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critical care
Started by scortch77
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You would probably be better off posting this in Gen Res Issues because EM is not the usual track for doing critical care. The usual way is to do a residency in IM, Anes or surgery and then do a fellowship in critical care. According to the SAEM web page U of Maryland will let you do a CC fellowship after an EM residency but I don't know if that gets you boarded.
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D
deleted6669
there is also a 6 year EM/IM/CC residency out there somewhere that results in triple board certification. I forget where it is( pitt maybe) but check on frieda (the ama residency site) to track it down
There are a number of programs that will take EM grads as fellows, but I was under the impression that you could not sit for the boards unless you are certified in IM or any other board eligible specialty (i.e. anesthesia). EM is not board eligble given some politics back in the days of EM's birth as a boarded specialty; though if you as me I think we should be since most critical patients come in through the ED. I think that there are a number of IM/EM grads that can tell you more; kgunner comes to my mind.
The big programs that I know that accept EM grads are
1. Maryland (shock trauma/CC)
2. U Pitt.
3. I think that Rush in Chicago also takes EM grads, but not sure on this.
Regardless of being board certified/eligible; EM trained fellows that graduate in CC tend to do very well. The biggest guru that comes to mind is Alan Tuttle.
The big programs that I know that accept EM grads are
1. Maryland (shock trauma/CC)
2. U Pitt.
3. I think that Rush in Chicago also takes EM grads, but not sure on this.
Regardless of being board certified/eligible; EM trained fellows that graduate in CC tend to do very well. The biggest guru that comes to mind is Alan Tuttle.
D
deleted6669
I CHECKED, IT'S IN DETROIT...
Henry Ford Hospital Program
Identifier: 775-25-44-001
Specialty: Internal Medicine/Emergency Medicine/Critical Care Medicine
Basic Information
Last updated: 04/30/2003
Survey received: not yet received
Program Director:
David Portelli, MD
Henry Ford Hosp and Med Ctr
2799 W Grand Blvd
Detroit, MI 48202-2689 Tel: (313) 916-1553
Fax: (313) 916-7437
E-mail: [email protected]
Web Address:
Program Co-Director:
John Buckley, MD
Henry Ford Hospital Program
Identifier: 775-25-44-001
Specialty: Internal Medicine/Emergency Medicine/Critical Care Medicine
Basic Information
Last updated: 04/30/2003
Survey received: not yet received
Program Director:
David Portelli, MD
Henry Ford Hosp and Med Ctr
2799 W Grand Blvd
Detroit, MI 48202-2689 Tel: (313) 916-1553
Fax: (313) 916-7437
E-mail: [email protected]
Web Address:
Program Co-Director:
John Buckley, MD
Hi all,
You can see similar postings discussing this in the EM/IM discussion and an earlier post on CCM in this forum.
Just a few clarifications:
1. As of now, there is no way a categorical EM resident can be board certified by an American board in CCM. The only tracks to certification are Peds, IM, Surgery, and Anesth. You can take the European boards, which many do, if you complete a 2 yr. CCM program. This will NOT hurt you. You can still get a great job.
2. There are several programs who will take EM trained residents. Please see an almost complete list we put together in the ACEP CCM section as well as FAQ:
http://www.acep.org/1,4252,0.html
You can also visit our website and look under education at:
http://www.ccm.upmc.edu
3. The best place to do a rotation, if you are interested in pursuing CCM, is the Univ. of Pittsburgh. Without a doubt, you will get more support from the biggest names in critical care, Mitch Fink, Michael Pinsky, John Kellum, Derek Angus, Paul Rogers (they will become more familiar when you start really reading the CCM literature).
4. The biggest guru is by far Manny Rivers at Henry Ford Hospital. He has single handedly changed the face of critical care and emergency medicine from his recently published manuscript in New England Journal of Medicine, Nov. 2001, Early Goal Directed Therapy in Severe Sepsis and Septic Shock. He also trained Alan Tuttle (and me) as well as a few other well known EM guys (Frank McGeorge - PD at Beaumont, Doug Ander and Leon Haley at Emory) just to name a few.
