number of months in the ICU during IM residency

[ResidentMD]

Hey - I had posted this in the other thread before - thought it may be more pertinent here (didnt know how to delete that thread )

I was comparing schedules at a few programs in categorical IM. Some programs have ICU rotations only for 3 months in the entire 3 years. However, some places have up to 6 months.

I was wondering, for someone interested in PCCM for fellowship, does this matter much (besides the fact one may get to publish more during their rotations and may have more options to choose LoRs eventually)? Does anyone bring it up on your interviews for PCCM or does it become an issue in selecting you for an interview (at good academic places)?

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[dragonfly99]

Yes, I do think that it matters, particularly if you want to do something like pulmonary/critical care or cardiology. You need to get experience with managing the sicker patients, the ones who are intubated, etc. Some of the smaller IM programs based at smaller hospitals or community hospitals just don't have a lot of sick patients in their ICU's. This is even true of some of the smaller university programs. This should definitely be a factor in your decision making about where to train, given your career goals.

 

[Tigerz_Fan]

Yes, I do think that it matters, particularly if you want to do something like pulmonary/critical care or cardiology. You need to get experience with managing the sicker patients, the ones who are intubated, etc. Some of the smaller IM programs based at smaller hospitals or community hospitals just don't have a lot of sick patients in their ICU's. This is even true of some of the smaller university programs. This should definitely be a factor in your decision making about where to train, given your career goals.

100% agree with DF. If you are interested in pulm/CCM, you really need to look into the programs that have 5-6 months of ICU months. The max ACGME allows for IM is 6 months for all three years.

We have had fellows come through from larger programs that do 5-6 months, and they are really proficient at procedures. It helps the transition and really prepares you to handle those sick patients. On the other hand, we have had a few from small programs that only have 3 months, or have other services such as surgery or CTS perform all their procedures. Sometimes those fellows really struggle.

And of course, you will have more months to find that perfect case for a poster presentation.

 

[ResidentMD]

100% agree with DF. If you are interested in pulm/CCM, you really need to look into the programs that have 5-6 months of ICU months. The max ACGME allows for IM is 6 months for all three years.

We have had fellows come through from larger programs that do 5-6 months, and they are really proficient at procedures. It helps the transition and really prepares you to handle those sick patients. On the other hand, we have had a few from small programs that only have 3 months, or have other services such as surgery or CTS perform all their procedures. Sometimes those fellows really struggle.

And of course, you will have more months to find that perfect case for a poster presentation.

Really.......this is good to know. I am glad I asked this question. Interestingly, a lot of good university programs also have only 3 months of ICU time.

From your experience, which are the programs from where you have got proficient incoming fellows? (please leave out UCSF, BWH, MGH and JHU - I would like to know more about programs I may have to decide between

 

[gutonc]

Really.......this is good to know. I am glad I asked this question. Interestingly, a lot of good university programs also have only 3 months of ICU time.

From your experience, which are the programs from where you have got proficient incoming fellows? (please leave out UCSF, BWH, MGH and JHU - I would like to know more about programs I may have to decide between

You will be looked at a little strangely at first but, if you request more ICU time, I don't think there's a program on the planet that wouldn't give it to you. The program I went to falls into the 4-5 month camp but there are residents who want to do Pulm/CC (or Cards as CCU counts as ICU) who have asked to do another month or two and the ones I know who have asked have gotten them. I personally traded a ward month for an ICU month and did not regret it.

 

[ResidentMD]

You will be looked at a little strangely at first but, if you request more ICU time, I don't think there's a program on the planet that wouldn't give it to you. The program I went to falls into the 4-5 month camp but there are residents who want to do Pulm/CC (or Cards as CCU counts as ICU) who have asked to do another month or two and the ones I know who have asked have gotten them. I personally traded a ward month for an ICU month and did not regret it.

That is really good to know..thanks!

 

[jdh71]

the mere mortals in your program will be more than happy to give up ICU months - just ask and trade

(And I don't personally count CCU as an ICU, not trying to be provocative, they just aint the same)

 

[ResidentMD]

the mere mortals in your program will be more than happy to give up ICU months - just ask and trade

(And I don't personally count CCU as an ICU, not trying to be provocative, they just aint the same)

haha..for some reason I have a feeling I am being a bit over-enthusiastic about wanting more ICU months ? But I guess I would have to do that if I eventually want to go for a competitive PCCM fellowship..thanks everyone, this was very helpful.

 

[Tigerz_Fan]

haha..for some reason I have a feeling I am being a bit over-enthusiastic about wanting more ICU months ? But I guess I would have to do that if I eventually want to go for a competitive PCCM fellowship..thanks everyone, this was very helpful.

I did 7 months, and had to list the 7th as a "hospitalist" month to hide from ACGME.

Anyway, PM me if you like and we can talk about the programs.....

 

[gutonc]

(And I don't personally count CCU as an ICU, not trying to be provocative, they just aint the same)

Depends on the setting. But overall, my CCU patients were a lot less sick than the ICU folks were. Didn't really complain though.

 

[jdh71]

Depends on the setting. But overall, my CCU patients were a lot less sick than the ICU folks were. Didn't really complain though.

Sure, you have your occasional cardiogenic guys on balloon pumps, but for the most part anything worse than that, especially if needing a vent, pulm/icu is either primary or the consultant running the show everywhere I've been.

EDIT:

What I am saying: Cardiac care is acute care - VERY acute in many instances, but it's not the same as MICU/SICU care

 

[gutonc]

Sure, you have your occasional cardiogenic guys on balloon pumps, but for the most part anything worse than that, especially if needing a vent, pulm/icu is either primary or the consultant running the show everywhere I've been.

EDIT:

What I am saying: Cardiac care is acute care - VERY acute in many instances, but it's not the same as MICU/SICU care

Actually, in my program, the only thing that got the Pulm/CC guys on board for CCU cases was if you had to tube the patient. And that was institutional policy for vented patients regardless of who was primary - Vent = Pulm Consult even in the SICU where Gas ran the show (no this is not logical but like all institution-wide policies it was made in a knee-jerk fashion by people who don't know what they're talking about). In general, the ICU folks were happy to keep their hands off the cards patients if at all possible.

And for the record, I have no dog in this fight any longer. I went into Onc and am happy to step back and let whoever take over when it gets to that point. I'll stay on board and be close by for sure but if we're dropping tubes and starting pressors, I know enough to step aside.