Brigham & Women's-Anesthesia Critical Care

Program Description

Type of Program
Multidisciplinary

The Fellowship in Anesthesiology Critical Care in Department of Anesthesiology, Perioperative and Pain Medicine at the Brigham and Women’s Hospital (BWH) has existed since 2002. Historically, our fellowship emerged from a joint fellowship with the Massachusetts General Hospital, and the separation was inspired by the recognition that in a one-year fellowship, trainees would benefit by focusing their time within a single institution.

Year Fellowship Started: 2002

EM-CCM Program Status
The fellowship is administered within the Department of Anesthesiology, Perioperative and Pain medicine.

This fellowship strongly supports emergency medicine residents who seek critical care training.

Application Method & Deadlines
Selection to the fellowship is highly competitive. Applications are available from the office of the fellowship director and should be submitted fifteen to twenty-one months prior to the planned starting date. Residents should apply in the winter/early spring of their PGY2 (in 3 year EM residency program) or PGY3 (in 4 year EM residency program). Individuals who have completed a 3 or 4 year ACGME accredited EM residency program and are ABEM eligible or certified are welcome to apply. Applicants who will have completed 4 years of training prior to fellowship are substantially more competitive than those who will have completed only 3 years. Selected applicants are invited for interviews in Boston. Successful applicants may begin their fellowship at various times throughout the year; starting dates are negotiable.

Application Requirements
• Personal Statement
• Curriculum Vitae
• 3 Letters of Recommendation
• In-training Exam Scores
• USMLE Scores or equivalent

Number of Fellows per year
7

Length of Fellowship
1-2

Primary Training Site Demographics
   Number of Hospital Beds: 777
   Number of ICU Beds: 100
   ED Annual Visits: 59,000

Affiliated Sites
Children's Hospital Boston

EM-CCM Fellowship Education
Benefiting from our uniquely rich multi-disciplinary faculty model, we have developed a fellowship designed to allow trainees to develop advanced proficiency in the management of all aspects of the care of critically ill patients and to develop the skills necessary to supervise critical care units. The one-year fellowship in Critical Care focuses on direct patient care. The fellow spends a minimum of nine months in the care of ICU patients while supervising residents and medical students under the direction of the critical care attending staff.

Clinical Rotation Schedule - The fellowship structure is composed of two-week rotations, thirteen of which are spent in the core units of the General/Vascular SICU, Burn/Trauma SICU and Thoracic/Pulmonary Transplant ICU. The remaining thirteen two-week blocks are divided among mandatory rotations, elective rotations and vacation. Mandatory rotations consist of the Cardiac Surgical ICU at BWH, the Metabolic Support Service at BWH, the Neurosurgical/Neurological ICU at BWH, and Pediatric ICU at Children’s Hospital Boston. Additional elective time is available on services caring for critically ill patients such as the Coronary Care Unit, the Medical ICU, and the cardiology, electrophysiology, renal, infectious disease, and transplant consult services.

Core Curriculum of the Fellowship - As outlined below, covers all the major aspects of the art and science of critical care, as outlined in “Requirements for Training in Anesthesiology Critical Care Medicine”:

Cardiopulmonary resuscitation: ACLS and ATLS provider certification, responsible for leadership at all resuscitations taking place in the core ICUs.

Respiratory: airway management; respiratory failure - ARDS; pneumonitis; use of inhaled nitric oxide and prostoglandins; ventilator management - ventilator modes; ventilator weaning; respiratory mechanics and work of breathing; barotrauma; care of postoperative thoracic patients, including special considerations for extrapleural pneumonectomy, lung transplantation, bronchoplastic and lung volume reduction surgery.

Cardiovascular: rhythm analysis; therapy of dysrhythmias; pacing and pacers; hemodynamic monitoring; biomechanics of hemodynamic pressure monitors; analysis of hemodynamic data; myocardial dysfunction; myocardial ischemia; valvular diseases; pericardial tamponade; pulmonary hypertension and right ventricular failure; use of vasopressors; shock - etiology, pathophysiology, and treatment; mesenteric vascular disorders; peripheral vascular disease; deep venous thrombosis and pulmonary embolism.

Renal/GU: renal physiology and dysfunction; renal failure - chronic and acute; peritoneal dialysis; intermittent and continuous hemodialysis and ultrafiltration.

GI: gastrointestinal bleeding; liver dysfunction and failure; necrotizing pancreatitis; management of stomas; ascites; intra-abdominal sepsis.

Hematologic: anemias, thrombocytopenia, management of neutropenic patients, DIC, coagulopathies, hypercoagulable states.

Metabolic: acid-base disorders; electrolyte disorders; calcium, magnesium, and phosphorous disorders.

Endocrine: management of diabetes in ICU patients; thyroid disorders; pituitary and adrenal dysfunction; parathyroid dysfunction.

Infectious diseases: culture and isolation techniques and interpretation; nosocomial and catheter-related infections; antibiotic resistance, dosing, and drug interactions.

Neurologic: treatment of acute head injury; measurement and management of cerebral blood flow and intracranial pressure; subarachnoid hemorrhage; acute stroke, acute spinal syndromes; delirium; alcohol withdrawal; perioperative management of myasthenia gravis and other neurologic diseases

Surgical: Management of multi-trauma, severe burns, necrotizing fasciitis, and compartment syndromes.

Additional Program Highlights
Clinical

There is a rich curriculum that has been developed in the use of ultrasound in the ICU, including basic echocardiography, pulmonary ultrasound, abdominal ultrasound, and ultrasonic guidance for vascular access procedures. Each core unit is equipped with its own state-of-the-art ultrasound device.
Because infectious complications are such a major component of SICU morbidity and mortality, there is a set of monthly lectures from a core set of Infectious Disease attendings that covers the gamut of SICU ID issues.

Given the complex ethical problems that predictable emerge in the ICU setting, there is a monthly session on medical ethics for the fellows, led by the program director and the director of the Ethics Consultation Service of the hospital. Topics covered include informed consent, withholding/withdrawal of life-sustaining therapies, disclosure of medical errors, surrogate decision-making, conflicts of interest, medical futility, DNR orders, definition of death and organ donation, among others that often arise in the care of critically ill patients.

Research and Education
Basic and clinical research is an important ongoing activity and a prime mission of the BWH. The anesthesia critical care fellowship provides the fellows with opportunities for participation in both clinical and basic science research.
Research in our ICUs is organized around the BWH Surgical ICU Translational Research (STAR) Center headed by Gyorgy Frendl, MD, PhD. One research project manager, and two to four research assistants participate in assisting with the clinical studies in the STAR Center. Critical care fellows who were selected have performed mentored clinical research as part of the STAR Center. STAR Center affiliated members include: a biostatistician, members of clinical research groups from Emergency Medicine, and the Renal, Infectious Disease, and Thoracic Surgery divisions, as well as basic science researchers focusing and sepsis, inflammatory mediator, muscle physiology, and ischemia- reperfusion research. The STAR Center works in close collaborations with the BWH Center for Surgery and Public Health, a joint research center of the BWH Department of Surgery and the Harvard School of Public Health.

Staff and fellows participate in bi-weekly journal clubs as well as at the monthly research meetings where proposed, active, and completed projects are presented and discussed.

Listing of Graduates & Years
2012 Kamal Medlej
2011 Raghu Seethala
2010 Jason Cohen
2008 Chad Meyers
2006 Nishi Rawat
2006 Alejandro Baez
2004 Peter Hou

Program Website
http://www.brighamandwomens.org/Departments_and_Services/anesthesiology/Medical/fellowships.aspx