How important is ICU experience?

[keeping-it-real]

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As compared to spending more months in the ED instead of an ICU setting?

Basically I'm looking at several programs with 4+ months of ICU vs. other programs that have 2-3 months of ICU but spend a much greater amount of time working in the ED.

I would tend to think that working in the ED is a better (and more enjoyable) learning tool, but does anyone have some feedback either way? thx.

 

[Seaglass]

ICU experience is very important but I think that somewhere around 3 months is ideal. In my opinion the best experiences will be where you are acting as the senior resident on service as it's really the medical decision making that happens in the ICU where the real learning is. Certainly it is also usually a procedurefest but even as the senior resident you'll have plenty of opportunities to place lines and may get called on to do some stuff your IM colleagues would usually pass of to IR (US guided lines, paracentesis, thoracentesis, LP were the ones I did for the team). In my residency (Wake Forest) we did trauma ICU, PICU, and MICU as upper levels and CCU as 'terns.

 

[WallowaWanderer]

I think ICU months are very important, and I prefer to go somewhere that emphasizes unit time. As Seaglass says, it's not the actual number of rotations that's important but how much responsibility you get when you are there. If they are good rotations, then I would rather have a few more months in the unit and a few less in the ED - you already have a ton of time in the ED and the unit really teaches you something different but directly applicable.

 

[roja]

ICU is very important. It is hard to say *which* is more important as there are so many factors.

Ultimately, what you need is experience managing sick, ICU patients. Either in the ED or in the ICU.

Quality of teaching is also very important. The ICU can be something of a waste if its not busy, or the quality of the teaching is poor. Ditto for the ED.

Your role in the ICU and the ED is also an important factor.

If the residency has a busy ED with plenty of critical care, then time in the ICU might be less important. Or vice versa.

 

[EMCC]

I am biased since I will be starting a trauma and critical care fellowship in July. Take what I am about to say with that in mind.

ICU time is ABSOULTELY critical to your functioning as an ED doc. The truly sick patients need proper treatment and recognition to start when they hit the door in the ED. If that means intubating an AA+O*3 old lady, so be it. Once you recognize they are sick, YOU (as the ED doc) need to start the right drips, drugs, abxs, etc... Central lines may be needed as well. Sadly, too many EM docs know the SIRS criteria, but fail to recognize them when the patient rolls in. The Rivers study has shown beyond a shadow of a doubt that patients NEED to be treated emergently and properly in the ED...

Many of these patients will sit in the ED for hours (at least 2-3 at a minimum), so it is extremely important to triage them and treat them appropriately.

One more thing. Remember, you are in residency/about to start residency. You have backup, you have backup, you have backup! If you don't recognize a sick patient, there will be someone there helping catch your mistakes. Once you are done, you are the top dog. Most residents end up working in a community ED where you are the only doc in house at night. So, you need all the procedures you can get... My sphincter still tightens up every time I intubate even though I have intubated "hundreds" of patients with success. You never know when you will have that airway nightmare...

So, again, ICU time is extremely important to an EM practioner. Sorry if this was a little strong/long or dramatic...