing model. Open ICU with surgeons and it could get wild when looking at a swan. But other than myself, my SICU has pretty much zero people who have any facility with a TTE probe (other than for a qualitative assessment of whether the pt is at cardiac standstill). Even worse are the few who have taken a basic POCUS course who slap the probe on the chest for 5 seconds and go "oh yea looks good" even though they only looked at one view and have no idea what the depth marker or normal RV/LV dimensions or a VTI or IVC plethora are.

Regardless, say even if I am staff, the swan is still helpful in certain situations. If a pt is borderline hypoperfusing, it is the gold standard for cardiac output. If the pt has concomitant pHTN, cant beat actually knowing the PAs vs derived TR RVSP. And more and more data keeps coming out validating the utility of PAPi and CPO. Above all, it is a continuous monitor, not a spot check, and it doesn't suffer the same interobserver variability as echo.

Furthermore, at some point I gotta go home (I am an anesthesiologist after all) and I'll have to rely on the bedside nurse or a resident. If the pt's UOP has dropped off, I can't exactly go tell the nurse to get me three views of the RV and tell me whether the function is now severely reduced from moderately reduced, can I? OTOH, nurse can tell me over the last 3 hrs the sPAP down 10, dPAP up 10, CI now 1.8, CVP rising, and remotely I have gained the information I need.

Meh. Lotta ways to skin a cat. I trained with them but don’t use them outside of bad PH/R heart or mega fat and unclear shock etiology.

And I would push back a bit about needing quantitative echo. I can do a Tapse, etc, but I really think that 95+% of what I need to know that can be learned from the patients heart I can get from qualitative observations - I can tell you if the LV is moderately or severely reduced, and that’s usually enough. I can tell you if the RV is struggling or not. I can tell if valves are critically stenosed or wide open. I can tell you if there’s spontaneous contrast anywhere. I can comment on the ivc or hepatic veins. That’s fairly rudimentary and can be done with just color; but it answers most of what I need.

 

[deleted171991]

Like many things in the hospital, it comes down to your staffing model. Open ICU with surgeons and it could get wild when looking at a swan. But other than myself, my SICU has pretty much zero people who have any facility with a TTE probe (other than for a qualitative assessment of whether the pt is at cardiac standstill). Even worse are the few who have taken a basic POCUS course who slap the probe on the chest for 5 seconds and go "oh yea looks good" even though they only looked at one view and have no idea what the depth marker or normal RV/LV dimensions or a VTI or IVC plethora are.

Regardless, say even if I am staff, the swan is still helpful in certain situations. If a pt is borderline hypoperfusing, it is the gold standard for cardiac output. If the pt has concomitant pHTN, cant beat actually knowing the PAs vs derived TR RVSP. And more and more data keeps coming out validating the utility of PAPi and CPO. Above all, it is a continuous monitor, not a spot check, and it doesn't suffer the same interobserver variability as echo.

Furthermore, at some point I gotta go home (I am an anesthesiologist after all) and I'll have to rely on the bedside nurse or a resident. If the pt's UOP has dropped off, I can't exactly go tell the nurse to get me three views of the RV and tell me whether the function is now severely reduced from moderately reduced, can I? OTOH, nurse can tell me over the last 3 hrs the sPAP down 10, dPAP up 10, CI now 1.8, CVP rising, and remotely I have gained the information I need.

The problem with the PAC is that it's VERY dangerous in the hands of the uneducated. Like CVP or IVC collapsibility etc. Most people don't understand its limitations (and the limitations of treating ANYTHING based on unreliable numbers). So they end up chasing numbers and hurting patients. Just look at the harm surgeons and bad intensivists do to patients while chasing the friggin' urine output, as if people should make 1 ml/kg/hr all day long.

Most people don't know what's dogma and what's really evidence-based in the books they read. So they end up applying the dogma and harming patients. For example, most people don't know that the PCWP usually underestimates the LVEDP (hence a normal PCWP may not mean ****), or that fluid overload/diastolic dysfunction can make PAC numbers look EXACTLY like systolic LV failure (high PA pressures, high PCWP, low CO). Or that the main cause of RV failure is chronic LV failure, which may or may not show up as an increased PCWP (hence they think it's cor pulmonale). Most of them have no idea of West zones, how to properly confirm the PAC location or properly measure a PCWP. Hence they rely on inaccurate numbers to make major therapeutic decisions.

