Hopkins Cardiac Critical Care fellowship

[Bleu225]

Has anyone heard about this fellowship at Hopkins?

http://www.hopkinsmedicine.org/heart_vascular_institute/education/cardiac_critical_care.html

They say it is an "ACGME-equivalent" clinical fellowship. Does this mean it will make you Critical Care certified, just like a "normal" critical care fellowship? I ask because it seems like you do not apply to it through the normal Critical Care pathway (i.e. SFMatch).

Does anyone know what the cardiothoracic volume is like at Hopkins? I assume it must be immense if they can support a separate fellowship like this.

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[deleted171991]

I don't know this fellowship, but be very careful. If it's not ACGME-accredited, not only will you not be able to sit for the critical care boards, you won't be able to get certified in advanced TEE either, even if you get the numbers.

Looking at their webpage, I think this is a waste of time. If you want to be outstanding at cardiac critical care, go do the ACGME ccm fellowship at Columbia.

 

[Bleu225]

If you want to be outstanding at cardiac critical care, go do the ACGME ccm fellowship at Columbia.

What are the other top-tier cardiac critical care ACGME-accredited programs Or is it really just Columbia?

 

[deleted547339]

This is a kind of critical care super-subspecialty. It looks like it's not supposed to be instead of a CCM fellowship, but rather in addition to a CCM fellowship. Probably for people who want a further niche in academic CCM.

 

[AdmiralChz]

Yes, this appears to be a "super" fellowship to be done after a formal CCM fellowship. I'm not the expert on this, but I think there are several out there that are sort of under the radar and I from what I've heard the majority of takers are ER-trained CCM docs who want additional training (and allowed access to) in a CICU.

I'm not doing CCM, but I'm pretty sure you need rotations in places outside of just the CICU for it to be considered a formal CCM fellowship?

Look elsewhere on this forum if you are interested in a combined CCM-Cardiac fellowship - as FFP said, if you want CCM boards and advanced TEE certification (essentially the entire point) BOTH have to be ACGME-accredited, which means it will take 2 years. A few programs have a truly combined approach that incorporates ~3-6 months of research (do a google search to find out which), but there is no way to compress this into 1 year and be eligible for both exams. Several "combined" programs are literally just 1 year of one specialty followed by the other year.

 

[POW16]

Look elsewhere on this forum if you are interested in a combined CCM-Cardiac fellowship - as FFP said, if you want CCM boards and advanced TEE certification (essentially the entire point) BOTH have to be ACGME-accredited, which means it will take 2 years. A few programs have a truly combined approach that incorporates ~3-6 months of research (do a google search to find out which), but there is no way to compress this into 1 year and be eligible for both exams. Several "combined" programs are literally just 1 year of one specialty followed by the other year.

What about the Duke program ? Seems like it's truly both in one year.

http://anesthesiology.duke.edu/?page_id=818043

 

[deleted171991]

This is a kind of critical care super-subspecialty. It looks like it's not supposed to be instead of a CCM fellowship, but rather in addition to a CCM fellowship. Probably for people who want a further niche in academic CCM.

It's worthless, because it does not lead to board certification, in a field where it matters a lot. Anybody who wants that niche should do CT+CCM.

And for somebody who already has CCM, it's not worth the loss of income for another year. It's not like cardiac intensivists are paid so well, or like anybody needs this fellowship on top of CCM to do cardiac ICU. All one needs is good echo skills, both TTE and TEE, and knowledge of assist devices. A cardiac anesthesia fellowship after CCM is a much better deal.

 

[Ezekiel2517]

What about the Duke program ? Seems like it's truly both in one year.

http://anesthesiology.duke.edu/?page_id=818043

No. In order to obtain advanced TEE certification, cardiac fellowship is required. This started back in 2009 with the rule change. Anyone can sit for the exam but you can't become certified w/o cardiac fellowship.