5. The EM/IM/CCM thing is official on paper, but I'm not sure if any programs are geared up and funded yet. Pittsburgh is not. There is no funding as of today. Ford will support you, but you have to petition the ABMS after being accepted in the EM/IM program. So far one resident (4th yr) is doing this. Most places that have an EM/IM program and a CCM program will allow you to develop a 6th yr CCM "fellowship" and then you can petition the ABMS to sit for the boards. Steve Treziak at Cooper in NJ did that while he was at UIC.
6. I would highly suggest any EM resident out there contact me or anyone of the mentors listed on the ACEP website for further guidance and DO NOT let anyone discourage you from pursuing this if this is what you want to do. There are enough of us out there to really start making a difference.
Good luck,
Kyle
You can see similar postings discussing this in the EM/IM discussion and an earlier post on CCM in this forum.
Just a few clarifications:
1. As of now, there is no way a categorical EM resident can be board certified by an American board in CCM. The only tracks to certification are Peds, IM, Surgery, and Anesth. You can take the European boards, which many do, if you complete a 2 yr. CCM program. This will NOT hurt you. You can still get a great job.
2. There are several programs who will take EM trained residents. Please see an almost complete list we put together in the ACEP CCM section as well as FAQ:
http://www.acep.org/1,4252,0.html
You can also visit our website and look under education at:
http://www.ccm.upmc.edu
3. The best place to do a rotation, if you are interested in pursuing CCM, is the Univ. of Pittsburgh. Without a doubt, you will get more support from the biggest names in critical care, Mitch Fink, Michael Pinsky, John Kellum, Derek Angus, Paul Rogers (they will become more familiar when you start really reading the CCM literature).
4. The biggest guru is by far Manny Rivers at Henry Ford Hospital. He has single handedly changed the face of critical care and emergency medicine from his recently published manuscript in New England Journal of Medicine, Nov. 2001, Early Goal Directed Therapy in Severe Sepsis and Septic Shock. He also trained Alan Tuttle (and me) as well as a few other well known EM guys (Frank McGeorge - PD at Beaumont, Doug Ander and Leon Haley at Emory) just to name a few.
5. The EM/IM/CCM thing is official on paper, but I'm not sure if any programs are geared up and funded yet. Pittsburgh is not. There is no funding as of today. Ford will support you, but you have to petition the ABMS after being accepted in the EM/IM program. So far one resident (4th yr) is doing this. Most places that have an EM/IM program and a CCM program will allow you to develop a 6th yr CCM "fellowship" and then you can petition the ABMS to sit for the boards. Steve Treziak at Cooper in NJ did that while he was at UIC.
6. I would highly suggest any EM resident out there contact me or anyone of the mentors listed on the ACEP website for further guidance and DO NOT let anyone discourage you from pursuing this if this is what you want to do. There are enough of us out there to really start making a difference.
Good luck,
Kyle
Kyle- Thanks great info!
My understanding is that there are some EM/IM/CCM programs on the books but no one anywhere has actually put anyone through the program yet. Is that true?
Another off topic ?. The Rivers sepsis study used a particular kind of CVP monitor to determine fluid reqs. I've heard other EM people say that they want to implement a sepsis pathway based on this but they need funding for the transducers. I would think that any CVP monitor would work. Do you really need a particular kind of CVP monitor?
And when is someone going to put together an EM/IM/Peds/CCM/Surgery/Law/Accounting/Animal Husbandry program?😉
My understanding is that there are some EM/IM/CCM programs on the books but no one anywhere has actually put anyone through the program yet. Is that true?
Another off topic ?. The Rivers sepsis study used a particular kind of CVP monitor to determine fluid reqs. I've heard other EM people say that they want to implement a sepsis pathway based on this but they need funding for the transducers. I would think that any CVP monitor would work. Do you really need a particular kind of CVP monitor?
