Good EM Residency to prepare for future Critical Care Fellowship

[emt30119]

Not looking for a "best EM residency debate" I know they all have there strengths and specialties. But I am seriously thinking about doing a CC fellowship after EM residency. Any residencies that are known to be strong in this area, that will either best prepare you for CC fellowship or best prepare you for getting into a CC fellowship (hopefully both). I assume that those with a little more ICU time would be good, but anything else I should be looking for. Thanks

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[crewmaster1]

I am from Cinci and I believe we are a great location for critical care. Being a fourth year program will typically give you more critical care exposure during your residency. We get 6 month of ICU experience and some residents have used elective time to get more experience. We also have a neurocritical care fellowship that many EM residents have been through. It would be worth your time to at least check out the website. I'm not a CC guy, so I don't know what else is out there.

 

[EMRAGE]

I can officially say that Mercy St. Vincent Hospital in Toledo, OH has a resident who has been accepted into a critical care fellowship. First EM resident to be accepted into the CC fellowship at that institution. Take that for what it's worth. Just be damn good resident and the program may or may not matter.

RAGE

 

[southerndoc]

Four-year programs generally offer more critical care time just because of more time available to fit it in.

It's been a while since I interviewed for residency, but from what I remember the following programs had at least 6 months of critical care time:

- University of Chicago
- University of Cincinnati
- University of Michigan
- Yale

I'm sure there are others, but those are the ones I'm familiar with.

 

[quicknss]

In NYC Mount Sinai is know for their critical care focus

 

[emt30119]

Thanks for all the input so far, it is really helpful. Keep the tips coming.

 

[WilcoWorld]

UNM has 3 EM grads who are CC boarded and now staff the UNM ICU. Last year's class sent one grad to Washington for CC fellowship and this year's class is sending someone to Stanford for CC fellowship.

Even without fellowship the UNM residents get a lot of CC time in during their 3 years of residency.

 

[Dwindlin]

IU has 6 months of ICU time (between Trauma, Peds and Adult) in their 3 year curriculum. IU also has a CC program that accepts EM trained residents.

 

[emt30119]

UNM has 3 EM grads who are CC boarded and now staff the UNM ICU. Last year's class sent one grad to Washington for CC fellowship and this year's class is sending someone to Stanford for CC fellowship.

Even without fellowship the UNM residents get a lot of CC time in during their 3 years of residency.

Sweet! This is just the kind of insider info I'm looking for and would take a lot of time to find to figure out other ways. Thanks Wilco World!👍

 

[iridesingltrack]

I am from Cinci and I believe we are a great location for critical care. Being a fourth year program will typically give you more critical care exposure during your residency. We get 6 month of ICU experience and some residents have used elective time to get more experience. We also have a neurocritical care fellowship that many EM residents have been through. It would be worth your time to at least check out the website. I'm not a CC guy, so I don't know what else is out there.

To echo Crewmaster, here at Cinci we have 5 CC trained faculty in our Department. In this year's graduating class 2/12 are doing fellowships in CC. In my 3rd year class, 4/12 are likely applying for CC fellowships. The majority of the residents are applying for neurocritical care fellowships but some are applying to general CC fellowships as well. Neurologic emergencies represent a strong local interest and EM trained physicians can sit for the NCC boards (not yet ABMS approved) making this attractive to many that come here.

I hear great things about Pitt, Maryland, and Wash U as well but I lack both personal experience and details about these programs.

 

[old_boy]

This isn't answering the OPs question, but just a side note, I've been meeting a lot of people on the residency interview trail who say they're interested in critical care after EM. It's somewhat surprising. Definitely a good thing.

...now if only the surgical CC folks let us sit for their boards too.

 

[emt30119]

...now if only the surgical CC folks let us sit for their boards too.

Thats my hope as well, I have a few years till fellowship, but the sooner the better. Hopefully the IM folks move through with their plan, have a good experience then the Surg/Gas folks see what they are missing out on.

Or better yet, EM forms their own well respected and credible CC boarding.

 

[Revolution #9]

A somewhat related question: to do an anesthesia style, one-year multidisciplinary critical care fellowship, do you have to graduate from a 4 year program? If you're coming from a 3 yr, do you have to do another fellowship before the CC, or perhaps work a while? Thanks!