There is a lot of bad knee-jerk medicine in places that regularly use PACs, hence the worse outcomes associated with its use. And that's why I don't float Swans, as much as I love having CO numbers, because I cannot be there all the time to prevent harm.

 

[vector2]

Meh. Lotta ways to skin a cat. I trained with them but don’t use them outside of bad PH/R heart or mega fat and unclear shock etiology.

Yea, that's pretty much what I said....swans have some selective utility.

And I would push back a bit about needing quantitative echo. I can do a Tapse, etc, but I really think that 95+% of what I need to know that can be learned from the patients heart I can get from qualitative observations - I can tell you if the LV is moderately or severely reduced, and that’s usually enough. I can tell you if the RV is struggling or not. I can tell if valves are critically stenosed or wide open. I can tell you if there’s spontaneous contrast anywhere. I can comment on the ivc or hepatic veins. That’s fairly rudimentary and can be done with just color; but it answers most of what I need.

If you can indeed do all those things accurately then I wouldn't really classify your skills as rudimentary. You may have trained yourself up out in practice to do what is exactly on par with what I would expect from newer EM grads and various CCM fellows given the much better POCUS education nowadays. However, there are many surgery and pulm/IM trained CC who have been out a few years who have crazy variability in their POCUS skills. If you have put in many dozens or hundreds of POCUS reps during your training or out in practice under supervision from an experienced echocardiographer and done the requisite studying, then you very well may have honed your eye to the point where your qualitative assessment gels pretty well with a quantitative exam. Expert level echocardiographers got to that "I have a really good eyeball" level because they went through the rigor of checking that eyeball against a quantitative measurement earlier in their training. More often than not in my experience though, people who know a bit of POCUS never actually learned the fundamentals of what they're doing or the importance of quality control.

Many times they don't know that one can/should bump the patient onto their left side to improve image quality. They make errors like foreshortening the ventricle in a 4ch or scanning a bit too apically in a LV mid-pap SAX and thus qualitatively overestimating function. They don't know that the LV dimension in diastole is the important part for diagnosing hypovolemia vs. low afterload, not whether the papillaries are kissing in systole. They undercall mild-moderate RV enlargement because they haven't seen enough normals and abnormals. They miss RWMAs because their exam didn't capture all the coronary distributions. They don't know that an incorrectly set Nyquist limit can cause one to severely over- or underestimate valvular lesions when using color-flow doppler. They don't know that overgaining can turn normal blood flow into SEC. They don't know or forget that PPV severely limits the specificity of IVC collapse. They can't tell the difference between a pericardial or pleural effusion in a PLAX. Etc etc etc.

It really is one of those "a little bit of knowledge can be dangerous" situations....

 

[vector2]

The problem with the PAC is that it's VERY dangerous in the hands of the uneducated. Like CVP or IVC collapsibility etc. Most people don't understand its limitations (and the limitations of treating ANYTHING based on unreliable numbers). So they end up chasing numbers and hurting patients. Just look at the harm surgeons and bad intensivists do to patients while chasing the friggin' urine output, as if people should make 1 ml/kg/hr all day long.

Most people don't know what's dogma and what's really evidence-based in the books they read. So they end up applying the dogma and harming patients. For example, most people don't know that the PCWP usually underestimates the LVEDP (hence a normal PCWP may not mean ****), or that fluid overload/diastolic dysfunction can make PAC numbers look EXACTLY like systolic LV failure (high PA pressures, high PCWP, low CO). Or that the main cause of RV failure is chronic LV failure, which may or may not show up as an increased PCWP (hence they think it's cor pulmonale). Most of them have no idea of West zones, how to properly confirm the PAC location or properly measure a PCWP. Hence they rely on inaccurate numbers to make major therapeutic decisions.

There is a lot of bad knee-jerk medicine in places that regularly use PACs, hence the worse outcomes associated with its use. And that's why I don't float Swans, as much as I love having CO numbers, because I cannot be there all the time to prevent harm.

