Leading The Way In Fellowship Education Training
Echocardiography and Critical Care Ultrasound
Stanford Critical Care Medicine has a long and extensive history in training fellows and residents in bedside echocardiography and ultrasound for critically ill patients. In 2009, Dr. Anne-Sophie Beraud enhanced the training through implementation of bedside training, simulation training, focused individual feedback for acquired images, and online resources.. Dr. Beraud and Dr. Sara Nikravan developed a self-directed online training course for Anesthesia, Internal Medicine, and Emergency Medicine trainees. This course is now available through Stanford EdX. The course will lead you through the core concepts of ultrasound physics, transthoracic echocardiography, lung ultrasound, and measurement techniques.
Dr. Vidya Rao became the Director of Point of Care Ultrasound for the Department of Anesthesiology, Perioperative, and Pain Medicine in 2017. Through her leadership, the Critical Care Ultrasound Training curriculum for CCM fellows has continued to grow. She is joined by a group of core faculty dedicated to state-of-the art ultrasound training for our fellows. These faculty include Dr. Paul Mohabir, Dr. Jenny Wilson, Dr. Yoshi Mitarai, Dr. Fred Mihm, Dr. Javier Lorenzo, Dr. Marianne Chen and Dr. Jai Madhok.
The formal ultrasound and echocardiography training for our fellows encompasses formal training in TTE as well as More TEE, non-cardiac applications (FAST exam, lung, abdominal, DVT and ocular ultrasound) of ultrasound in the ICU, as well as ultrasound-guided vascular access.
Training in transthoracic echocardiography for critically ill patients takes place over the entirety of the fellowship program in order to provide a longitudinal learning experience. All fellows spend one week of intensive training in TTE during the first two months of fellowship. The week incorporates simulation training, one-on-one bedside scanning with attending physicians, in addition to one-on-one bedside training with the echocardiography ultrasonographer technicians. Each fellow is expected to review all images during this one-week training. The week concludes with a one-on-one review session with Dr. Rao to review all images obtained. This bootcamp week prepares fellows to use critical care ultrasound 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.
Many fellows choose to complete an elective in Advanced Echocardiography and Critical Care Ultrasound. This elective incorporates advanced transthoracic echocardiography techniques, training in transesophageal echocardiography, and involvement and participation in the many ultrasound and echocardiography research studies conducted at Stanford and our affiliate sites. During this elective the fellow is encouraged to attend reading review sessions hosted by the Cardiac Anesthesia Division and the monthly ECHO rounds didactic. Fellow are encouraged to record all studies and document all studies throughout fellowship training in MedHub. All fellows trained to reach competency at the advanced level by the end of their training. The recommended studies for competency in critical care ultrasound training are listed below and are adapted from SCCM, SOCCA, and Stanford CCM guidelines.
Airway Management Training
The Stanford Advanced Airway Management Program (SAAMP) of the Department of Anesthesiology offers comprehensive, multidisciplinary airway training to a national and international audience. The course is ideally suited for anesthesiologists, critical care, emergency medicine, and ENT physicians. Critical care fellows will attend this course during their fellowship training to advance their airway management skills. Many of our current and former faculty in addition to current and former fellows are highlighted in this video showcasing the course.
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).
Critical Care Simulation
Stanford is well known for being one of the originators of simulation in Anesthesia. The Simulation Center is now being used in the area of Critical Care to help improve physician response in highly stressful, life-threatening situations.
Fellows serve as instructors in a critical care simulation course for medical students and participate in simulation-based team training activities at both the VA and Stanford hospitals. Facilities include high capability simulation centers at both adult hospitals and Packard Children’s hospital, and use of workplace-based (in situ) simulations throughout these facilities. Stanford has a long-standing tradition in using patient simulation to research human performance in the operating room and ICU.
Fellows can use research time to develop a scholarly concentration in simulation activities by participating as an instructor in existing programs and potentially developing their own curricula. Fellows are welcome in simulation instructor courses, debriefing workshops as well other medical education programs throughout the medical school.
Current developed Curricula during Critical Care Fellowship
- Code team training
- Unannounced in situ mock codes at the VA hospital
- Unannounced in situ sepsis and hemorrhage crises at the VA hospital
- Anesthesia Crisis Resource Management for anesthesia residents
- Twice monthly ICU crisis management simulations at the VA
- High risk maternal-fetal simulation
- Monthly code team training at the VA