Department of Anesthesiology
Division of Critical Care

Fellow Education

Introduction

The Department of Anesthesiology’s ACGME accredited critical care fellowship offers a graded exposure to the entire variety of critical care experiences including six months of direct patient care in the 20 bed general surgical ICU and the 24 bed cardio-thoracic & vascular intensive care unit. The fellow is both directly responsible for patient care as well as increasingly responsible for supervising senior and junior residents from the Anesthesiology and Surgery departments. Rotations in the medical ICU, neurosurgical ICU are typically included as well as elective rotations including transesophageal and transthoracic echocardiography, in-patient nephrology/hemodialysis services, infectious diseases. The fellow is also an integral member of the extra-corporeal life support team (ECMO). The University of Michigan has been the leader in the development of ECMO clinical protocols and research and supports among the largest ECMO centers in the country.

Our goal is to provide the clinical, educational and administrative experiences for fellows to develop a wide-ranging but also deep knowledge of the variety of ICU problems and approaches to managing critically ill patients. Fellows will have both in-patient call experiences (every fourth night call along with senior and junior residents) as well as ICU rotations where call is from home in order to develop the appropriate skills to manage patients in different models of critical care.

Supervision of Fellows
Critical Care Fellows will be under the direct supervision of the faculty Intensivist on 24/7 call for the ICU in which they are assigned. This faculty will directly supervise and be ultimately  responsible for the evaluation, management and decision making of the critical care fellow. Similarly, when the ICU fellow is asked to evaluate patients outside of the ICU (PACU, floor, ED etc), they will continue to be under the direct supervision of the attending ICU faculty on call. These faculty are also responsible to be sure the ICU fellow is competent to perform standard ICU procedures such as intravascular access, intubations, bronchoscopy etc. More complex ICU procedures such as tracheotomies, ECMO cannulation and bedside operative procedures will be performed by an ICU fellow, only with direct supervision of an ICU faculty credentialed to do these.

Education
The anesthesiology critical care fellowship is intimately associated with its counterpart in the department of surgery so that Anesthesiology and surgery fellows maximize cross-departmental skills and experiences. Core critical care didactic conferences combine the two fellowships.
Formal Didactic session related to Critical Care and Anesthesiology include;
1. CVC Critical Care lecture Series:
Every Monday, & Friday 11:30 a.m. – 12:30 p.m.
This Conference is organized and coordinated by Dr. Rosenberg and one of the Critical Care Fellows.  This lecture series is a 2 month-repeating one-hour tutorial that  is presented to the ICU residents, medical students, nurses, physician assistants and nurse practitioners.  It provides a structured review of key topics in critical care education as well as an opportunity for specialist surgeons, cardiologists and other medical specialists to supplement rounds and bedside teaching by the ICU Faculty.  The Conference is also a venue for in-services on new devices, equipment and protocols as well as any time-sensitive information.

2. Critical Care Fellows’ Seminar & Journal Club:
Every Tuesday 11:30 a.m. – 12:30 p.m.
This conference includes review of recent critical care literature as well as ‘classic’ critical care papers in a standard journal club format. The goal is to foster interactive discussions, review the methodologies of scientific articles as well as provide a forum to discuss other issues important to the fellows’ future clinical practices, organization and direction of intensive care units. Basic sciences related to critical care, ethics, medico-legal and regulatory requirements of medicine are also discussed in this seminar.

3. Critical Care Core Lectures Series:
Every Wednesday 12:00 p.m. – 1:00 p.m
The core lecture series is the primary venue for the most up-to-date reviews of critical care issues at the University of Michigan Medical Center. Faculty from Anesthesiology, Surgery, Medicine and other specialties provide the most recent data regarding the variety of topics that span modern critical care including advanced ventilator management, mechanical assist devices, innovative antimicrobials and techniques to prevent, treat infections from resistant organisms, evidence-based practices for ICU related complications etc. Fellows from all the critical care programs attend this lecture.

4. Rotating Critical Care Special Topics
Every Thursday 11:30a.m -12:30 p.m
These lectures/seminars offer a wide range of special topics or highly specialized and focused discussions to be offered to the fellows including small group sessions with visiting faculty.

5. ICU Morbidity and Mortality Conference:
Last Thursday of each month, 12:00 p.m. – 1:00 p.m.
The ICU Morbidity and Mortality Conference is coordinated by the ICU Fellows.  Their responsibility is to report on all mortalities in the SICU and CVC ICU during the preceding month, with comments and discussion by the ICU attendings. Detailed and focused discussions are made for especially pertinent cases including sentinel events, unexpected outcomes, or especially unique clinical cases. 

6. Departmental Weekly Grand Rounds;
Each Thursday, 7:00 a.m. – 8:00 a.m.
Both Anesthesiology and Surgery Departments conduct a weekly grand rounds where critical care related issues are often discussed. These conferences are also the primary venue for noted visiting faculty’s presentations. Critical Care Fellows are expected to present and interesting case or review of an important critical care topic in this forum at least twice a year.

Administrative & Academic Experience
An integral part of critical care is the proper oversite and clinical leadership of an intensive care unit including experience with quality improvement projects, clinical protocols and the collection, analysis and dissemination of important data used to improve care in an ICU. Fellows attend all ICU and departmental administrative meetings including the monthly SICU and CVC ICU administrative meetings, bi-monthly Cardiac-workgroup meetings and monthly ICU administration meetings. Fellows are also able to attend the medical center LEAN quality system training offered by the medical center as well as a variety of other medical administrative training programs during elective time.

Fellows are also responsible for teaching conferences and coordinating morbidity and mortality conference and critical care journal club.
Our Fellows are encouraged to attend major critical care meetings such as the American Society of Critical Care Anesthesiologists (ASSCA) or the Society of Critical Care Medicine (SCCM).  The Department of Anesthesiology provides $3000 each year toward academic support and activities for each Fellow.

Research Activities
The Universtity of Michigan Medical Center  is a nationally prominent research institution  with over $300 million in extra-mural grant support per year. A tradition of collaboration between the basic science researchers and their clinical colleagues is especially noteworthy. In addition, the School has a strong tradition of clinical research including the highest funded single Clinical Research Center in the nation and a newly established Center for Clinical Therapeutics. The Medical School's biomedical research environment is also enriched by the prestigious Howard Hughes Medical Institute, whose research programs address areas of molecular genetics.

Throughout the past decade, the Medical School has ranked nationally in the top tier institutions in federally funded research. In fiscal year 2004, the National Institutes of Health ranked the Medical School eleventh among all institutions. In generating approximately 70 percent of the University's total NIH research funding, the Medical School has maintained a key position of scientific leadership within and beyond the University's scientific community in the pursuit of discovery, in the translation of pioneering breakthroughs to the clinical setting, and in the dissemination of new knowledge to the public at large.

Areas of special interest in the Department of Anesthesiology include;

1. Clinical information systems, predictive modeling, ICU information systems.
2. Neurobiology, mechanisms of sleep and consciousness
3. Sepsis
4. Acute lung injury/ ARDS
5. Hemostasis following cardio-vascular procedures.

Areas of special interest in the Department of Surgery related to Critical Care include;

1. Nosocomial infections and ICU related infectious diseases
2. Transfusion practices in ICU
3. Mechanical assist devices
4. ECMO
5. Acute Lung injury/ARDS
6. Surgical Outcome models

Goals and Objectives

Fellow Expectations

Fellowship
Application