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Critical Care

The mission of the Division of Critical Care is to develop an educational program, which addresses the needs of both the patients and trainees. In order to support this educational mission, the program will encourage research initiatives and clinical practice improvements in order to promote excellence and address the challenge of providing care in the most effective and efficient manner to the critically ill patient.

The Fellowship

The Fellowship in Critical Care Medicine is accredited by the AGCME and the American Board of Anesthesiology, and is one year to two years in duration. Entry occurs after completion of three years of specialty training in Anesthesiology. The fellowship may be combined with an additional year in cardiac anesthesia.

General Goals

1. The Fellowship in Critical Care Medicine at the Beth Israel Deaconess Medical Center is designed to maintain the general standards of accreditation of the AGCME and the specific requirements for accreditation of fellowship programs in Critical Care Medicine as defined by the American Board of Anesthesiology.

2. The Fellowship will ensure that by the completion of their training the fellows will be able to provide complete care of critically ill patients, function as a leader of a multidisciplinary health care team providing such care, have a working knowledge of the administration and management of a critical care unit, be able to critically appraise the literature as it pertains to critical care medicine, and have a basic understanding and facility with the principles of research in critical care medicine.

3. The trainee completing the Fellowship will also demonstrate the appropriate attitudes to provide effective care of the critically ill patient and his/her family, and function appropriately in the critical care environment.

Fellowship Content and Organization

The Fellowship in Anesthesia Critical Care at the BIDMC is an organized program of rotations and educational experiences, both mandatory and elective, designed to provide each fellow with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The fellowship in critical care is based in the surgical ICU's at the BIDMC with an external rotation to the Children's Hospital, Boston, for Pediatric and Neonatal Intensive Care experience. There are electives in the medical ICU', interventional pulmonology and to other subspecialty services. Successful completion leads to certification eligibility by the American Board of Anesthesiology. The fellows take an active role in teaching, conducting rounds, and participating in research projects. The purpose of the fellowship is to prepare individuals for a career emphasizing care of critically ill patients and the management of an ICU.

The minimum educational requirements for training in adult critical care medicine are described below. Additional experience may be required by the program director.

1. Prerequisite:
One year of Internship in Medicine/Surgery and three years of Anesthesiology must be completed prior to entry into the critical care medicine program.

2. Requirements:
One year of adult critical care medicine, including primary patient care, consultative, and administrative functions, at an appropriate level of seniority. During their training fellows will be provided with a graduated increase in responsibility appropriate to their level of competence for the evaluation and management of critically ill patients under appropriate supervision.

Overall Educational Objectives

To effectively and efficiently manage all aspects of a complex critically ill patient.

  • To develop a solid basis of important physiologic concepts from which a wide base of cognitive knowledge can continue to grow. Due to the nature of the field and rapidity with which it is expanding, fellows in critical care medicine must be able to progress in of not only body systems but bioengineering technology, nutrition, infectious diseases, ethics and other pertinent areas.
  • To develop the skills of organization and appropriate delegation of duties in order to administer appropriate care promptly and efficiently. These qualities are particularly important for trainees who will be starting a new ICU in an environment where the concept of an "intensivist" is unknown.
  • To have a clear assessment of one's limitations and know when to ask for advice.
  • Ultimately, to function as an "intensivist consultant" being self confident while earning the respect of their peers.

Evaluation and Performance

There are mechanisms in place to ensure the systematic collection and interpretation of evaluation data on each Fellow enrolled in the program, including participation in the national Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP). Fellows will have an evaluative interview with the Program Director monthly, and undergo written evaluation by all the Critical Care Faculty twice yearly.

BIDMC Critical Care Fellows' Curriculum

I General ICU Topics

  1. Cardiopulmonary Resuscitation (CPR)
  2. Transport of the Critically III
  3. Sedation in the Critically III
  4. Analgesia
  5. Neuromuscular Blockade
  6. Acid-base Balance
  7. Thromboembolic Disease
  8. Nutritional Support/TPN

II Respiratory System Topics

1. Airway Management in the Critically III
2. Chronic Airway Management
3. Management of Mechanical Ventilation
4. Weaning from Mechanical Ventilation
5. Lung Protection Strategies
6. Pneumonia

III Cardiovascular System Topics

1.Diagnosis and Treatment of Dysrhythmias
2. Diagnosis and Treatment of Myocardial Ischemia
3. Valvular Heart Disease
4. Support of the Failing Circulation
5. Rational use of the PA catheter
6. Management of the Cardiac Surgical Patient
7. Echocardiography in the ICU

IV Renal Topics

1.Management of Renal Failure
2. Renal Replacement Therapy
3. Fluid Management
4. Acid Base Balance

V Gastrointestinal Topics

1. GI Bleeding
2. Acute Abdomen
3. Liver failure
4. GI Bleeding Prophylaxis
5. Pancreatitis

VI Infectious Disease Topics

1. Antibiotic Therapy and Infections
2. Antibiotic Prophylaxis
3. Sepsis
4. Management of the Immunocompromised Patient

VII Hematology

1. Massive Transfusion
2. Coagulopathies
3. Appropriate use of Blood Components

VIII Neurologic Topics 

1. Neurologic Critical Care
2. Management of Increased Intracranial Pressure

IX Miscellaneous Topics

1. The Multiple Organ Dysfunction Syndrome
2. Toxicology and Support of Patients with Drug overdose
3. Solid Organ Transplant
4. Trauma Management
5. Burn Management
6. Critical Care Obstetrics
7. