Is Trauma Surg considered "critical care" experience?

[HankReardon]

Like many newcomers, I'm enamored of this CC fellowship and boarding possibility and so I'm counting up the critical care month rotations at different residencies while trying to make a decision. Would you consider your Trauma Surgery rotation as a "critical care" experience? What if you were at an institution with a separate TICU? Without a separate TICU? Under what conditions would a Trauma Surg rotation fit as "critical care experience"?

Taking a step back, if I am genuinely interest in the CC pathway, how should I choose a residency?

- Straight number of trauma months?
- "Best" name program? (I'm sorry I did that, but I mean it)
- Specific trauma faculty?
- Residencies at places with CCM fellowships?
- Residencies at places with CCM fellowships that have accepted EMPs?
- Just go to Pittsburgh already?

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[HankReardon]

Anyone? Beuhler?

 

[ccfccp]

There was a post recently talking about CCM fellowships from EM and residencies particularly strong in CCM. For the most part the names that seem to come up most frequently are Indiana, Cincinnati, and Pittsburgh, although there are plently of other places. We (at ORMC) do 5 months of CCM on top of 2 months of trauma surgery as an intern.

I would not consider the trauma surgery months critical care (at least at our shop) unless those months are specifically focused on ICU medicine (which most would undoubtedly not be.) We also have a month (one of the five) in surgical/trauma ICU. We have had a couple of people recently go into CCM fellowships, and have a couple of people in our class who are interested in them.

 

[KYTNOH]

It depends on the way trauma is setup. At my program we do a "trauma intern" month our first year that is basically floor and stepdown trauma care. We also do a month our intern year that's called the "intensivist" month. It is basically a good intro to the ICU side of trauma as well as surgical critical care. Lots of lines, chest tubes, and introduction to invasive monitoring, vent management, and sepsis/shock. Our second year we do a dedicated month of ICU for trauma and surgical critical care with a census usually between 15-25 for which we are primary call. A lot of places don't have the volume to dedicate a month to just the trauma ICU, so that will definitely vary from place to place.

 

[ORL10]

as an intern who has done more than a fair share of work on trying to establish an opportunity in CCM I'll bite.

I don't think it matters where you do your residency per say. I don't think doing a million months in an ICU is going to be advantageous to you becoming a critical care fellow. You also have to look at what your roles and responsiblities are at these different institutions so for example 9 months at a place with fellows, multiple senior residents and attendings 24/7 may mean less for you the intern/2nd year ER resident to do while rotating through.

I will say it is advantageous to go to an academic place with a CCM fellowship because it is easier to do electvies with names in the field and get LOR/research opportunities, since the application process for IM-based CCM fellowships starts winter of your second year (if it is a 3 yr program).

Also you can do a trauma CC fellowship from EM but cannot currently be boarded by the surgical society. Currently the only sponsoring board is the american board of internal medicine (ABIM) who "has accepted" that EM residents can sit for the boards aftger a 2yr fellowship in an IM-accredited CC program, although no word on when the first opportunity to sit for the exam will be. examples of some programs who have CCM fellowships (without pulmonary and are IM-based) are pitt/mayo/cooper/SLU/ and many others (see FRIEDA). While Indiana and others are suppose to be excellent fellowships they are not currently accredited by the internal medicine (to the best of my knowledge) and those completing a fellowship there are thus not eligible for board certifcation after completion.

I don't think worrying about a trauma vs medical CCM fellowship for you is very helpful right now. instead pick a residency where you are likely to succeed and be happy because ultimately that will make you the best applicant for a CCM fellowship after residency. (PS these fellowships aren't necessarily COMPETITIVE most of the best IM applicants apply to pulm/cc not a CC medicine fellowship).

Lastly the best ER program is pretty meaningless because the "best ER program", isn't necessarily the ones attendings from large academic centers will know about.

You certainly will not find the answer to the "best program" for you on this website, to "help you get into a CCM fellowship." Pick a place you will be happy your sanity will thank you when you are an intern next year.

Feel free to PM me.