 

[deleted171991]

No. In order to obtain advanced TEE certification, cardiac fellowship is required. This started back in 2009 with the rule change. Anyone can sit for the exam but you can't become certified w/o cardiac fellowship.

You don't want to get me started. Let's just say that a number of CCM fellows are still becoming certified in advanced TEE, as they should. A truly motivated CCM fellow in the right program can generate enough paperwork to become certified, not just testamur.

Honestly, the loophole is there because the whole echo certification (vs testamur) business is a joke, and everybody knows that. The real value is not the difference between testamur and certified, the real value is the cardiac anesthesia fellowship. They should certify any anesthesiologist who passes the exam, without any extra paperwork, and create a separate subspecialty board exam in cardiac anesthesiology.

 

[Psai]

"ACGME-equivalent" clinical fellowship

hahaha
if you fall for that, you deserve the lost salary

 

[pgg]

No. In order to obtain advanced TEE certification, cardiac fellowship is required. This started back in 2009 with the rule change. Anyone can sit for the exam but you can't become certified w/o cardiac fellowship.

This is the letter of the requirement from NBE:

Applicants must have a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease. Training obtained during the core residency (anesthesiology, internal medicine, or general surgery) may not be counted toward this requirement. Fellowship training in cardiothoracic or cardiovascular anesthesiology must be obtained at an institution with an ACGME or other national accrediting agency accredited fellowship in cardiothoracic anesthesiology.

It specifically demands "fellowship training in cardiothoracic or cardiovascular anesthesiology." Furthermore, a strict reading clearly excludes CCM fellows because even a single month spent in a MICU is not perioperative care of surgical patients.

That said, I know CCM fellows who are getting sufficient periop TEE exams to meet the number requirements, who expect full certification. I'm not sure what specific verbiage will be on their fellowship certificates to satisfy NBE, but I'm under the impression that it's worked out fine in the past.

 

[bigdan]

I work with a guy who did the Hopkins Cardiac ICU fellowship. He's fuc#ing ninja, and is one of those guys that absolutely loves cardiothoracic critical care.

His background was in medicine, then did the ACGME pathway through critical care (so is ICU boarded), then Hopkins superfellowship. I know there are many valid opinions on this, but I'd say that if you do/want to do cardiothoracic surgical critical care BUT not have a ton of intraop exposure to cardiac surgical care, it may make sense. My partner loved his experience at Hopkins, and loves the work he does.

I'm biased*, but I, think the most complete path to pure CTSICU for anesthesiologists (and longest path, and biggest income sacrifice path) is to do CCM + CTA fellowships.

*DISCLAIMER* I, too, know people that did one of, or none of, the aforementioned fellowships and are complete rockstars.

 

[FuzzyBK]

This is the letter of the requirement from NBE:
It specifically demands "fellowship training in cardiothoracic or cardiovascular anesthesiology." Furthermore, a strict reading clearly excludes CCM fellows because even a single month spent in a MICU is not perioperative care of surgical patients.

That said, I know CCM fellows who are getting sufficient periop TEE exams to meet the number requirements, who expect full certification. I'm not sure what specific verbiage will be on their fellowship certificates to satisfy NBE, but I'm under the impression that it's worked out fine in the past.

No, it doesn't. It says if you do a CT fellowship it has to be ACGME accredited (as opposed to non-ACGME approved CT Fellowships). You can do other fellowships as well.

 

[deleted171991]

No, it doesn't. It says if you do a CT fellowship it has to be ACGME accredited (as opposed to non-ACGME approved CT Fellowships). You can do other fellowships as well.

I re-read the application for the advanced exam, and it can be interpreted exactly like you said. Never thought of that.

 

[Bleu225]

I work with a guy who did the Hopkins Cardiac ICU fellowship. He's fuc#ing ninja, and is one of those guys that absolutely loves cardiothoracic critical care.

