Critical Care Medicine  

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.

ICU

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. 

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