University of Michigan Critical Care Fellowhsip

Univeristy of Michigan

By Carrie Harvey, MD and Ivan Co, MD
Critical Care Fellows, University of Michigan

Name of program:  University of Michigan

Specialty certification pathway:  Anesthesia or Internal Medicine

Length of fellowship: Two years

Number of fellows: Anesthesia - 1 dedicated EM fellow/year, Internal Medicine - 1 dedicated EM fellow/year

Internal Medicine Curriculum:

All rotations are in four week blocks, with a total of 13 rotations per year. 

First year:
Medical ICU: 3 blocks
Surgical ICU: 2 blocks
Emergency Critical Care Center: 3 blocks
Cardiac ICU: 1 block
Trauma/Burn ICU: 1 block
Neuro ICU: 1 block
Elective: 2 blocks

Second year:
Medical ICU: 3 blocks
Surgical ICU: 1 block
Emergency Critical Care Center: 3 blocks
Cardiovascular ICU: 1 block
Elective: 5 blocks

Total months in ICU:  11 first year, second year variable

Vacation:  3 weeks per year

Call responsibilities: Varies depending on rotation, night float 2-4 weeks/year

Didactics: Conference schedules sponsored by the Department of Internal Medicine, other Departments, and our own Division include the following weekly or biweekly conferences:

  1. Core Pulmonary Clinical Conference
  2. PCCM Case Conference and Journal Club
  3. Research Conference
  4. Core Surgical Critical Care Conference
  5. Tumor Board: Weekly Multidisciplinary Conference
  6.  Interstitial Lung Disease Case Conference
  7. VA Joint Pulmonary/Thoracic Conference
  8. Pulmonary & Critical Care Board Review

Program director: Kevin Chan, MD (kevichan@med.umich.edu)

Associate Program Director: Kyle Gunnerson, MD (kgunners@med.umich.edu)

Program coordinator: Patty Urban (patk@med.umich.edu)

Application process:  All inquiries please email Drs. Chan (kevichan@med.umich.edu) and Gunnerson (kgunners@med.umich.edu)

 
Anesthesia Curriculum

All rotations are in four week blocks, with a total of 13 rotations per year. 

First year: 
Surgical ICU: 4 blocks
Cardiovascular ICU: 3 blocks
Emergency Critical Care Center: 2 blocks
Medical ICU: 1 block
Neuro ICU: 1 block
Elective: 2 blocks

Second year:
Emergency Critical Care Center: 4 blocks
Surgical ICU: 1 block
Cardiovascular ICU: 1 block
Trauma/Burn ICU: 1 block
Anesthesia: 2 blocks
Elective: 4 blocks

Total months in ICU:  11 first year, second year variable

Vacation:  4 weeks per year

Call responsibilities: Varies depending on rotation, night float 2-4 weeks/year

Didactics:  A separate and robust curriculum exists exclusively for the Anesthesia and Surgical Critical Care fellows.  This includes weekly core curriculum lectures by faculty, Journal Club, and ICU Morbidity and Mortality.  In addition, fellows are encouraged to attend the weekly Emergency Medicine didactic conference if their schedule permits.  A multidisciplinary critical care educational series that includes all critical care services is under development.

Program director:  Dr. Michael Maile (mmaile@med.umich.edu)

Faculty mentor:  Dr. Kyle Gunnerson (kgunners@med.umich.edu)

Program coordinator:  Kymberly Holler (kholler@med.umich.edu)

Application process: Emergency Medicine applicants will be interviewed separately and offered a position outside of the match.  Interviews will begin in January of the year preceding the start of fellowship (about 18 months in advance).  The next available position will be July 2016.

 

Identical to both fellowship pathways:

ICU rotations: Medical, Surgical, Cardiovascular, Cardiac (non-surgical), Neuro/Stroke, Trauma/Burn, and Emergency Critical Care Center

Electives:  Critical Care Ultrasound, Pediatric ICU, VA ICU, Acute Renal Failure, Infectious Disease, Palliative Care, Nutrition, Radiology, Acute Pain Service, Airway (OR), and Research

Program Highlights:  In addition to the outstanding education the fellows receive at a nationally renowned, quaternary care center, the following are some of the highlights specific to the University of Michigan:

  1. Emergency Critical Care Center – A 14 bed Emergency Critical Care Center (EC3) is planned to open in January 2015.  This unit is located in the Emergency Department and includes 4 large resuscitation bays and a 5th hybrid resuscitation bay/critical care room. The EC3 will be managed by the Division of Emergency Critical Care and staffed by board certified EM-intensivists and other EM faculty with extra critical care training.  The mission focuses on the tripartite mission of the University and which includes distinction in clinical care with data driven protocols, cutting edge acute critical illness research, and educating future leaders in Emergency Medicine and Critical Care.  State-of-the-art devices, monitors, and data collection systems will help us achieve this mission of excellence in all three domains.
  2. ECMO – UM has been an international leader in the use of extra-corporeal life support with over 34 years of service http://www.med.umich.edu/ecmo/.  Fellows are responsible for accepting and arranging all ECMO transfers and consequently gain an understanding of the logistics involved in such a task.  In addition, fellows are the only providers allowed to write ECMO orders and therefore exclusively manage the daily aspects of care.  It is expected that the fellow participate in ECMO cannulation whenever possible.  The ECMO service averages close to 100 ECMO cases each year.
  3. CRRT – In the SICU, the fellow is responsible for initiating and maintaining patients on CRRT therapy.  Fellows are expected to write CRRT orders and become proficient in this therapy by the end of training.
  4. Survival Flight – Our flight program has been providing benchmark life-saving transportation of our most critically ill patients for over 30 years http://www.med.umich.edu/survival_flight.  Survival Flight is staffed by nurse-paramedic teams extremely experienced in critical illness and injury.  The program has 3 new Eurocopter EC-155B1 twin-engine helicopters with a range of 350 nautical miles at a speed of 175 mph.  The helicopters are equipped with sophisticated equipment to allow the expert crew the ability to transport complex critical care patients that require lifesaving support modalities such as IABP, ECMO, LVAD, and nitric oxide.  Survival flight ride-alongs are encouraged and extremely popular among the fellows.

Clinical Sites:  The University of Michigan, an 865-bed, state-of-the-art referral center.

ED Shifts:  General ED shifts are not part of the curriculum.  Fellows do spend time in the ED during their rotation in the Emergency Critical Care Center.

Call responsibilities: Varies depending on rotation, night float 2-4 weeks/year

Research opportunities: A wide variety of research is available to the fellows, enhanced by the traditional excellence of the University of Michigan Medical School and consistent NIH funding, including over $310 million in research grants last year.  Research is not limited to the Anesthesiology or Pulmonary Medicine, with opportunities also available through the Michigan Center for Integrative Research in Critical Care http://www.micircc.org/.  We are most excited to initiate research in the EC3, as the “hyperacute” resuscitation phase will provide endless study opportunities for fellows interested in the Emergency Medicine and Critical Care interface.

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