Critical Care Track for Cardiology

This one-year ACGME-approved clinical fellowship provides a comprehensive training program for fellows interested in leading the field of cardiovascular critical care. 

The objective of this program is to provide an advanced fund of knowledge and specialized skills in the management of critically ill patients for critical care board certification eligibility and provide training for fellows interested in leading in the field of cardiovascular critical care medicine. The program follows the ACGME/ABIM critical care curricular guidelines.

Curriculum

Fellows spend several months in the Medical Intensive Care Unit, Cardio-thoracic Surgical Intensive Care Unit, and Cardiac Intensive Care Unit working alongside Intensivists with backgrounds in Pulmonary Critical Care, Cardiac Surgery, Anesthesiology and Surgical Critical Care. The faculty provides opportunities for the fellow to acquire an in-depth knowledge of critical care as well as advanced clinical skills in the post-operative care of cardiac surgical patients. Fellows will function as an integral member of the ICU team and are responsible for the initial assessment, plan and follow up of all patients. Additional rotations in Neuro intensive care unit, and Trauma intensive care unit further allow for the fellow to acquire critical care skills.

The program offers excellent clinical exposure as well as directed, expert instruction, promoting self-directed education, and fostering the refinement of the fellow’s scientific and academic pursuits. Educational opportunities are tailored to suit the needs and interests of each fellow and consist of a combination of mentoring, monthly journal clubs, evidenced based case presentations, morbidity and mortality conferences, CCM topic/board review along with one on one fellow driven topics for medical knowledge gaps.  

Orientation

Each fellow will participate in:

• STAR Center Skills Simulation Lab – This is a one day course covering:
  • Central and arterial lines: Indications, contraindications, preparation, technique, complications and their management. 
  • Bronchoscopy: Integrating fundamental bronchoscopic techniques, gaining cognitive knowledge and clinical decision making skills.
  • Airway management: Provide practical, effective skills and strategies for intubation.
• Cadaver Lab- The human cadaver lab in collaboration with our Anesthesia Residency Program augments the fellows procedural experience in direct laryngoscopy, bronchoscopy, chest tube placement, pigtails, and IO’s ensuring optimal hands-on training while providing confidence and ensuring patient safety.
• Ultrasound Course - Utilizing standardized patients the fellow will perform critical care ultrasonography for Vascular - access and anatomy; Thoracic – pleural, lung and pneumothorax; Abdominal - ascites, bowel and bladder, renal; and Cardiac - image acquisition and interpretation.   SonoSim equipment and modules is also available for portable, online ultrasound training.  In addition, throughout the year ultrasound training sessions conducted in the MICU will provide the fellow with competency in the performance of critical care ultrasonography

Rotations

• Medical ICU - Each fellow will have 6 months of MICU training, which encompass all aspects of critical care, including ARDS, PE, shock, respiratory failure, upper and lower GI bleeds, liver failure, hematological/oncological emergencies, toxic and metabolic disorders, and renal disorders. During these months, fellows will learn conventional and unconventional modes of mechanical ventilation including, Bilevel, APRV, and PAV. As the fellow progresses their role will become that of a Junior Attending leading MICU team rounds, rounding with a physician extender, and reviewing plans with the attending physician. This graduated responsibility provides the fellow more autonomous growth and confidence in handling an ICU upon graduation.
• Trauma - Fellows will rotate through our Trauma Unit which is a Level One Trauma Center.  Fellows will learn primary and secondary surveys, respond to trauma codes with the trauma team, participate and lead trauma rounds, and perform critical care procedures.
• Cardiovascular/thoracic ICU rotation - The fellow will gain experience with VA and VV ECMO, pulmonary artery catheters, mechanical devices, post-operative care of cardiothoracic patients, and the management of those patients admitted to the intensive care unit following coronary artery bypass graft surgery, valvular heart surgery, thoracic surgery, and solid organ transplant.
• Neurosurgical ICU – AGH is a comprehensive stroke center and has a robust neurosurgical service.  6 of our current faculty members are also boarded in Neuro-critical Care. The fellow will rotate daily with the neurosurgical and neurology team.

Anesthesiology

This rotation allows the fellow to gain airway skills in the non-emergent setting.  Skills include bag mask ventilation, LMA insertion, and endotracheal intubation with direct laryngoscopy and glidescope.

Application Information

To be eligible to apply for the Cardiology Critical Care Track, physicians must have:

1. Graduated from an accredited medical school
2. Foreign medical graduates must hold a valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG)
3. Completed an ACGME approved internal medicine residency, and cardiovascular disease fellowship
4. Achieved board eligibility in medicine and cardiovascular disease

Interested applicants should email a letter of interest and curriculum vitae in October to:

Sharon Mastele, Fellowship Program Coordinator

For questions, please call (412) 359-5136