As I implied to MoMo, I would definitely think twice about a swan if it's to be used in an open ICU or any situation where anyone other than you or someone else you trust will have any power over the decision making.

Also, I wedge pretty much never.

 

[chocomorsel]

“Hmmm urine output is dropping. Let’s start some renal dose dopamine.”

Yeah last week I was in the Unit and in one of our many codes, my patient ended up on dopamine. I missed the code because I was in another unit. My colleague texted me that my patient had just coded and she was now on dopamine. I literally asked the nurse when I got up there “who uses dopamine anymore”?

Anyway, when I saw the patients she was already gone. Dopamine wasn’t gonna fix her situation.

Some people love dopamine. Some people love Swans.

 

[dchz]

ALL people love dopamine.

 

[chocomorsel]

Haha. Not in that euphoric sense. It's not my go to drug and I hardly see it used. Maybe you cardiac people use it more.

 

[MoMoGesiologist]

Is it safe to give DA peripheral? That’s what I was taught in residency but I’ve also read different. I like it for RV dysfunction... a lil chronotropy, inotropy, diuresis...

 

[chocomorsel]

Is it safe to give DA peripheral? That’s what I was taught in residency but I’ve also read different. I like it for RV dysfunction... a lil chronotropy, inotropy, diuresis...

When do you use Dopamine? Never mind. Just seen your edit.

 

[dchz]

Is it safe to give DA peripheral? That’s what I was taught in residency but I’ve also read different. I like it for RV dysfunction... a lil chronotropy, inotropy, diuresis...

It's safe to give any drug in a peripheral. You just have to know it's in the vein and not in subcutaneous tissue.

 

[AdmiralChz]

Is it safe to give DA peripheral? That’s what I was taught in residency but I’ve also read different. I like it for RV dysfunction... a lil chronotropy, inotropy, diuresis...

Diuresis isn’t helpful though and many studies show dopamine not only does not help prevent AKI but can cause it. Dopamine has a fairly narrow therapeutic window and you can get some wild arrhythmias/tachycardia at higher doses. Ive seen it several times during heart procedure ends where the OPO will let you use only dopamine as a vasoactive. We’ve had to shock the heart twice due to rapid, unstable a fib. Not great.

Dobutamine, Milrinone and even epinephrine are all better RV drugs depending on the clinical situation.

 

[BIGphysician]

Thinking of applying to some of these CCM fellowships that didn’t match. Why is Stanford not matching to capacity consistently every year? They sent me a pack to fill out that would choke a horse- anyone with any experience on the inside of Stanford, mt Sinai, etc. what are the good programs?


Sent from my iPhone using Tapatalk

 

[Nivens]

Thinking of applying to some of these CCM fellowships that didn’t match. Why is Stanford not matching to capacity consistently every year? They sent me a pack to fill out that would choke a horse- anyone with any experience on the inside of Stanford, mt Sinai, etc. what are the good programs?


Sent from my iPhone using Tapatalk

I have zero insight into Stanford's program specifically, but as a general explanatory principle there simply aren't enough applicants to CC to fill the spots nationally, so even places with solid reputations/brand names struggle to fill. Again- *general* principle- I am sure places with legendary CC fellowships fill every year, but these are the exception rather than the rule. I would be much more concerned about a CT or Pain fellowship that consistently didn't fill than a CC fellowship, just given the ratio of applicants:spots in those subspecialties.

 

[deleted171991]

Anesthesiology-CCM fellowships don't remain unfilled because they are not good. They are usually heads above any community-based Pulm-CCM fellowship, and many academic ones.

The reason the anesthesia programs don't fill is because there are very few combined jobs for fellowship grads, and even 100% CCM jobs are not easy to find. A CCM fellowship is almost like switching to a different specialty (except a specialty that's turfed out to surgeons and internists). It can be a royal waste of time and money. One should do it out of passion, not calculation (the latter is how bad intensivists are made, the kind that stop reading when they graduate).

 

[chocomorsel]

Thinking of applying to some of these CCM fellowships that didn’t match. Why is Stanford not matching to capacity consistently every year? They sent me a pack to fill out that would choke a horse- anyone with any experience on the inside of Stanford, mt Sinai, etc. what are the good programs?


