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After graduating from nursing school, I was fortunate to land a job in the adult critical care unit of the regional level one trauma center in my town. As a new nurse I was constantly awed by the knowledge and experience of everybody around me, and I wondered if I would ever operate with the same efficiency and intuition that the rest of the team seemed to have. Among all of these talented individuals there were two doctors who seemed to stand out above the rest. It was rumored among the nurses that the reason why one was so good was because he had been a nurse before becoming a doctor. Go figure! Who would have thought that nurses would hypothesize that doctors would be much better doctors if they had been nurses first? However, rumor had it that the second doctor was so good because he had been an anesthesiologist and then went back to do a second residency in internal medicine and intensive care.
After several months I decided I would ask that doctor about the path that lead him to do two residencies. It was then that I was first introduced to the wide array of specialties that a residency in anesthesiology can lead to. He chuckled as I told him of the rumors of his dual residency and clarified that he had done a residency in anesthesiology and then a fellowship in critical care. He told me that anesthesiology residents have a variety of fellowships to choose from and that critical care was simply one of the paths he could have chosen.
What is the Critical Care fellowship?
The Critical Care fellowship is an additional 12 months of training after completing residency in anesthesiology. There are 54 accredited fellowships available throughout the United States. Critical Care medicine is a multidisciplinary field concerned with patients who have sustained, or are at risk of sustaining, life threatening, single- or multiple-organ system failure due to disease or injury. The fellowship in Critical Care medicine will train fellows to recognize and manage acutely ill patients, providing care for these patients in the setting of the intensive care unit through continuous observation and interventions.
What is learned during the fellowship?
Critical Care medicine is mastered through both clinical experience as well as didactics. For those who are thinking they’ve already endured a lifetime worth of didactics, these sessions don’t seem to be the “run of the mill sleeper hold” lectures. Fellowship didactics include learning transesophageal echocardiogram (TEE), external cardiac echocardiogram techniques, learning modules that are integrated into monthly simulation exercises, advanced trauma life support (ATLS), and learning the nuances of invasive monitoring necessary to care for the critically ill patient. But perhaps the keystone of the Critical Care training is the clinical experience. Most programs offer nine months of clinical experience in the multidisciplinary adult surgical ICU and three months of elective rotations in areas such as cardiovascular, neurosurgical, orthopedic, transplant or vascular surgery patients. One surprising feature of several Critical Care fellowships is that a portion of the time spent clinically is actually in the O.R. providing anesthesia for critically ill patients and practicing some of the skills such as TEE in cardiothoracic cases.
Finally, what fellowship would be complete without research? Critical Care fellowships offer a myriad of research opportunities in a mentor-guided environment to allow fellows the opportunity to advance their skills in anesthesia or critical care based research.
Why choose a Critical Care fellowship?
Choosing which fellowship is right for you is a highly individualized decision. The doctor that I worked with in Flagstaff, AZ, chose critical care medicine because he liked the challenge that the ICU represented. The cerebral nature involved with providing care for 15 critically ill patients at once drew him to critical care. Perhaps others will be drawn by the variety of cases that will be encountered every night while working with this patient population. Further, others may be drawn out of the O.R. by the continuity of care. Anesthesiologists in the O.R. generally only see patients for a few hours while a critical care trained anesthesiologist in the ICU may see a patient through the entire period of their acute illness.
Whatever the reason might be, if you loved your rotations in the ICU as a medical student, then the Anesthesia Critical Care route will provide the best training to successfully become a leader within critical care team.
Resources:
Find more information about the Critical Care fellowship and specific programs at Society of Critical Care Anesthesia - http://www.socca.org
Duke University Critical Care fellowship - http://anesthesiology.duke.edu/?page_id=818043
Vanderbilt University Critical Care fellowship - https://www.mc.vanderbilt.edu/root/vumc.php?site=1anesthesiology&doc=32537
posted summer 2015
