Critical Care Medicine Fellowship
The Stanford University Critical Care Medicine (CCM) fellowship programs are ACGME certified and open to applicants with background residency training in anesthesiology, emergency medicine and internal medicine. Emergency medicine residents may either apply via the ABIM or the ABA pathway. One and two year duration fellowships are available, with the duration of training dependent upon background residency training, fellowship research interests, and the specific eligibility requirements for licensing board certification.
Overview
The Stanford Medical-Surgical ICU service is considered the primary service for the training program. Patients are located in the D1 ICU that specializes in the care of critically ill hematology, oncology, and bone marrow transplant patients and the M4 ICU that cares for patients with a wide variety of medical problems including pre- and post-lung transplantation care and management of pre-transplant end-stage liver disease. The patients are co-localized allowing the fellow to provide coverage and assume primary responsibility for the management of 12-15 patients on each ICU service. The fellow is exposed to a broad scope of pathophysiology and disease states. The service is composed of faculty trained in Anesthesia, Internal Medicine (+subspecialties), and/or Emergency Medicine. All the attendings have completed specialized training in Critical Care Medicine. The service is divided into three teams each consisting of an attending, fellow, APPs, and residents from Anesthesia, Internal Medicine and Emergency Medicine. Critical Care is a required 4-week clerkship in the School of Medicine so medical students are active members of the care teams in the ICU.
The MSICU also has a robust triage service that operates 24/7, 365 days a year led by our CCM fellows, backed up by an attending intensivist. The triage service is responsible for responding to emergencies all across the hospital, handling ICU consults, evaluating requests from the transfer center, and assisting in navigating bed flow along with the nursing supervisor. Other members of the triage team include residents and APPs.
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 Health Care system and assuming the role as a specialist in critical care medicine. 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 in a night float system with anywhere between 5-7 night shifts on core ICU rotations. The fellow is always backed up by an attending intensivist. As the year continues, fellows progress to senior fellow activities which include running rounds intermittently during the week, 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 Cardiovascular ICU service, which provides excellent exposure to complex open heart, major vascular, and heart, lung, heart/lung transplant patients in addition to extracorporeal membrane oxygenation and various types and configurations of temporary mechanical circulatory support. Additional experience is obtained at the Santa Clara Valley County hospital in their Medical ICU, our Surgical-Trauma ICU, and the Neuro Critical Care Unit to provide a well-rounded and comprehensive critical care education.