 

[pballa24]

So just a shout out for Maricopa. As it stands we do 2 mo. in the MICU (1st and 3rd year), 1 in the PICU and 1 in Burn. Starting next year we will add another month in the SICU to make it 5 total critical care months. We don't have any CC boarded attendings but it looks like we will have a graduate in the next year or two go on to do a CC fellowship.

 

[old_boy]

A somewhat related question: to do an anesthesia style, one-year multidisciplinary critical care fellowship, do you have to graduate from a 4 year program?

No

If you're coming from a 3 yr, do you have to do another fellowship before the CC, or perhaps work a while? Thanks!

No

Obviously showing an interest (strong letters from your rotations as a resident, possibly research) will help and it's harder to get these things at a 3 yr program but not impossible.

Source: The SICU program at my hospital which regularly takes EM folks.

 

[emt30119]

Source: The SICU program at my hospital which regularly takes EM folks.

Which hospital, a SICU program is what I'm most interested in. Thanks

 

[ORL10]

As an intern interested in critical care here is what I thought about when applying, for what its worth.


I would say pick the best ER program (whatever your definition of that is) and train there regardless of ICU time. You'll get all the ICU time you need in a fellowship, but you can't go back and redo EM residency. I think the most important things I have learned this year have been in the room, even having done two months in the MICU already. Learning when to pull the trigger and tube someone, running a code, putting in lines being responsible for multiple sick patients at once, these are things that i think make ER docs better suited for CC than IM atleast right out of residency.
Just my own opinion

 

[Xerxes1729]

Someone I spoke with who's been involved in some of the ABEM/ABIM discussions said that the medicine CCM programs are unlikely to change their admission requirements for EM-trained physicians. He made it sound like this included three months of MICU. However, he was kind of vague, so take this with a grain of salt.

 

[old_boy]

Which hospital, a SICU program is what I'm most interested in. Thanks

PM sent.

 

[pdp2001]

cooper university hospital. we have, arguably, one of the best ICU groups in the country (dellinger, perrillo, gerber, spevitz, trzeciak, zanotti). trzeciak is EM/IM trained so not only do you get a lot of time with him in the ED, he's also a great advocate for taking EM residents into the fellowship. they've had a few go through since before EM residents could be boarded in CC. we do 2 months ICU, 2 weeks CCU, 2.5 months TICU total in 3 years, not to mention managing all the ICU players who are in the ED (there's at least 1 per shift). CC isn't my cup of tea, but it's all about what you make of it. you get enough exposure to be comfortable mananging sickies in the ED and if you're interested in CC, enough to start off as a decent fellow.

 

[lushmd]

Check out UPMC. There are several EM-CC trained attendings and it seems that they take several EM trained folks into the fellowship program each year. Also, its a top-notch place to train and a very well known/regarded department.

 

[DrPepperDO]

Although it is a new program, and hasn't had a graduating class yet to see what kind of fellowships we can match, Case/UH is very ICU heavy. We have 7 months of ICU in our 3 year program. (2 months MICU, 1 month CICU, 1 month NeuroICU, 1 month Trauma/SICU, 2 months PICU). I think if you are looking to do critical care, you should keep this in mind.

 

[Arcan57]

Although it is a new program, and hasn't had a graduating class yet to see what kind of fellowships we can match, Case/UH is very ICU heavy. We have 7 months of ICU in our 3 year program. (2 months MICU, 1 month CICU, 1 month NeuroICU, 1 month Trauma/SICU, 2 months PICU). I think if you are looking to do critical care, you should keep this in mind.

2 months PICU? I'd have put a bullet in my brain.

 

[Hamhock]

2 months PICU? I'd have put a bullet in my brain.

Me too.

And I would argue that PICU doesn't prep one well for adult CCM. Indeed, it may confuse and disorient.

NICU is even worse...that's not even CCM.

(opinion only!)

HH

 

[Cerberus]

2 months PICU? I'd have put a bullet in my brain.

Seconded.

 

[Venko]

Check out UPMC. There are several EM-CC trained attendings and it seems that they take several EM trained folks into the fellowship program each year. Also, its a top-notch place to train and a very well known/regarded department.

Not to mention that UPMC is essentially the birthplace of critical care medicine in the US.

 

[AquaFortis]

Has there been any word about the board cert. via IM CC since the announcement? Is it official in that EM residents who do an IM CC fellowship can now be board certified? Or is it still "in the works"?

 

[Zanegray]

Not to mention that UPMC is essentially the birthplace of critical care medicine in the US.

