ICU and CT fellowships

[uoflmed2019]

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Anesthesia resident and very interested in critical care and/or ICU. However, I do not know good programs that you all recommend that would be good training. Obviously there are powerhouse names but I don't want to go to a brand program if the training is not going to make me competent. Would love your all suggestions on places to be on the lookout for

 

[psychbender]

Anesthesia resident and very interested in critical care and/or ICU. However, I do not know good programs that you all recommend that would be good training. Obviously there are powerhouse names but I don't want to go to a brand program if the training is not going to make me competent. Would love your all suggestions on places to be on the lookout for

Pretty much any program should provide you the ability to become a competent intensivist. The questions are, in what kind of ICU do you want to practice? What region of the country? How much are you willing to put up with to earn that knowledge and capabilities?

Q3 call, "80" hours every single week getting your ass kicked covering multiple units at night with only interns, multiple people on mechanical circulatory support having problems, etc is not always the best training. You can still learn how to run an ICU and take care of these complex patients without killing yourself with work.

People that get their ass handed to them always say that they had the best training, because they have to justify to themselves what they went through was worth it. At the same time, a M-F, 7-3 only program probably isn't letting you see and do enough to allow you to thrive in your own.

 

[DG51]

Anesthesia resident and very interested in critical care and/or ICU. However, I do not know good programs that you all recommend that would be good training. Obviously there are powerhouse names but I don't want to go to a brand program if the training is not going to make me competent. Would love your all suggestions on places to be on the lookout for

Here's my two cents:
1) When applying for programs, focus on locations where you would be happiest. Whether it be proximity to family, beautiful weather, access to big city amenities, etc. You will likely end up taking a job in the same region as your training program.
2) interview at these programs. Ask yourself, would I get along with these staff and fellows? Are the fellows supported? Are they burned out? I interviewed at some "prestigious" places, but the fellows seemed miserable and/or were doing the zoom interviews from their beds in PJs. stuff like this says a lot!
3) trust your gut, and make a rank list. The quality of your training will be greatly enhanced if you are at a program where you are happy and feel supported. This will give you time to study and learn from your patients without perpetually being in fight or flight mode.

 

[uoflmed2019]

Pretty much any program should provide you the ability to become a competent intensivist. The questions are, in what kind of ICU do you want to practice? What region of the country? How much are you willing to put up with to earn that knowledge and capabilities?

Q3 call, "80" hours every single week getting your ass kicked covering multiple units at night with only interns, multiple people on mechanical circulatory support having problems, etc is not always the best training. You can still learn how to run an ICU and take care of these complex patients without killing yourself with work.

People that get their ass handed to them always say that they had the best training, because they have to justify to themselves what they went through was worth it. At the same time, a M-F, 7-3 only program probably isn't letting you see and do enough to allow you to thrive in your own.

very interested in Cardiac ICU!

 

[Ronin786]

very interested in Cardiac ICU!

As somebody who practices in a cardiac ICU, some of the weakest ICU folks I meet are the ones that only know cardiac ICU and echo. There's so much more to critical care than the cardiac ICU and while it's a niche subsegment you need a well-rounded experience. You don't need a cardiac anesthesia fellowship to be good at cardiac ICU management and if anything many dual-trained folks end up just doing cardiac.

Truth of the matter is ICU fellowship is far from competitive these days and how good you're going to be at the end of the year is incredibly dependent on you and your drive and willingness to learn and seek out knowledge. Go to whatever program gives you a wide breadth of pathology, doesn't kill you schedule wise and looks good on your resume.

 

[psychbender]

very interested in Cardiac ICU!

So are most, until they have to work nonstop with CT surgeons. I kid.

Still, even with a desire to work in the CVICU and do all the high acuity MCS stuff, get good, BROAD, critical care training. Not a lot of programs have MICU as a core rotation, which is sad. Often, those are actually the sickest patients in the hospital, not the post-cardiotomy VA ECMO patient. Find something that'll give 8 weeks CVICU, 8 weeks various SICUs, 4-8 weeks MICU, 4 weeks Neuro. Fill out the rest with electives like ID and transplant ID, echo service, heart failure consult, nephrology, and more ICU time in whichever unit you like best.

 

[abolt18]

So are most, until they have to work nonstop with CT surgeons. I kid.

Still, even with a desire to work in the CVICU and do all the high acuity MCS stuff, get good, BROAD, critical care training. Not a lot of programs have MICU as a core rotation, which is sad. Often, those are actually the sickest patients in the hospital, not the post-cardiotomy VA ECMO patient. Find something that'll give 8 weeks CVICU, 8 weeks various SICUs, 4-8 weeks MICU, 4 weeks Neuro. Fill out the rest with electives like ID and transplant ID, echo service, heart failure consult, nephrology, and more ICU time in whichever unit you like best.

I was very interested in ICU when my only experiences were MICU and CVICU. Neuro ICU really started to decrease my interest. THEN, my last year of residency, we had experienced a ton of turnover in ICU nurses and we were left with terrible and/or brand new nurses everywhere and I quickly learned how much my experience in the ICU was affected by the quality of the nursing staff. That killed all remaining desires to ever consider ICU fellowship.

 

[POW16]

Anesthesia resident and very interested in critical care and/or ICU. However, I do not know good programs that you all recommend that would be good training. Obviously there are powerhouse names but I don't want to go to a brand program if the training is not going to make me competent. Would love your all suggestions on places to be on the lookout for

There are great programs everywhere. All have pros and cons. It really depends on what you want out of your career.

 

[vector2]

As somebody who practices in a cardiac ICU, some of the weakest ICU folks I meet are the ones that only know cardiac ICU and echo. There's so much more to critical care than the cardiac ICU and while it's a niche subsegment you need a well-rounded experience. You don't need a cardiac anesthesia fellowship to be good at cardiac ICU management and if anything many dual-trained folks end up just doing cardiac.

Truth of the matter is ICU fellowship is far from competitive these days and how good you're going to be at the end of the year is incredibly dependent on you and your drive and willingness to learn and seek out knowledge. Go to whatever program gives you a wide breadth of pathology, doesn't kill you schedule wise and looks good on your resume.

The way I think about it is that just being able to make an echo diagnosis on a hypotensive or hypoperfusing CTICU pt in the first few hours post-op is not sufficient to get them safely through the rest of the potentially prolonged ICU stay. The sick ones have so many more problems that involve all the organ systems.

However, despite not being dual trained myself, when looking at CTICU candidates I am partial to dual trained folks who had strong ICU training in all the non-CTICU domains, and then developed their mastery of CV pathophys/mgmt and echo during their CT year. One year makes it tough to really learn all the general ICU principles plus specialized CTICU principles plus potentially get enough exposure to take the critical care echo exam without compromising the first part.