EM/CC questions

[sanityonleave]

Alright, so here's the story -- I'm a third year student applying in EM with a very strong interest in critical care / plan to do a fellowship after EM (not sure re: CCM/surgical, leaning surgical). Eventually, I'd ideally like to split time between the ED and ICU environments, though I don't know how doable that is. There has been a lot of information posted given all the excitement over the last 12 months with regard to new board certification, but I didn't see a lot about how to specifically evaluate programs with regard to CC.

My questions:

How do I go about figuring out if an EM program has a strong critical care aspect / interest? Are there any programs that are known for being very strong in CC?

Second, for residents/fellows/attendings, how well do you feel your EM residency prepared you if you were to do a CC fellowship? Any aspects of your training that you felt were lacking from that perspective?


I apologize of these questions have been asked before, but despite quite a few threads on EM-->CC over the last year I didn't see a lot of information on this. Thanks in advance for the responses!

---

Members don't see this ad.

 

[EMquest3]

Alright, so here's the story -- I'm a third year student applying in EM with a very strong interest in critical care / plan to do a fellowship after EM (not sure re: CCM/surgical, leaning surgical). Eventually, I'd ideally like to split time between the ED and ICU environments, though I don't know how doable that is. There has been a lot of information posted given all the excitement over the last 12 months with regard to new board certification, but I didn't see a lot about how to specifically evaluate programs with regard to CC.

My questions:

How do I go about figuring out if an EM program has a strong critical care aspect / interest? Are there any programs that are known for being very strong in CC? For instance, I know in my home program the EM residents don't rotate in the SICU or TBICU, but only in the MICU, which to me would be a negative from a CC perspective.

Second, for residents/fellows/attendings, how well do you feel your EM residency prepared you if you were to do a CC fellowship? Any aspects of your training that you felt were lacking from that perspective?


I apologize of these questions have been asked before, but despite quite a few threads on EM-->CC over the last year I didn't see a lot of information on this. Thanks in advance for the responses!

Just from the interview trail I can say that U Mich. has a huge CC focus. The new chair there is basically building a 5 bed ICU in the ED IIRC.

 

[Old_Mil]

My advice would be this: the only decision you should be making now is whether you want a 3 year or 4 year program, whether you like teaching and want an academic career or not, and what part of the country you want to be in. So many things will happen during residency that will radically alter what sort of fellowship you want to pursue - or even if you want to pursue one - that this is a bit like a 1st year medical student picking a specialty after 1 semester.

Go where you think you will be happy for the next few years and you like the people.

 

[Old_Mil]

..

 

[RandomChaos]

Ones that i saw with big CC focus, Indiana, Henry Ford, U Pitt, U Maryland, Christ, U Iowa and U Rochester all were sending seniors into CC fellowships.


heres some good info

http://emcrit.org/critical-care-fellowship-faq/

and heres a link of the ones that are known for taking EM peeps

http://www.emccmfellowship.org/programs.php

 

[namethatsmell]

I think Northwestern has the most unit time of any program -- about 10 months and most residents seem to rave about the experience they get.

Agree with Maryland and Pitt also having very strong CC experiences.

 

[dotcb]

My advice would be this: the only decision you should be making now is whether you want a 3 year or 4 year program, whether you like teaching and want an academic career or not, and what part of the country you want to be in. So many things will happen during residency that will radically alter what sort of fellowship you want to pursue - or even if you want to pursue one - that this is a bit like a 1st year medical student picking a specialty after 1 semester.

Go where you think you will be happy for the next few years and you like the people.

Agree with this poster.

Add programs UNM, Wash U, UCSF, Cinci, Cooper, BIDMC, MGH, UAB, Stanford, U Arizona - where they either have a fellowship, CCM faculty on EM staff, or are sending seniors into CCM. There are more, but those are off the top of my head.

If there's a chance you may just do EM or another fellowship, go where you think you'll get the best training and be happy during residency.

If you're dead-set on doing CCM, I'd go to the best program, and prolly 3 years, where you can do CCM at the same site without having to move again. That is very difficult to predict and count on though and I wouldn't stress out about it too much.

I spent 3 years of my 4 year residency debating whether to do a CCM fellowship. I felt very prepared, but ultimately decided not to do it. I still toy with the idea from time to time, but I'm also very happy practicing EM, without a pager, doing shifts, for similar pay, with my hands in critical care as it pertains to the ED.

 

[emergiQ]

Agree with this poster.

Add programs UNM, Wash U, UCSF, Cinci, Cooper, BIDMC, MGH, UAB, Stanford, U Arizona - where they either have a fellowship, CCM faculty on EM staff, or are sending seniors into CCM. There are more, but those are off the top of my head.

If there's a chance you may just do EM or another fellowship, go where you think you'll get the best training and be happy during residency.

If you're dead-set on doing CCM, I'd go to the best program, and prolly 3 years, where you can do CCM at the same site without having to move again. That is very difficult to predict and count on though and I wouldn't stress out about it too much.

