The Stanford-Medical Surgical ICU service is considered the primary service for the training program. Patients are located in the E2-Medical-Surgical ICU, a 36-bed multispecialty unit, however the team provides care to critically ill patients in remote areas (PACU, ED, alternate units) as needed. This allows the fellow to provide coverage and assume primary responsibility for the management of 15 - 30 patients. The fellow is exposed to a broad scope of pathophysiology and disease states. The service is composed of a faculty of 14 attendings trained in Anesthesia, Internal Medicine, and/or Emergency Medicine. All the attendings have completed specialized training in Critical Care Medicine. The service is divided into two teams each consisting of an attending, fellow, and four residents from Anesthesia, Medicine and Emergency Medicine. Medical students as a part of the Critical Care Core Clerkship are also active members of the teams.

The clinical training in Critical Care begins with an introduction to critical care medicine in the Stanford Medical-Surgical ICU. The first month provides a transition to providing care within the Stanford Healthcare system and assuming the role as a specialist in critical care medicine. The fellow completes a minimum of two weeks of primary patient-care duties on one of the teams. During that time, he or she takes call and admits patients, completes detailed documentation within the EMR, reports to a supervising senior fellow, and participates in the resident-call schedule (approximately taking call every fourth night. The subsequent two weeks in the first rotation are spent taking fellow-level ICU shifts under direct supervision of experienced fellows. This allows the fellow to transition into the fellow role prior to taking call solo. This month also includes an introduction to mechanical ventilation through weekly bedside ventilator rounds, hands-on procedural and ultrasound workshops, and participation in the morning lecture series provided for the residents on basic critical care medicine topics.

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 of our fellowship, which was published on the Society of Critical Care Anesthesiologists (SOCCA) website in 2012. Our critical care fellowship leadership members strive to make changes to improve the program on a yearly basis, so many things have advanced since this publication. We believe the review captures the essence of our critical care learning environment.