Did he also do a cardiothoracic fellowship? Where does he work now, private or academic? Is he ICU-only, or does he also do cases in the ORs?

 

[pgg]

No, it doesn't. It says if you do a CT fellowship it has to be ACGME accredited (as opposed to non-ACGME approved CT Fellowships). You can do other fellowships as well.

It's pretty clear that the NBE means cardiothoracic anesthesia fellowships.

If you look at the application, and their acceptable sample letter documenting completion of fellowship, it includes the statements "This letter confirms that Dr. ____________________ successfully completed a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease at our institution between _______________ and _______________. This letter further confirms that fellowship training in echocardiography was obtained at an institution with an accredited cardiothoracic anesthesiology fellowship."

(emphasis mine) http://www.echoboards.org/sites/default/files/AdvPTE Cert App_1.pdf

The phrase "12 months of clinical fellowship training dedicated to the perioperative care of surgical patients" appears and reappears verbatim in multiple places ... it is absolutely clear that they mean a whole year of just perioperative care of surgical patients. I don't see how a CCM fellowship that includes any time in a MICU meets that requirement, without some wink-wink pretending that caring for COPD exacerbations and other medical problems somehow fits that description.

Now I suppose if the CCM fellow was at an institution that also had an accredited CT fellowship the CCM training they received there in the general vicinity of the CT fellowship program would meet the literal truth of the statement in the letter because after all they got their fellowship training at an institution with a CT program even if they weren't part of it but I can't really make that argument with a straight face.


I think it's an overly narrow and silly requirement, and that CCM fellows who get to the OR often enough to do the required number of TEE exams ought to be allowed to obtain full certification. And I know some do. But the requirement is there, in the application, in black and white.

I also think that the NBE is interested in collecting the exam fee from as many people as possible, and probably doesn't look too hard at what CCM fellows who apply are actually doing, lest future CCM fellows decide the exam isn't worth taking.

 

[AdmiralChz]

Clearly CCM programs must be pretty different across the country, outside of echo electives the CCM fellows at my institution (and at my med school) were almost exclusively in the ICU dealing with management and hardly (if ever) seen in the OR.

There's no way a CCM fellow here could get the experience/numbers necessary to become a competent perioperative TEE expert, although they get quite good at transthoracic exams. Maybe other places are set up in different ways?

 

[inspirationmd]

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[Man o War]

It's pretty clear that the NBE means cardiothoracic anesthesia fellowships.

If you look at the application, and their acceptable sample letter documenting completion of fellowship, it includes the statements "This letter confirms that Dr. ____________________ successfully completed a minimum of 12 months of clinical fellowship training dedicated to the perioperative care of surgical patients with cardiovascular disease at our institution between _______________ and _______________. This letter further confirms that fellowship training in echocardiography was obtained at an institution with an accredited cardiothoracic anesthesiology fellowship."

(emphasis mine) http://www.echoboards.org/sites/default/files/AdvPTE Cert App_1.pdf

The phrase "12 months of clinical fellowship training dedicated to the perioperative care of surgical patients" appears and reappears verbatim in multiple places ... it is absolutely clear that they mean a whole year of just perioperative care of surgical patients. I don't see how a CCM fellowship that includes any time in a MICU meets that requirement, without some wink-wink pretending that caring for COPD exacerbations and other medical problems somehow fits that description.

Now I suppose if the CCM fellow was at an institution that also had an accredited CT fellowship the CCM training they received there in the general vicinity of the CT fellowship program would meet the literal truth of the statement in the letter because after all they got their fellowship training at an institution with a CT program even if they weren't part of it but I can't really make that argument with a straight face.


I think it's an overly narrow and silly requirement, and that CCM fellows who get to the OR often enough to do the required number of TEE exams ought to be allowed to obtain full certification. And I know some do. But the requirement is there, in the application, in black and white.

I also think that the NBE is interested in collecting the exam fee from as many people as possible, and probably doesn't look too hard at what CCM fellows who apply are actually doing, lest future CCM fellows decide the exam isn't worth taking.

