Stanford School of Medicine
Critical Care Medicine– In the Department of Anesthesia

Fellowship Program

RELATED INFO

Fellows Research

Current/Past Fellows

Fellowship Application

Critical Care Medical References (SUNet ID Required)

The Stanford CCM Program is approved by the Accreditation Council for Graduate Medical Education (ACGME) for both anesthesia and medicine CCM.
Anesthesia CCM Fellowship application. (Beginning for 2008 slots, Medicine CCM applicants only will use ERAS. Link to Medicine CCM webpage.)

Anesthesia CCM The Anesthesia CCM Fellowship is a 1-year program involving patient care at Stanford and the PAVAMC and opportunity for research that may include additional training if desired. Satisfactory completion of CCM training allows Anesthesia CCM fellows to apply for subspecialty certification in CCM by the American Board of Anesthesiology (ABA) if they are certified by the ABA in Anesthesiology.

Surgical CCM The American Board of Surgery in 2006 has announced that a fully trained surgeon (or a surgical resident with at least 3 years of General Surgery training) may obtain CCM training in an accredited Anesthesia CCM program for 1 year of training. Surgical applicants should apply through our Anesthesia CCM site and application process. Surgeons who complete CCM training with us are eligible to take the ABS Critical Care exam.

Medicine CCM
Two years of CCM training are required for subspecialty certification by the American Board of Internal Medicine (ABIM) if certified by the ABIM in Internal Medicine. Alternatively, ABIM certified internists with ABIM certification in another subspecialty (e.g., Pulmonary, Nephrology, Cardiology, Hematology, Infectious Disease) are eligible for ABIM certification in CCM with 1 year of CCM training.

CCM fellows are expected to advance their knowledge of critical care medicine through a concentrated exposure to critically ill patients as well as concentrated time for the study of materials related to such patients. We provide an intimate relationship with experienced ICU attendings who can help translate that knowledge into clinical skill. Fellows are also expected to learn how to convey knowledge/skill, and become teachers of their specialty. Lastly, they are also expected to acquire skills with regard to the management of an ICU and the triage of critically ill patients.

With the initiation of accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in 1987, the Stanford CCM Programs in Anesthesiology and Internal Medicine have gained accreditation status each evaluation period and with the establishment of subspecialty board certification in 1986, the CCM fellows graduating from Stanford have had 100% success in attaining certification.

Clinical Training

The Stanford Intensive Care Units consist of a 32-bed Medical Surgical Intensive Care Unit and a 25-bed Cardiovascular Surgical Intensive Care Unit. The main service for training during the fellowship is the Medical-Surgical Intensive Care Unit Service on which the fellow works is responsible for the primary management of 20 - 40 patients in these units. The fellow is exposed to a broad scope of pathology. The service is composed of a faculty of seven attendings trained in Anesthesia and/or Internal Medicine. All the attendings have completed specialized training in Critical Care Medicine. Each month the service is under the direction of an attending, who supervises the patient care delivered by six residents from Anesthesia, Medicine and Emergency Medicine. The six residents are on call every third night. In addition, each month there are two or three medical students.

The clinical training in Critical Care begins with the fellow serving one month as a resident. During that time, he or she takes call and admits patients as a resident, staying in-house every third night. All patient care orders are written by the ICU resident under the supervision of the ICU fellows and faculty. The next 2-3 months the fellow works as a junior fellow supervising resident and student performance along with the ICU attendings. Night call during this time and for the rest of the year is 7-8 times per month, during which the fellow is available (not necessarily in-house) to the on-call house staff for advice, assistance and supervision. In order to take call from home the fellow must reside within 15 minutes of the hospital. The fellow, in turn, is backed up by one of the ICU faculty. As the year continues, fellows progress to senior fellow activities which include running rounds intermittently during the week and on weekend call days, lecturing, etc.

Fellows will also rotate to the Medical-Surgical ICU at the Palo Alto Veterans Administration Medical Center . The experience there is similar to that at Stanford, providing additional training in post-operative surgical and cardiac surgical critical care.

Fellows also have the opportunity to train at Stanford hospital on a the Trauma ICU Service which is staffed by critical care surgeons, anesthesiologists and pulmonary medicine attendings.

Fellows may also train on the newly formed (2005) Cardiothoracic ICU Service at Stanford Medical Center. This service provides more training in the care of major heart, vascular, heart/lung transplant patients in the immediate postoperative period and is staffed by anesthesia and pulmonary medicine faculty.

Near the end of a first year of clinical training, the fellow serves one month as junior attending on the service, being responsible for all patient care and teaching activities. One of the ICU faculty physicians is available and frequently present to evaluate and critique the fellow's performance and to ensure optimal patient care. 

Echocardiography

Training in echocardiography is provided each year with a 4 week course taught by Stanford cardiologists with emphasis on basic echocardiographic techniques with helpful case examples.

