ID/CC Combo

[doktorcult]

I´m torn between ID and CCM after residency. I know you can do CC after almost any IM subspecialty but I was wondering about certain particularities of a ID/CC combo. Does it have the "synergy" of pulm/CC? Can you really divide your work load between the unit and HIV clinic/inpatient duties? Would it be better to do a 2 year CC program and then do an ID fellowship or the other way around?

Thanks for any info

---

Members don't see this ad.

 

[howelljolly]

I dont know
But, I'll try and offer some guidance since youve been ignored by the folks that actually know what they are talking about.

The "synergy" of Pulm and CCM seems to be that 1. the skillset has a lot of overlap (PA catheters, chest tubes, vents...), 2. The side of CCM which is more than just Internal Med on steroids (which most of it is), seems to be a lot like inpatient pulmonology. When you're in critical condition, You have to support the ABC's. The Circulation part is dependent on the Airway and Breathing. It seems theres a bit more more that can be fine tuned in physiology involved in maintaining adequate oxygenation and perfusion than there can be in keeping the heart beating

Sepsis is a huge part of CCM, and Im sure that knowing your ID would help. However, the skillset doesn't overlap like Pulm/CC. You'd be learning the entire skillset in your CCM fellowship.

Lots of CCM programs look for specialists in other fields such as Cardio, ID, EM.

As far as balancing your practice. You can always work as little or as much in each of your subspecs as you want. Plenty of people attend in the ICU 2-3 days a week, and to Pulmonology consults on the other days.

 

[howelljolly]

CCM Skillset:
Airway management and endotracheal intubation; ventilator management and noninvasive ventilation; insertion and management of chest tubes, and thoracentesis; advanced cardiac life support (ACLS); placement of arterial, central venous, and pulmonary artery balloon flotation catheters; calibration and operation of hemodynamic recording systems; ultrasound guidance for central line placement and thoracentesis.

Pulmonology Skillset:

• Airway management including endotracheal intubation.
• Fiberoptic bronchoscopy and accompanying procedures
• Noninvasive and invasive ventilator management; thoracentesis; arterial puncture
• Placement of arterial, central venous and pulmonary artery balloon flotation catheters
• Calibration and operation of hemodynamic recording systems
• Supervision of the technical aspects of pulmonary function testing
• Progressive exercise testing
• Insertion and management of chest tubes
• Moderate sedation

ID skillset:

• Microscopic evaluation of diagnostic specimens including preparation, staining and interpretation
• Management, maintenance and removal of indwelling venous access catheters
• Administration of antimicrobial and biological products via all routes

(ABIM website)

Keep in mind that these are skills... not knowledge... But, they are things that require some degree of psychomotor, hands on, preceptor-ed training. As such, they are specifically listed.

 

[howelljolly]

Oh, and if you complete and ID fellowship, CCM will only take you one year -- not two.

Only candidates certified in a subspecialty following at least two years of accredited fellowship training (three years for cardiovascular disease and gastroenterology) are permitted to take the critical care medicine examination after completion of 12 months of accredited clinical critical care medicine fellowship training.

(ABIM website)

 

[KGUNNER1]

I´m torn between ID and CCM after residency. I know you can do CC after almost any IM subspecialty but I was wondering about certain particularities of a ID/CC combo. Does it have the "synergy" of pulm/CC? Can you really divide your work load between the unit and HIV clinic/inpatient duties? Would it be better to do a 2 year CC program and then do an ID fellowship or the other way around?

Thanks for any info

One of my CCM fellows had an ID base. He did just fine during his one year. If you do an intense 1 yr ccm fellowship, like at U. Pitt, then you can handle anything in the ICU regardless of how you spent your previous 2 yrs.

If you want to do clinic/round on the floor, you can. Really depends on what you want to do in life. I knew an intensivist at Henry Ford Hospital in Detroit who was ID/CCM. I don't think he did clinic, but he did ID consults.

Definitely do your 2 years first in ID (or whatever subspeciality) then add on that additional 1 yr in CC.

Good luck,
kg

 

[ravasgatti]

Thank to everyone in this site for your precious help,

I will be doing my ID fellowship next year (UofL) , I am planning to do CCM after my fellow because I am planining to go back to my country with robust fund of knoweldege in most of the areas of internal medicine.

Most of residents from my program have excelent experience in CCM since we round CCU , NICU, MICU for more 6 months during our training.

I am wondering if any of you guys know which programs are offering 1 year fellow after the completition of 2 year of subspeciality .

I am looking on FREIDA but seems there is not much information about CCM 1 year.

Thanks guys of your help .

Raul

[email protected]

 

[howelljolly]

I'm pretty sure that all of the programs which offer the categorical 2 year CCM fellowship simply modify the curriculum for IM subspecialists so they get done in one year. You apply for the regular CCM fellowship, and they deal with it once you get there. But I could be wrong.

 

[ravasgatti]

Thanks howelljolly..... By the way...Do you how hard is to get CCM fellow possition for IM subspecialist? ... I really aprecciated your help...

Thanks,

 

[howelljolly]

I'm pretty sure that all of the programs which offer the categorical 2 year CCM fellowship simply modify the curriculum for IM subspecialists so they get done in one year. You apply for the regular CCM fellowship, and they deal with it once you get there. But I could be wrong.

Whatever. Im not sure about my statement any more. Anyone else want to clarify? I'm really wondering this myself over the last week, because the issue might come up for me.

 

[KGUNNER1]

I'm pretty sure that all of the programs which offer the categorical 2 year CCM fellowship simply modify the curriculum for IM subspecialists so they get done in one year. You apply for the regular CCM fellowship, and they deal with it once you get there. But I could be wrong.

This is pretty much on track. They just have an extra slot for the next years class after you do your 1 year. It is not uncommon for fellowships to have to juggle these "moving" positions due to people leaving or coming in with the above mentioned expectations.

You do need to find a pure IM/CCM spot though. I'm not sure if you can "break up" a pulm/ccm position.

 

[howelljolly]

This is pretty much on track. They just have an extra slot for the next years class after you do your 1 year. It is not uncommon for fellowships to have to juggle these "moving" positions due to people leaving or coming in with the above mentioned expectations.

You do need to find a pure IM/CCM spot though. I'm not sure if you can "break up" a pulm/ccm position.

Thanks for the info.

The plot thickens when you're looking for a CCM year after a 2 year pulmonology fellowship. Would you still have to find a CCM fellowship, or could you break up a PulmCCM position in that case?

 

[KGUNNER1]

Thanks for the info.

The plot thickens when you're looking for a CCM year after a 2 year pulmonology fellowship. Would you still have to find a CCM fellowship, or could you break up a PulmCCM position in that case?

The rules still apply. We had that at Pittsburgh. AGH only had a pulm program and they came over to UPMC for their CC year.

To even thicken the plot more. Some Pulm/CCM programs are APPROVED for 1 or 2 spots each year of pure CC. However, they don't advertise this and RARELY fill them because their curriculum and staffing isn't set up for it. However, in a pinch, they are able to make an exception and still abide by ACGME/RRC rules.

KG

 

[ravasgatti]

i have not expect some much help from you guys , you are awesome!....... does anybody of you know some programs of pure CCM beside Pittsburgh.....or others may potential offer that fellowhip?

thanks again..............

 

[howelljolly]

i have not expect some much help from you guys , you are awesome!....... Does anybody of you know some programs of pure ccm beside pittsburgh.....or others may potential offer that fellowhip?

Thanks again..............

freida