I spent 3 years of my 4 year residency debating whether to do a CCM fellowship. I felt very prepared, but ultimately decided not to do it. I still toy with the idea from time to time, but I'm also very happy practicing EM, without a pager, doing shifts, for similar pay, with my hands in critical care as it pertains to the ED.

University of Utah has EM-trained intensivists working in the SICU, NeuroICU, and CancerICU. No dedicated fellowship yet.... but plenty of unit time for the residents, dedicated critical care conference hour once per month, and a commitment to growing this aspect of the residency program.

In terms of fellowship training, look where you can get experience in lots of different units. Do them all - Neuro, surgical, medical... there are W-A-Y more similarities then differences, but the places that let you rotate through them all generally have a more collaborative environment. If the attendings actually staff in multiple units, this is a good thing... and if they have common critical care grand rounds, journal clubs, etc. where various representatives from different units can co-exist amicably, you've hit the jackpot.

 

[fahimaz7]

All the EM residencies in the country have to have at least 5 ICU rotations now. With that said, I don't think it matters where you go, unless you are set to practice in a particular place when you get out. I'm looking at critical care myself, and after doing ~15 interviews I feel that at least 10 of them would set me up really well for an CC fellowship.

Lots of paths to get to the same goal.

 

[RustedFox]

All the EM residencies in the country have to have at least 5 ICU rotations now.

You sure about this ? I'm still in touch with people at a few different programs... some have only 3, some have 4.

 

[winkleweizen]

All the EM residencies in the country have to have at least 5 ICU rotations now. With that said, I don't think it matters where you go, unless you are set to practice in a particular place when you get out. I'm looking at critical care myself, and after doing ~15 interviews I feel that at least 10 of them would set me up really well for an CC fellowship.

Lots of paths to get to the same goal.

I thought it was just 4?

 

[sylvanthus]

I dont think its 5. I remember at an interview looking at the schedule with the PD because I wanted to be sure I got enough critical care time; and that specific program had 4 months of icu time.

 

[winkleweizen]

I dont think its 5. I remember at an interview looking at the schedule with the PD because I wanted to be sure I got enough critical care time; and that specific program had 4 months of icu time.

Yeah im pretty sure the requirement is 4. One of my top programs had 3 but is converting to 4 because of the new requirements

 

[2bnevryorfis]

Here, at the University of Arizona we currently have two dual trained EM/CC faculty on staff (with a 3rd next year). One predominately splits time between the Emergency Department and the CT ICU while the other does EM/MICU. We also have partnered with the Division of Pulmonary and Critical Care Medicine to offer a 2 year fellowship to EM grads (will be taking our 3rd fellow next year) http://emergencymed.arizona.edu/fellowships/critical-care. A residency in EM will have you well prepared for a fellowship in CCM, however as this pathway is newly developed it is helpful to train with folks that already do it or to train at an institution where it is offered.

 

[sanityonleave]

Just wanted to say thanks everyone for the responses. I definitely have a lot of things to think about and a lot of programs to look at.

I look forward to working with you guys in the future!

 

[ORL10]

As a third year graduating and doing a critical care fellowship I think I have pretty good insight into the process. The most important thing you do is pick program that you are going to excel at. Don't pick one with a CC fellowship, or one that does 100 ICU months just because. You do an emergency medicine residency to be a badass EM resident, and do a CC fellowship to learn to be an intensivist. Sure while you are in EM residency your focus will be on CC if that is your interest, but I don't think having done a million ICU months makes you more prepared.

Go to a program where there is a ton of autonomy, IMHO these are generally not huge universities, do everything yourself read constantly and use your electives to do particular ICU months that interest you. Remember that while on a scheduled ICU month as a junior your role is far less appealing than a CC fellow. You will be writing daily PN, fielding lots of phone calls, calling primary docs, and consulting specialists. In an ED where no fellows (or attending's for that matter) come down, you will be managing intubated DKAer's, asthmatics on the vent, and a multitude of other sick patients in the ED with little backup. I think I learned better this way, and it made me a more decisive resident, with a good clinical grasp in the end. I probably have more work to do in terms of learning about sick BMT patients, but I probably have a better grasp on the initial ICU management and resuscitation.

As far as programs that get you into CC, dont worry its not that competitive. While it seems hot on the market right now, most EM residents do not want to do a 2-yr fellowship with overnight call for two more years making sub-70K annually. If you are interested, do well in residency, maybe become chief and do some research or scholarly work on the side you'll get into a good program.

I digress to say pick the residency you will be most happy, and you are most likely to succeed. Don't get caught up in 3/4 yr, ICU months, roles on trauma etc...

 

[fahimaz7]

For some reason I thought it was 4.. but, is headed to 5 this year. I guess it's 3 now and must be 4? I can't remember. I think I blacked out some of the interview days.

 

[Lambofbob]

Might I suggest listening to one of my podcasts as well where I interviewed Scott Weingart and Haney Mallemat about EM/CC Fellowships:

http://emrespodcast.libsyn.com/episode-8-critical-care-with-weingart-and-mallemat

We go over a bunch of questions regarding EM/CC, and might give you some helpful information.