Surgical Critical Care Fellowship
The one-year ACGME accredited surgical critical care fellowship program encompasses all aspects of care of the critically ill surgical patient, with emphasis on cardiopulmonary mechanics, principles of resuscitation, and mechanical ventilation. University of Cincinnati Medical Center is the primary teaching facility for the surgical critical care fellowship. It is the tertiary referral hospital for southern Ohio, eastern Indiana, and northern Kentucky, serving a population of over 2 million with over 90,000 emergency department visits annually. The hospital also maintains the only verified adult Level 1 trauma center and adult burn center for the regions of Southwest Ohio, Eastern Indiana and Northern Kentucky.
University of Cincinnati Medical Center has approximately 100 adult critical care beds, distributed through the surgical, medical, neuroscience, and cardiovascular intensive care units. The SICU consists of 34 adult beds with 150-170 monthly admissions from all surgical specialties, including trauma, general surgery, transplantation, surgical oncology, vascular surgery, urology, ENT, thoracic surgery, obstetrics/gynecology and ENT. Daily multidisciplinary rounds are collaborative in nature, with input and discussion from all team members, including respiratory therapists, pharmacists, nurses, Subspecialty services, such as nephrology, infectious disease, rehabilitation medicine, cardiology, and hematology are available and consulted as needed. Additional clinical support in the SICU includes nutrition services, nurse educator, and dedicated SICU social worker.
The SICU at University of Cincinnati Medical Center serves as a critical care educational venue for residents not only from numerous specialties but also from other local and regional institutions. Other required critical care rotations include the Neurocritical care unit, Cardiovascular Intensive Care Unit, and the Pediatric Intensive Care Unit at Cincinnati Children’s Hospital Medical Center. The NSICU is a 20 bed unit with neurosurgical admissions following tumor and skull base surgery, spine surgery, advanced neurovascular interventions, and traumatic brain injury. As the region’s stroke center, patients undergoing state of the art therapy for stroke, seizures, and other neurologic diseases are also cared for in the NSICU. Patients in the CVICU include post-operative patients as well as those with heart failure and acute coronary disease. ECMO and LVAD are supported as well.
The Pediatric Intensive Care Unit in the renowned Cincinnati Children’s Hospital Medical Center is a 36 bed multidisciplinary unit for children beyond the newborn age with over 2000 combined medical and surgical admissions annually. I addition to pediatric trauma patients other PICU admissions include neurosurgical, airway reconstructive surgery, solid organ transplantation, and orthopedic patients. All forms of mechanical ventilatory support, including liquid ventilation and high frequency ventilation, renal dialysis, continuous veno-venous / veno-arterial ultrafiltration, and ECMO are available and employed as support modalities in the PICU.
Other venues for critical care education include the other adult units at University of Cincinnati Medical Center (Medical, and Adult Burns) and the pediatric Shriner’s Burn Institute. These can be arranged according to fellow interest and availability. Experience in trauma surgery is also offered and encouraged during the one-year fellowship through elective rotations.
The surgical critical care fellowship was reviewed by the ACGME in 2016 and was granted Continued Full Accreditation. Options for extending the fellowship for a second, non-ACGME accredited year are available and include acute care surgery, trauma, and advanced research and educational opportunities. Second year positions will be considered on an individual basis depending on funding.
In accordance with requirements set forth by the Accreditation Council for Graduate Medical Education (ACGME), the didactic curriculum and clinical skills that a Fellow is expected to master are categorized into six core competencies:
- Patient Care
- Medical Knowledge
- Practice-Based Learning and Improvement
- Interpersonal and Communication Skills
- Systems-Based Practice
These competencies serve as a general, but not exhaustive, guide to the knowledge, skills, attitudes and behaviors that should be demonstrable over the course of the fellowship program.
The fellow will acquire advanced knowledge of essential aspects of critical care, particularly as they related to the management of patients with hemodynamic instability, multiple system organ failure and complex co-existing medical problems. These aspects include, but are not limited to:
- Cardiorespiratory resuscitation
- Physiology, pathophysiology, diagnosis and therapy of disorders of the cardiovascular, respiratory, gastrointestinal, genitourinary, neurological, endocrine, musculoskeletal and immune systems, as well as infectious diseases
- Metabolic, nutritional and endocrine effects of critical illness
- Hematologic and coagulation disorders
- Critical obstetric and gynecological disorders
- Trauma, thermal, electrical and radiation injuries
- Inhalation and immersion injuries
- Monitoring and medical instrumentation
- Critical pediatric surgical conditions
- Pharmakokinetics and dynamics of drug metabolism and excretion in critical illness
- Ethical and legal aspects of surgical critical care
- Principles and techniques of administration and management
- Biostatistics and experimental design
Fellowship training activities generally consist of the following:
- Attendance and participation in morning rounds. The fellow is expected to provide input regarding patient care, and to assist in resident teaching.
- Continued care of the patient following rounds, under the supervision of the attending, incorporating patient care with education of the residents.
- Participation in fellow-faculty conferences: journal club and multidisciplinary critical care presentation in a grand rounds format. These are respectively conducted the second and fourth Mondays of each month. Other lectures and conferences may be added during the academic year.
- Attendance at multidisciplinary critical care core lecture series (schedule provided). If a conflict with patient care arises, the attending will provide clinical care coverage so that the fellow can attend the lecture.
- Preparation and lectures as scheduled and may include SICU resident lecture, Thursday trauma conference, or Critical Care Grand Rounds.
- Participation in administrative meetings, i.e., SICU Protocol Committee, SICU Morbidity and Mortality Conference. This will provide exposure to quality assurance activities, as well as other activities related to SICU administration.
- Attendance at Trauma Division meetings to discuss ongoing issues, resident evaluations, and related administrative/ professional matters as needed.
- Interaction with the clinical trials group during regularly scheduled research meetings, and informally, as patients are screened and entered into clinical trials. Participation in at least one research project is encouraged, with the goal of publication, and/or presentation at a national meeting.
- Participation at monthly billing meetings to become familiar with documentation and coding regulations.
Daily, supervised training is supplemented with independent reading. The fellow is expected to supplement didactic learning experiences with independent learning, including, but not limited to materials provided in the independent reading lists.
- SICU Multidisciplinary Core Lecture Series
- Fellows Conference – Multidisciplinary Case Presentations (monthly)
- Resident Trauma Conference (weekly)
- Critical Care Journal Club (monthly)
- SICU Morbidity & Mortality Conference (monthly)
Program Administration: Krishna Athota, MD, Program Director
How to Apply
Qualifications: Candidates for the Surgical Critical Care fellowship must have completed an accredited residency in general surgery. At this time, the fellowship is open only to residents who will have completed an ACGME-accredited residency program. While, as a general rule, the ACGME allows third year residents to participate in surgical critical care fellowships, our faculty believe that the fellow will obtain the maximal benefit from the program after completing general surgery residency. In addition, the completion of the residency allows the fellow to participate fully in operative trauma cases during the critical care fellowship.
The application process for any of these fellowships includes a written or online application, at least three letters of recommendation, and a personal interview. One letter of recommendation must be from your Program Director; the others should be from individuals with first-hand knowledge of your skills and performance. Personal interviews begin in April of the year proceeding the initial fellowship year. Applications are made and interviews are arranged through the Section of General Surgery, Division of Trauma, Surgical Critical Care and Acute Care Surgery.
Application for Surgical Critical Care Fellowship
Click here [http://sccpds.org/] for more information on applying for Surgical Critical Care fellowships. Applications will not be accepted after April 30.
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