The goal of this course is to allow critical care fellows to use echocardiography to assist in the bedside assessment of critically ill patients in order to quickly assess volume status (e.g. inferior venal caval diameter) and to identify cardiac tamponade, cardiac function (e.g. significant wall motion abnormalities) and major valve dysfunction.

Airway Management Training

Non-anesthesia fellows receive hands-on training in basic airway management with all routine intubations using an outstanding video laryngoscopy system, so that subtleties of direct laryngscopy can be learned, in the realtime ICU environment.

An Advanced Airway Workshop in all areas of airway management is held in conjunction with the Anesthesia department to train fellows in basic/advanced Fiberoptic intubation techniques, as well as many other advanced techniques (LMA, Fastrach LMA, Trachlight, Double lumen endotracheal intubation, Retrograde
guidewire, classical and percutaneous Cricothyrotomy).

Didactics

A fellowship didactic lecture series runs weekly throughout the year and provides lectures delivered by the ICU faculty and faculty from numerous departments within the medical center. This lecture series is designed on a 1 year schedule to cover the broad range of Critical Care Medicine. This is an independent lecture series from the resident lecture series. The current year's lectures are listed below.

DATE

TOPIC

LECTURER
Sept 7 Hemodynamic Monitoring I Fred Mihm, MD
Sept 14 Hemodynamic Monitoring II Fred Mihm, MD
Sept 21 Mechanical Ventilatory Support Stephen Ruoss, MD
Sept 28 Airway Management Ed Bertaccini, MD
Oct 5 Analgesia, Sedation and Neuromuscular Blockade Tim Angelotti, MD
Oct 12 No Lecture- ASA and ASCCA Meetings this week None
Oct 19 Hemodynamic Pharmacology Andrew Patterson, MD
Oct 26 Pathophysiology of Altered Hemodynamic States Mike Rosenthal, MD
Nov 2 Dx/Rx of Supraventricular Tachyarrhythmias Paul Zei, MD
Nov 9 Current Management of Myocardial Ischemia/Infarction Bill Fearon, MD
Nov 16 Mechanical Support of the Heart Marc Patrick Pelletier, MD
Nov 23 Thanksgiving - no lecture Happy Thanksgiving
Nov 30 Shock and Sepsis Mike Rosenthal, MD
Dec 7 Pathophysiology of Respiratory Failure Norm Rizk, MD
Dec 14 Acute Respiratory Distress Syndrome Ann Weinacker, MD
Dec 21 Pulmonary Hypertension Ronald Pearl, MD
Dec 28 Holidays season / New Years No lectures
Jan 4 Pulmonary Thrombo-embolic Disease Peter Kao, MD
Jan 11 Pulmonary Venous Air/Amniotic Fluid/Fat Embolism Fred Mihm MD
Jan 18 Renal Insufficiency - Pathophysiology and Management Mike Rosenthal, MD
Jan 25 Pulmonary Insufficiency in the Immunocompromised Patient Ann Weinacker, MD
Feb 1 Anaphylaxis Fred Mihm, MD
Feb 8 Asthma Stephen Ruoss, MD
Feb 15 Techniques for Renal Support Jeffrey Petersen, MD
Feb 22 Nutritional Support Juli Barr, MD
Mar 1 Non-variceal GI Bleeding and Variceal GI Bleeding Subhas Banerjee and Mindie Nguyen
Mar 8 Hepatic Insufficiency - Pathophysiology and Management Gabriel Garcia, MD
Mar 15 Liver Transplantation – Selection, Intraop and Postop Management Waldo Concepcion, MD
Mar 22 Obstetrical Emergencies Mark Taslimi, MD
Mar 29 The Trauma Patient David Spain, MD
Apr 5 Bone Marrow Transplantation Ginna Laport, MD
Apr 12 Diagnosis and Management of Seizure Disorders Robert Fisher, MD
Apr 19 Endocrine Emergencies Fred Mihm, MD
Apr 26 Approach to the Comatose Patient Christine Wijman, MD
May 3 Medical Management of Subarachnoid Hemorrhage Christine Wijman, MD
May 10 Management Raised Intracranial Pressure Christine Wijman, MD
May 17 Palliative Care and the ICU VJ Periyakoil, MD
May 24 Encephalitis and Meningitis Jaime Lopez, MD
May 31 Drowning Stephen Ruoss, MD
June 7 Coagulopathies - Evaluation and Management Steven Coutre, MD
June 14 CQI Peter Rudd, MD
June 21 Life-Threatening Pediatric Emergencies Saraswati Kache, MD
June 28 ICU Administration Norm Rizk, MD, Fred Mihm, MD & Eran Geller, MD

Research Training

The nonclinical portion of the fellowship is flexible. We expect each fellow to participate in some area of research related to critical care. We have facilities to do clinical and laboratory physiologic and molecular biological studies. A laboratory with technical, financial and computer support is available. The varied interests of our faculty can introduce the fellow to a wide variety of investigative skills

Anesthesia Fellowship application
Beginning for 2008 slots, Medicine CCM applicants only will use ERAS. (Link to Medicine CCM webpage.)

 

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