I remember having to submit a case log in addition to a TEE list when I sent my application in for board certification, so I am thinking you definitely have to do a CT fellowship.

 

[psychbender]

I understand the intent, but I can also interpret those highlighted segments to mean that other fellowships may be possible, if there is an ACGME-accredited CT anesthesiology fellowship there, fellows get the echoes, and meet the twelve month requirement. In a PICU, there will likely be some congenital cardiac kids. Some programs have the pulmonologist in the MICU handling ECMO patients. I have also seen plenty of MICU patients with CV disease that head to the OR for a CABG, or other surgical procedure. One can obey the spirit of the law, or the letter of it.

I, for example, fully intend to submit a packet for certification after my CCM fellowship. I am also prepared to have it rejected, and would understand their logic. I'm a weird case, in that I meet the requirements of the practice pathway, except that I graduated residency in 2013. I'm doing CCM, as I have a passion for it, but in this day of limiting privileges to only those "certified" in something, I would also like recognition that I've spent a lot of time and money teaching myself echo, and can do it just as well as many off the graduating fellows, and people who obtained certification by the practice pathway pre-2009. My fellowship also includes a butt-ton of echo, with a high level of acuity for CT surgery.

 

[AdmiralChz]

Honest question - for your CCM experience would you feel comfortable giving real-time intra operative surgical advice for valve repairs, evaluating anastomotic leaks and the such? 3D reconstruction of mortals? To the level a CT-anesthesiologist should feel after fellowship? Because I think that is the intent of an advanced cert.

 

[bigdan]

Did he also do a cardiothoracic fellowship? Where does he work now, private or academic? Is he ICU-only, or does he also do cases in the ORs?

"His background was in medicine, then did the ACGME pathway through critical care (so is ICU boarded), then Hopkins superfellowship."

He's not an anesthesiologist, he trained in IM. Academic hospital - Level 1 trauma, 700 beds.

 

[Ezekiel2517]

Honest question - for your CCM experience would you feel comfortable giving real-time intra operative surgical advice for valve repairs, evaluating anastomotic leaks and the such? 3D reconstruction of mortals? To the level a CT-anesthesiologist should feel after fellowship? Because I think that is the intent of an advanced cert.

I think that's also the intent of the advanced exam.

 

[psychbender]

Not sure what you meant by 3D reconstruction of mortals, but yes, I feel comfortable giving real-time intraoperative advice for valve repair vs replacement and assessing and grading perivalvular leak. That skill and comfort does not have to come from one year of doing primarily hearts. It can also come after several years of doing a broad variety of cases, including hearts, attending conferences, CME and self-study material, etc (hence, why there was a practice pathway to begin with). After a year back at a real academic institution, more formal TEE training with CT anesthesiology staff, and post-op care in a high-acuity CVICU, I think I will be even more comfortable. There are absolutely certain areas where CT-fellowship trained anesthesiologists will surpass me (congenital, VAD, transplant), but non-CT fellows can learn enough echo to do most CABGs, AVRs, MVRs (repair or replacement), aortic aneurysms, etc to the expected level of a CT fellowship grad, given sufficient time and motivation.

 

[Nivens]

non-CT fellows can learn enough echo to do most CABGs, AVRs, MVRs (repair or replacement), aortic aneurysms, etc to the expected level of a CT fellowship grad, given sufficient time and motivation.

This is undoubtably true. However, with the decline (and possible future elimination) of private practice anesthesiology and the rise of a corporate/employment model, we are likely entering an age where what you are permitted to practice is determined more by credentials than skills. If you are able to secure the advanced TEE cert through CCM, then you will be treated the same by your employer as a CT-trained echocardiographer. If they deny you certification, I wouldn't count on doing intra-op echoes long-term.

Don't think for a second I agree with this, but seems to be the direction we're headed.