UPMC = University of Pittsburgh Medical Center
CCM is very EP friendly here, with an EM trained doctor as head of CCM at our biggest campus and several other EM trained docs as well. Our residency usually sends 1-2 residents to the fellowship per year.

Training CCM from EM here is 2 years regardless of whether you went to a 3 or 4 year EM residency ( so i say go three 🙂)

gl...

Zane

 

[ORL10]

Pretty much agree with everything people have said above. I am pretty involved in the ICU applying process as I will be applying late this winter (PGY-2) for a spot.

I think going to a program with "great critical care training" is like going to a med school that has a good program in what you are interested in. You meet people in the field and get some good contacts and LOR. I don't think this going to make/break you as a CC doc. These are the things you pick-up in a fellowship/attending life.

Pick an ER residency that you will be sane at and enjoy. Burning out before you get to a CC fellowship because you picked some place you thought would be the best place to get you "into a CC fellowship" and not a place you'll be happy is ludacris. You'll get into "a" CC fellowship they're not that competitive (IM people that are pretty badass for the most part do Pulm/CC).

I am at a good ER program without a strong CC department atleast MICU.
But I am rotating at Upitt in september just because they have an excellent fellowship (along with all the others mentioned, cooper, SLU, stanford, OHSU, etc....). I am pretty involved in research related to CC and all of these things were accomplished at an institution that is not an "academic powerhouse but I think is an ER powerhouse". just my two cents.

I am not looking into ER CC fellowships that are not certified by ABIM only because I want to be bordered in case I decided to work in an ICU after a fellowship.

PM if you have questions I am about elbow deep in the process now.

 

[DrGaryGoodman]

pretty much agree with everything people have said above. I am pretty involved in the icu applying process as i will be applying late this winter (pgy-2) for a spot.

I think going to a program with "great critical care training" is like going to a med school that has a good program in what you are interested in. You meet people in the field and get some good contacts and lor. I don't think this going to make/break you as a cc doc. These are the things you pick-up in a fellowship/attending life.

Pick an er residency that you will be sane at and enjoy. Burning out before you get to a cc fellowship because you picked some place you thought would be the best place to get you "into a cc fellowship" and not a place you'll be happy is ludacris. You'll get into "a" cc fellowship they're not that competitive (im people that are pretty badass for the most part do pulm/cc).

I am at a good er program without a strong cc department atleast micu.
But i am rotating at upitt in september just because they have an excellent fellowship (along with all the others mentioned, cooper, slu, stanford, ohsu, etc....). I am pretty involved in research related to cc and all of these things were accomplished at an institution that is not an "academic powerhouse but i think is an er powerhouse". Just my two cents.

I am not looking into er cc fellowships that are not certified by abim only because i want to be bordered in case i decided to work in an icu after a fellowship.

Pm if you have questions i am about elbow deep in the process now.

to be clear, the american board of emergency medicine has approved critical care through abem and abim combined residency. I am aware of it as of this year. So check wtih abem and some residencies have fellowships - for example north shore university hosptial in manhasset, ny - nyu based. I know because i am from there.

 

[mrhealth]

I think northwestern EM has some of the most ICU time.

 

[guitarologist]

According to Northwestern they have THE most ICU time. Like 8-9 months total, 4 as an intern.

Others I saw with lots of ICU time were UNM and UW.

 

[Tiger26]

According to Northwestern they have THE most ICU time. Like 8-9 months total, 4 as an intern.

Others I saw with lots of ICU time were UNM and UW.

That sounds horrible – I have four more ICU shifts left in my life. Next Friday can't come soon enough when I'm done forever and get to do ER shifts the rest of my career!

 

[Lambofbob]

You may know about this already, but if you go to saem.org, they have residency and fellowship directories you can browse, might be helpful to look through.

I totally agree with the fact that you should not base your residency decision on who does the most critical care. If you do a fellowship, that's where you'll really learn it. Pick a place where you fit in, where you'll be happy, and where you feel like you'll learn EM the best. You never know if your desire for CC might change. I went into residency thinking I hated research and wouldn't want to do a fellowship of any kind. By 2nd year, I wanted to do a CC fellowship during the winter months (maybe due to seasonal affective d/o, who knows🙂, and I now am in an US fellowship and really like research. So you never know what will happen and the last thing you want is to pick a place that does 10 ICU months and you find out in month 2 you hate ICU.