Sent from my iPhone using Tapatalk

I believe Stanford is truly multidisciplinary and you get good training there. Some of my attendings went there and one was a neurologist working in the NICU. Smart as hell. They take a lot of call looks like.

 

[deleted171991]

I believe Stanford is truly multidisciplinary and you get good training there. Some of my attendings went there and one was a neurologist working in the NICU. Smart as hell. They take a lot of call looks like.

Call is educational (a good number would be 60/year), as long as the attending is not in-house, babysitting the fellow.

ICU patients have a tendency to decompensate after business hours, plus the fellow needs to learn how to deal with consults and OSH transfers.

Stanford is known as a great multidisciplinary program, probably the best in the area.

 

[chocomorsel]

Call is educational (a good number is 60/year), as long as the attending is not in-house, babysitting the fellow.

ICU patients have a tendency to decompensate after business hours, plus the fellow needs to learn how to deal with consults and OSH transfers.

I understand. Completely. But I was too old to be doing Q4 call when I went back. Didn’t like it when I was in my 20s and certainly don’t like it now.
But I have never claimed to be a superstar.

 

[deleted171991]

I understand. Completely. But I was too old to be doing Q4 call when I went back. Didn’t like it when I was in my 20s and certainly doing like it now.
But I have never claimed to be a superstar.

I was just adding to your post, not criticizing it.

I myself went to a relatively cushy place, when compared to some big places (like Columbia), because I didn't want to get a heart attack during my fellowship. Still, it was good that we had at least 50-60 (possibly more) "independent" in-house calls during that year, because I learnt a lot during them.

Unfortunately, this is a world in which people get all excited about worthless (to me) brands, and not about board scores, professional knowledge/skills and individual qualities (such as passion). I say worthless to me, because I have worked with enough people from fancy-shmancy places to know that most brands don't mean crap nowadays. But, in the real world, it's good to have a Stanford-level name on one's diploma, especially if one's name sounds foreign.

 

[chocomorsel]

I was just adding to your post, not criticizing it.

I myself went to a relatively cushy place, when compared to some big places (like Columbia), because I didn't want to get a heart attack during my fellowship. Still, it was good that we had at least 50-60 (possibly more) "independent" in-house calls during that year, because I learnt a lot during them.

Unfortunately, this is a world in which people get all excited about worthless (to me) brands, and not about board scores, professional knowledge/skills and individual qualities (such as passion). I say worthless to me, because I have worked with enough people from fancy-shmancy places to know that most brands don't mean crap nowadays. But, in the real world, it's good to have a Stanford-level name on one's diploma, especially if one's name sounds foreign.

Didn’t take it as criticism at all.
I just wish there would be a 12 hour night call week situation instead of 24 hour call every few days which I find cruel and inhumane.
Not to mention unsafe.

 

[deleted171991]

Didn’t take it as criticism at all.
I just wish there would be a 12 hour night call week situation instead of 24 hour call every few days which I find cruel and inhumane.
Not to mention unsafe.

We had night float, so only the weekend calls were 24 hours.

 

[BIGphysician]

I understand. Completely. But I was too old to be doing Q4 call when I went back. Didn’t like it when I was in my 20s and certainly don’t like it now.
But I have never claimed to be a superstar.

Q4 call at that place for a year, I can see that wearing you down. Especially if you’re already board certified and have been out in practice for a few years. And sacrificing like 250k to be there. Sounds like an amazing experience and nice for your resume but I bet you can have an equally rewarding experience elsewhere that is a little less demanding with the schedule? Just thinking aloud.


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[Sushirrit0]

Thinking of applying to some of these CCM fellowships that didn’t match. Why is Stanford not matching to capacity consistently every year? They sent me a pack to fill out that would choke a horse- anyone with any experience on the inside of Stanford, mt Sinai, etc. what are the good programs?


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Hi - this doesn’t explain why they didn’t fill this cycle, but the spots available for this July were recently added - I think this is due to Stanford being approved for more fellowspots recently (new hospital, more beds, etc). PD on int day said this year they have 12 spots total, up from I think 10.

 

[Steege305]

This was a weird year for fellowships. Probably the zoom interviews and people wanting to stay closer to home.