EM/Surgical Critical Care fellowships: How was your first year structured?

[Vickz]

Hey everyone,

I'm a new fellow on a Surgical Critical Care program where I'm one their first fellows from EM that they've recruited. As this is still new for them and me, the line between being a fellow and "resident" is very murky as well as what things should I learn this year apart from surgical disease. Although the second year is the regular Surgical Critical Care fellowship for everyone, the first year/'preliminary year" is very abstract in what my position is or should be. For those of you who are from EM and did a Surgical CC fellowship or those who have seen this option in their training programs, how was this year set up? Did you work more as a resident or where you given a fellow status? OR experience or procedural experience during this year? Mostly ICU patients or more ED/Floor patients? I would like to have a better idea so that I may best channel this year to my educational needs. Thanks in advance!

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[CCM-MD]

I guess what you should be doing depends on your career goals. If your goal is to be an Intensivist... you want a broad experience caring for various types of critically ill patients. Does not sound like you are doing that right now. I am not sure what your goals are but that sounds like a terrible fellowship to me if your eventual goal is to work as an community/academic Intensivist. The best critical care fellowships are those that expose you to medical, surgical, cardiac, and neuro ICU patients.

I guess if you plan on only seeing surgical patients, this would prepare you for that. Can’t imagine what kind of jobs exist for a non-surgeon wanting to do that. Regardless, working in the role of a “surgical prelim” or “resident” during your fellowship years, seems like a giant waste of your time.

 

[Dr.CCM]

Hey everyone,

I'm a new fellow on a Surgical Critical Care program where I'm one their first fellows from EM that they've recruited. As this is still new for them and me, the line between being a fellow and "resident" is very murky as well as what things should I learn this year apart from surgical disease. Although the second year is the regular Surgical Critical Care fellowship for everyone, the first year/'preliminary year" is very abstract in what my position is or should be. For those of you who are from EM and did a Surgical CC fellowship or those who have seen this option in their training programs, how was this year set up? Did you work more as a resident or where you given a fellow status? OR experience or procedural experience during this year? Mostly ICU patients or more ED/Floor patients? I would like to have a better idea so that I may best channel this year to my educational needs. Thanks in advance!

They are all structured differently. Some have you as actually an intern level...what a waste. I’d look at Shock Traumas program. I’d also make sure, since you are doing SCC, you should get the opportunity to do plenty of perch trachs and Pegs so you can do those when you come out. You’ll need about 50 or so of each minimum to be completely comfortable on your own when out. I know some hospitals would credential you with less though. You could help out your private group by being the guy who does these procedures for the group when needed. Keep the RVUs in house.

I’d push for getting a lot of CVICU and MICU months during that first year as a fellow level, not doing scut. Do as many of those months as your are able. Do the least amount of SICU possible. I’d also recommend doing CV Surgery and Vascular Surgery so you can get ECMO cannulation experience if that interests you. Also when you are in the OR, intubate every patient. Put in double lumen tubes, do some advance airway stuff if they let you.

 

[chocomorsel]

It sounds like terrible idea IMO. Surgeons are very territorial and tend to look down at non surgeons. And you need more well rounded training to be an intensivist with more than just surgical patients.
I would honestly not want to be the surgeons’ experiment. Why did you chose this fellowship?

 

[deleted547339]

There’s a reason I didn’t consider SCC fellowship programs.

 

[DrGasPasser]

There’s a reason I didn’t consider SCC fellowship programs.

I’ve often wondered if the EM applications to SCC fellowships would start to dry up now that anesthesia-CC fellowship training will lead to board certification for EPs. Perhaps that might get the SCC fellowships to change their structure...assuming they want EPs to apply.

 

[Modanq]

In my experience surgical based critical care fellowships for EM basically means shadowing surgeons for 1 year and basically being bossed around, or as mentioned a prelim surgery work level. Do you really think if you are on your 1 month of CT surgery or trauma in fellowship as a rotation they will let you operate over the pgy 4, 5, 6, or 7. And do you really think the surgeons in the critical care year really understand your educational needs. The EM person is only fellow by name. You're not going to do surgery and pretty much everyone will underestimate your technical skill and rightfully so they are surgeons. On the other hand the medical knowledge you gain will be pale in comparison to medical or anesthesiology driven fellowships. It's very surprising to me - seeing EM folks gravitating toward surgical critical care fellowships. I think critical cares is an excellent route for EM...but would choose an anesthesiology or medical one 10x over a surgical one.

 

[Food]

poor guy, you're telling him his fellowship is useless. Do you feel like you have the support of your PD in trying to make this a good experience for you? If your PD is genuinely interested in making this a good experience for you, I'd recommend you appeal to them to get you electives in the MICU or other specialty ICUs. Maybe even doing infectious disease or nutrition electives would be far more useful than just doing surgical floors. I agree that doing floor work is totally useless. My fellowship is heavily SICU focused but the good thing is that I only have ICU rotations and electives - there is no floor work stuff. granted, i'm not doing an Surgical critical care fellowship.

On the other hand, lets say that your PD isn't really amenable to changing things up and you are stuck. The fact is that graduating will allow you to get board certified and move on to get a job somewhere. You'd have to be super motivated about self-learning so you come out with a decent knowledge base, maybe try to get an away elective if you can.

Your other choice is to quite and apply for a different fellowship but this is the least practical option.

But yes, to re-emphasize above points, this is exactly the reason I didn't apply for surgical critical care fellowships as a non-surgeon. It's the least adapted of the 3 pathways to EM docs. Like there is nothing I could technically do better than a surgeon except maybe ultrasound stuff or airway and that isn't really much of an edge when critical care programs are becoming so ultrasound heavy. At least I have more surgical chest tube experience than most anesthesiologists and IM docs, and can do central lines just as well as anesthesia, whereas IM/pulm is master of bronching.

 

[deleted547339]

poor guy, you're telling him his fellowship is useless. Do you feel like you have the support of your PD in trying to make this a good experience for you? If your PD is genuinely interested in making this a good experience for you, I'd recommend you appeal to them to get you electives in the MICU or other specialty ICUs. Maybe even doing infectious disease or nutrition electives would be far more useful than just doing surgical floors. I agree that doing floor work is totally useless. My fellowship is heavily SICU focused but the good thing is that I only have ICU rotations and electives - there is no floor work stuff. granted, i'm not doing an Surgical critical care fellowship.

On the other hand, lets say that your PD isn't really amenable to changing things up and you are stuck. The fact is that graduating will allow you to get board certified and move on to get a job somewhere. You'd have to be super motivated about self-learning so you come out with a decent knowledge base, maybe try to get an away elective if you can.

Your other choice is to quite and apply for a different fellowship but this is the least practical option.

But yes, to re-emphasize above points, this is exactly the reason I didn't apply for surgical critical care fellowships as a non-surgeon. It's the least adapted of the 3 pathways to EM docs. Like there is nothing I could technically do better than a surgeon except maybe ultrasound stuff or airway and that isn't really much of an edge when critical care programs are becoming so ultrasound heavy. At least I have more surgical chest tube experience than most anesthesiologists and IM docs, and can do central lines just as well as anesthesia, whereas IM/pulm is master of bronching.

It’s certainly not useless. It’s just not optimized. i felt like learning CC took about 18 months. Not 12, but not 24. He or she can learn it, just will have to put up with an unnecessary amount of scut when he or she could be learning more effectively or doing more research. .