Critical Care Medicine  

Fellowships Training

Thank you for your interest in our Fellowship Training Program in Critical Care Medicine.  We offer CCM fellowship training, beginning in July, August.  These positions are open to candidates who are Board eligible or certified in Anesthesia, Internal Medicine, Emergency Medicine, Neurology and Surgery.

The Stanford Intensive Care Units consist of a 36-bed Medical Surgical Intensive Care Unit and a 25-bed Cardiovascular Surgical Intensive Care Unit. The Medical-Surgical ICU Service on which the fellow works is responsible for the primary management of 15 - 24 patients in these units. The fellow is exposed to a broad scope of pathology. The service is composed of a faculty of 14 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 8 residents are on call every fourth 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 fourth 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 general surgical and cardiac surgical critical care. Fellows also rotate on the Stanford Cardio-Thoracic ICU service, which provides excellent exposure to complex open heart, major vascular, and heart, lung, and heart/lung transplant patients. Additional experience is obtained at the Santa Clara Valley County hospital in their Medical ICU.

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.  The remainder of the fellowship is flexible. Fellows are encouraged to take an elective month in Echocardiography/ultrasound, Airway management (non-Anesthesia fellows), or various specialties of Medicine or Neurology.   We expect each fellow to participate in some area of research or academic work related to critical care.  We have facilities to do clinical physiology 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.

For more detailed information, applicants are encouraged to read an in-depth review (page 8 of the newsletter) of our fellowship by 2 of our recent fellows, which was published on the Society of Critical Care Anesthesiologists (SOCCA) website.

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