And when is someone going to put together an EM/IM/Peds/CCM/Surgery/Law/Accounting/Animal Husbandry program?😉
My theory on the number of board certifications and degrees is much like that of the theory of the number of cats one has... the more you have above 2, the weirder you are!
But seriously, being proficient in 3 medical disciplines is not impossible, but certainly not an easy task!
But seriously, being proficient in 3 medical disciplines is not impossible, but certainly not an easy task!
Really any central line will work. When we first started the trial, back in 1996 or so, we were just aspirating samples from the distal port. We then had some interest in developing a fiberoptic continous catheter from Baxter. We went through many different proto-types. It was fun trying these out. Some worked better than others. Edwards Lifesciences merged with Baxter and took the lead in developing this. We had a fully functional continuous model by about 1999. The same monitor is used with their PA caths. Now we have a full fledged CVP line called the "Edwards PreSep Central Venous Oximetry Catheter", you can find this on their website www.edwards.com. It gives you continous ScvO2 readings.
You don't need this to manage your patients, it just makes it easier. You can aspirate blood and run an ABG every 30 min to make sure your therapy is going in the right direction. A femoral line will NOT work. It needs to be either in the right atrium or in the very distal SVC.
Hope this helps.
Kyle
You don't need this to manage your patients, it just makes it easier. You can aspirate blood and run an ABG every 30 min to make sure your therapy is going in the right direction. A femoral line will NOT work. It needs to be either in the right atrium or in the very distal SVC.
Hope this helps.
Kyle
Since EM/IM/CCM is a 6 year program and was only approved in 2001, nobody has gone through it yet. I'm not sure if there are any 1st years enrolled in any of the programs. I know Pitt does not have anyone yet and Ford has an EM/IM 4th year who has transitioned over to the 6 yr. program. I bet you'll see more of the later as this takes form. It is really asking a lot out of a fresh med school grad to commit 6 yrs to a new triple board program. It really is a very long haul, and you need to be very dedicated and know this is what you want to do. So I expect you'll have more people jumping over to it later in their residency training after they have had more exposure.
About degrees. I must be nuts because I'm going for my masters in research design next.
Kyle 😱
About degrees. I must be nuts because I'm going for my masters in research design next.
Kyle 😱
Kyle:
For a straight EM residency graduate who is thinking of doing a critical care fellowship, what things should he/she do to be competitive among a field of surgical and medical applicants?
Is it better to have gone through a university-based program rather than a community-based one? A four-year program versus a three year one? What "numbers" will they be looking at (e.g. in-service exam percentages)?
I would imagine that research, especially critical care based, can certainly help your chances.
For a straight EM residency graduate who is thinking of doing a critical care fellowship, what things should he/she do to be competitive among a field of surgical and medical applicants?
Is it better to have gone through a university-based program rather than a community-based one? A four-year program versus a three year one? What "numbers" will they be looking at (e.g. in-service exam percentages)?
I would imagine that research, especially critical care based, can certainly help your chances.
To make yourself a strong candidate, probably the best thing possible is to show a dedication to critical care. Since you are taking a non-traditional route, there will be detractors. You have to be strong in your convictions and relay that in your interviews. If you apply to Pitt, you will get an interview. We actively seek out ED grads. We have the largest program in the world, up to 20 fellows in the first year class and usually a total of 25-28 fellows total, we always interview ED grads and they all usually score highly during our interviews. Research will be a bonus. Not necessarily focused on critical care. High board scores are impressive, but won't help you if you come across as a lazy doorknob in your interview. Our interviews are comparable to the ED interview process in general. We have an extremely busy fellowship and you need to know to work hard and learn about critical care. I know Shock Trauma in Baltimore can take up to 4 ED grads/year. It is only a 1 yr program, so my advice would arrange a research year after this so you can get credit and sit for the European boards.
If anybody has any other questions that you don't want to post, just drop me an email at my address below anytime.
Good luck
Kyle
If anybody has any other questions that you don't want to post, just drop me an email at my address below anytime.
Good luck
Kyle
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