Indiana University

Program Description

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Type of Program
This is a multi-discipline program with an equal mixture of medical and surgical critical care rotations that aims to create an intensivist product equally skilled in the complex care of the critically ill surgical and medical patient.

Goals:
Critical care deals with complex surgical and medical problems in critically ill patients. This program aims to provide the educational, clinical, and administrative resources to allow fellows to develop advanced proficiency in the management of critically ill patients, to develop the qualifications necessary to supervise critical care units, and to conduct scholarly activities in critical care. These goals are achieved through a flexible pathway that is customizable to the individual learner’s ambitions.

The first year curriculum consists of a procedural-based rotation along with a core set of clinical rotations with a flexible working order and call schedule that is designed to offer a maximized exposure to a variety of critical pathology.

The second year curriculum consists of core clinical rotations, elective months, administrative rotations, and clinical or basic science research rotations that allow the fellow flexibility to tailor experiences based on the learners individual training goals.

Year Fellowship Started: 2006

Application Method & Deadlines
Fellowship applications are downloadable via PDF from our website. There is a standard rolling admissions and application, usually evaluated over 1 year in advance. Residents should apply in the spring of their PGY2 (in 3 year EM program) or PGY3 (in 4 year EM program).
The application deadline is December 26 of each academic year. For example the deadline for a start in July 2012 would be December 26, 2011.

Application Requirements
Fellow Selection Criteria
Candidates must be a graduate of a certified ACGME program.
Candidates should have an educational background that includes at least two months of critical care training.
Candidates should complete a formal on-site interview and be deemed compatible for training.
Documentation Requirements for Application
A recent photograph
A copy of your current curriculum vitae
A copy of your USMLE scores
A copy of your ECFMG certificate (if applicable)
A copy of your medical school diploma
Copies of both your undergraduate and medical school transcripts
Three letters of recommendation (one of which must be from your program director)
A one page statement describing why you are choosing to pursue additional training in critical care

Number of Fellows per year
2

Length of Fellowship
2 years

Salary
Fellows are paid as PGY-4 level trainees and in 2011-2012 would be paid a stipend of $50,830 and receive a benefits package of approximately $20,000.

Primary Training Site Demographics
   Number of Hospital Beds: IU Health-Methodist Hospital- 800 bed Level I Trauma Center
   Number of ICU Beds: 130 adult critical care beds
   ED Annual Visits: 110,000

Affiliated Sites
Indiana University Hospital
Wishard Memorial Hospital

EM-CCM Fellowship Education
To assure a diversified competence, fellows participate in all educational activities including a core lecture series, educational workshops, educational modules, journal club luncheons, grand rounds lectures, research, and quality improvement conferences. Monthly competency based evaluations are completed by each of the oversight faculty, and fellows complete procedural assessment forms and an oral case review as part of their competency based progression.

Didactics incorporate a series of targeted lectures on core components of critical care, pharmacotherapeutics, nutritional support, and respiratory management. Additionally, fellows will be enrolled in the European Society of Intensive Care Medicine’s Patient-Centered Acute Care Training Program, “a modular multidisciplinary distance-learning program, aimed at improving and harmonizing the quality of acute care medicine.”

A two-year curriculum has been designed in accordance with the recommendations from the American College of Critical CareMedicine’s Guidelines for critical care medicine training and continuing medical education. These guidelines have been combined with the Competency Based Training Program in Intensive Care Medicine for Europe and other world regions (COBaTrICE) to create a comprehensive syllabus.

Year One: The focus of this year is on clinical care, although fellows are encouraged to consider future research ideas.

General Adult Critical Care 2 months
Pulmonary Critical Care 2 months
Neurosurgical Critical Care 2 months
Trauma Surgical Critical Care 1 month
Surgical Critical Care 1 month
Cardio-Vascular Surgical Critical Care 1 month
Thoracic-Transplant Critical Care 1 month
Cardiopulmonary Procedures 1 month
Administration/research 1 month

Year Two: The focus changes from clinical time to administration and research.

General Adult or Pulmonary Critical Care 2 months
Surgical Critical Care 1 month
Research 4-5 months
Administration/quality improvement 1 month
Electives 3-4 months

Electives: (Include rotations with critical care focus)

Cardiology
Nephrology/renal replacement
Infectious diseases
Cardiac anesthesia
Pediatric critical care
Electronic ICU experience
Palliative care
Pain management
Clinical pharmacology and nutrition


The fellow will be assessed by monthly staff/attending evaluations and will complete an online curriculum that is available through the European Society of Intensive Care Medicine. This Patient-centered Acute Care Training (PACT) curriculum is composed of training modules that have been peer-reviewed and contain exams at the end of each module to assure that the trainee has comprehended the necessary knowledge base successfully to have completed that module. Our expanded didactic curriculum combines PACT information along with core lectures and edcuational materials from the Society of Critical Care Medicine and the American College of Chest Physicians. This composite curriculum exposes the fellow to a broad variety of educational modalities to assure formal comprehension.

