Training in Critical Care Medicine
For fellows entering the one-year track, typically those who have completed a prior ACGME-accredited internal medicine subspecialty fellowship, the program consists of a minimum of 12 months devoted to clinical experiences. At least six months must be dedicated to the direct care of critically ill medical patients in settings such as the MICU. In addition, a minimum of three months must be spent caring for critically ill non-medical patients, such as those in trauma, neuro, or surgical ICUs. The remaining time may be allocated to clinical electives, procedural training, or scholarly activity based on the fellow’s interests.
For fellows entering the two-year track, such as those coming directly from residency without prior subspecialty fellowship training, the program spans 24 months. At least twelve of these months are devoted to clinical critical care experiences, including a minimum of six months managing critically ill medical patients and at least three months in non-medical ICU environments. The remaining three months of the clinical year may include electives or other ICU rotations. An additional twelve months of the two-year program are customized to include further clinical training, focused electives, or scholarly activity, including research, quality improvement, or medical education initiatives, taking into accounts the fellow’s career goals.
The objectives of the medical ICU rotation are to allow the trainee to provide ongoing care to a wide variety of critically ill patients, develop appropriate skills for making an accurate diagnosis, learn how to prioritize areas of urgency, and apply appropriate therapy to assist these patients.
Critical Care Medicine Rotations
1. Core Rotations
- Medical ICU – Day Rotation
- Medical ICU – Night Rotation
- Neuro-Critical Care Rotation
- Cardiovascular ICU Rotation (CVICU)
- Trauma ICU Rotation
2. Elective Rotations
- Trauma ICU
- Neuro ICU
- Cardiovascular ICU (CVICU)
- Pulmonary Consultation Service
- Point-of-Care Ultrasound
- Anesthesiology
- Research
3. Procedural Training
- Point-of-Care Ultrasound Workshop
- Central Venous Catheter Insertion Workshop
- Airway Management Simulation Training
- Difficult Airway Workshop
- Chest Tube Insertion Workshop
- Blakemore Tube Placement Workshop
Medical ICU Rotation
The Medical ICU rotation provides fellows with comprehensive experience managing a wide variety of critically ill medical patients. Fellows develop skills in accurate diagnosis, prioritization of urgent issues, and application of evidence-based therapies. The rotation emphasizes procedural competency in airway management, ventilator management and weaning, central venous catheter placement (internal jugular, subclavian, axillary under ultrasound guidance), thoracentesis, chest tube placement and management, pulmonary artery catheterization, flexible bronchoscopy, cardioversion, cardiopulmonary resuscitation, and post-resuscitation care. Fellows also gain experience managing non-intubated patients requiring advanced airway support and work collaboratively within multidisciplinary teams to optimize patient outcomes.
Cardiothoracic ICU (CTICU) Rotation
During the Cardiothoracic ICU rotation, fellows care for patients undergoing complex cardiac and thoracic surgeries, including heart and lung transplantation and patients requiring mechanical circulatory support such as ECMO or ventricular assist devices. The rotation focuses on advanced hemodynamic monitoring, management of vasoactive agents, and post-operative care in collaboration with cardiac surgery, anesthesiology, and perfusion teams.
Trauma ICU Rotation
The Trauma ICU rotation focuses on the resuscitation and ongoing management of patients with multisystem trauma, including traumatic brain injury, thoracic and abdominal trauma, and hemorrhagic shock. Fellows develop expertise in invasive monitoring, chest tube placement, advanced airway management, and complex resuscitative strategies, working closely with trauma and acute care surgical teams.
Neurocritical Care ICU Rotation
The Neuro ICU rotation provides fellows with experience managing critically ill patients with acute neurological conditions such as stroke, intracranial hemorrhage, status epilepticus, CNS infections, and coma. Fellows develop cognitive and procedural skills in neurocritical care under the supervision of board-certified neurointensivists, with a focus on multimodal monitoring, elevated intracranial pressure management, and neuroprotective strategies.
Point-of-Care Ultrasound (POCUS) Elective
All fellows participate in a dedicated full-day POCUS workshop featuring didactic sessions and hands-on training in diagnostic imaging and ultrasound-guided procedures. A full-month POCUS elective is available, during which fellows conduct daily supervised ultrasound rounds focusing on advanced critical care applications.
Anesthesia Elective
The anesthesia elective provides fellows with focused training in airway management and perioperative physiology. Fellows work alongside attending anesthesiologists in the operating room to gain proficiency in airway assessment, bag-mask ventilation, endotracheal intubation (including advanced techniques), laryngeal mask airway placement, and pharmacologic management of sedation and neuromuscular blockade. This experience strengthens the fellow’s skills in managing difficult airways and complex cardiopulmonary physiology in critically ill patients.
Pulmonary Consultation Elective
The pulmonary consultation elective offers fellows additional exposure to the diagnosis and management of complex pulmonary disorders in hospitalized patients. Under the supervision of pulmonary faculty, fellows gain focused procedural experience in flexible bronchoscopy, including airway inspection and bronchoalveolar lavage. The rotation also provides hands-on training in thoracentesis and chest tube placement and management for pleural diseases. Fellows refine their ability to integrate procedural skills related to bronchoscopy and pleural diseases, enhancing their readiness for independent critical care practice.
Training in Research
Fellows are expected to be engaged in performing scholarly activity under the supervision of a faculty. A total of 6 months during the 2 years of fellowship can be dedicated to research. Fellows are exposed to various research opportunities and ideas. Progress in scholarly activity is monitored at regularly scheduled research conferences. Evidence of completion of a given project will be through a presentation of an abstract at a regional or national meeting and authorship of a publication stemming from the research.