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Critical Care Medicine

Critical Care Tracks in Emergency Medicine

Jenelle Holst, MD
Denver Health Medical Center

JenelleHolst2015HSNow that there are multiple board-eligible pathways for critical care fellowships available to EM residents, interest in this career path is blossoming. The critical care applicant’s road can be challenging, though, and guidance and support through residency is needed to navigate these new pathways. The critical care track during residency is an effective tool not only to recruit potential residents to a career in critical care medicine but also to cultivate their interests and talents throughout residency and create competitive fellowship applicants.

Some EM residencies, especially those that host critical care fellowships open to EM residents and have EM-critical care medicine (EM-CCM) faculty on staff, have already created critical care tracks. Most tracks seem to have four essential components: faculty mentorship and research support, critical care clinical rotations, critical care oriented didactics, and regular track meetings.

Faculty mentorship is essential for a successful track, and EM-CCM staff associated with EM residencies is the obvious choice. It is important to avoid mentor burnout by hopefully having more than one mentor available for residents and having support from faculty leadership to allow for protected time for facilitating track activities. Although growing, the pool of EM-CCM faculty is currently relatively small and not available for personal mentorship at all residencies. One solution has been the Virtual Mentorship Program, which can help pair residents with mentors across the country.

Clinical critical care rotations can take many forms, including rotations in ICUs, resuscitation electives in the emergency department or rotations through an ED-ICU. It is important for residents to have both junior (intern) and senior level rotations in the ICU to teach graduated responsibility and provide the foundation for future advancement to the fellow level. The senior ICU rotation is a good opportunity to get letters of recommendation from critical care faculty. Critical care tracks can also be utilized to ensure that residents applying to the internal medicine-based programs complete the 6 months of required internal medicine rotations during residency, 3 of which must be in the medical ICU. Surgery, anesthesiology, and neurocritical care fellowships do not have additional clinical prerequisites during the EM residency, but additional rotations can help prepare residents for fellow responsibilities through these tracks as well.

There are many creative themed didactics options including invited speakers, resident lectures, EM-CCM faculty lectures, journal clubs, reading lists from textbooks, access to webcasts and podcasts, critical care morbidity and mortality conferences, etc. Skills labs are a fun and hands-on way to inspire interest in and teach critical care skills including: resuscitation simulation, bronchoscopy, ultrasound, extracorporeal membrane oxygenation, continuous renal replacement therapy, and cadaver procedure labs.

Creating a sense of community with regular track meetings helps strengthen mentorship, disperse information among members from national EM-CCM meetings (ACEP, EMRA, SCCM), field questions and troubleshoot challenges as they come up throughout residency, and launch new ideas for the track.

Creating a critical care track is a powerful way to provide much-needed support and preparation for fellowship-bound residents.

Here are a few examples of some successful critical care tracks:

Washington University in St. Louis  
Mentorship Clinical Rotations Didactics Track Meetings

EM-CCM dual boarded faculty (6) in the residency

EM boarded faculty with EM-CCM special interest (5)

6 months ICU embedded in standard curriculum

Resident-led lectures based on a critical care textbook, article or topic of interest

Faculty-led lectures

Procedure labs: bronchoscopy, ultrasound

SICU fellow lecture series, journal club and M&M

Access to SCCM's resident ICU lecture series

Meet monthly during conference

Central website repository for all materials

Contact: Chris Holthaus, MD


University of Iowa  
Mentorship Clinical Rotations Didactics Track Meetings

Mentored by EM-CCM dual boarded faculty

Research mentorship

4.5 ICU months embedded in standard curriculum

Critical care themed lectures 25-30 hours per year

2 skills labs

Journal club 2-3 times per year

Quarterly mentor meetings

Contact: Nicholas Mohr, MD


University of Arizona, Tucson
Mentorship Clinical Rotations Didactics Track Meetings

Mentored by associate
fellowship and residency
director and internal colleagues

Dedicated research project

4 months ICU embedded in
standard curriculum

Optional elective in
"critical care topics"

Senior resident MICU
rotation (fellowship preparation)

Sub-fellow rotation in the ICU

Resident created grand rounds

Monthly journal club

Quality improvement projects

Monthly faculty lecture
Quarterly  meetings

Contact: Jarrod Mosier, MD

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