Complete monthly PACT Modules throughout the year as an extension of this early didactic primer.
Fellows complete unique cadaveric skills labs, simulation excercises, and procedural training modules to maximize care proficiency.
Fellows participate in weekly didactic sessions and discussion excercises.
Fellows participate in biweekly journal clubs.
Fellows participate in bimonthly pharmaco-therapeutic lectures (ex. sedation, paralytic agents, antimicrobial therapy, etc.).
Fellows participate in bimonthly nutritional lectures (ex. parenteral/enteral nutrition, electrolytes, etc.).
Fellows participate in combined morbidity, mortality, and case conferences with Emergency Medicine.
Fellows participate, when available, in additional lectures in conjunction with medical and surgical education:

Resident educational lectures
Tuesday Morning Radiograph Conference
Wednesday Morning Fellows Conference
Thursday Morning Chest Conference

Sample Curriculum
Sample Schedule Rotation
Month -Discipline-Preceptor / staff

July General Critical Care Ferry
August Neurosurgical Critical Care Payner/Simala
September Diagnostic Cardio-Pulmonary Procedures Ferry/Fadl
October Pulmonary Critical Care Weller
November General Critical Care Bortenschlager
December Cardio/Thoracic Critical Care Coffey/Beckman
January Pulmonary Critical Care Naum
February Trauma Critical Care Skinner/Pohlman
March Neurosurgical Critical Care Payner/Simala
April IU Surgical Critical Care Falimirski
May Thoracic Transplant Critical Care Reynolds
June Vascular- Critical Care Clarian Cardiovascular

Additional Program Highlights
Unique Multidisciplinary Program Objectives
This program aims to broaden critical care training and provide training exposure to individuals from various medical educational backgrounds and thus directly address the call for additional intensivist training as outlined by The Leapfrog Initiative, the National Quality Forum, the ACGME, the Society of Critical Care Medicine and the Institute of Medicine.
This program addresses the broader spectrum of critical illness incorporating and investigating both medical and surgical approaches to the care of the critical patient. The multidisciplinary approach of this program seeks to foster improved communication amongst the medical and surgical disciplines and promote evidence based application of care as it applies to the care of the critically ill patient. Ideally this program seeks to create a core curricular body and rotational structure that can be tailored to the individual learner’s needs/background with the ability to produce multidiscipline intensivists.
Overcrowding is a growing concern nationwide and has directly led to increased emergency department (ED) occupancy, patient boardiing, and the need for critical intervention within the ED setting. Meanwhile, delayed transfer and more importantly the delay in critical care delivery have been directly linked to increased healthcare costs and poorer patient outcomes.

This program seeks to incorporate the training of emergency physicians in a critical care educational model to directly address elements of the emergency department-critical care interface and promote research directed at improving the care of the critically ill patient through the transition from the pre-hospital setting, to the emergency department, and finally to the critical care unit.

Academic emergency medicine is rapidly maturing and specializing. Emergency medical education continues to grow in its scope of practice and complexity of content. This evolution places added demands on the EM faculty base to develop a broader expert skill set. This program allows emergency medical physicians with an interest in academic medicine a pathway to subspecialty education in critical care medicine that fosters further academic progression and discovery.

Knowledge exchange and teaching are fundamental abilities requisite to professional advancement. The expanded role of the multidisciplinary fellowship aims to utilize a near-peer approach to further resident and student education within the critical care environment.


The fellow will have a co-supervisory role over residents and medical students functioning within the critical care environment and will be responsible for providing educational and procedural guidance as part of this role.
The fellow will participate in resident/student critical care didactic lectures, chest conferences, and journal club discussions.
Fellows will also be encouraged to participate in nursing and ancillary staffing continuing education and encouraged to foster an environment of free knowledge exchange.

Listing of Graduates & Years
Tim Ellender: First Program Fellow and Graduate- 2008
J. Chris Skinner: Second Program Fellow and Graduate-2009
Angella Fiege: Third Program Fellow and Graduate-2009
Ryan Mihata: Fourth Program Fellow and Graduate-2011

Program Website
http://emergency.medicine.iu.edu/divisions-fellowships/critical-care/em-cc-fellowship/