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

Vickz

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Aug 12, 2011
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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!
 

CCM-MD

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Oct 11, 2016
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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.
 
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kimbosliced

7+ Year Member
Jan 12, 2010
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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.
 
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chocomorsel

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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?
 
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Feb 9, 2019
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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

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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.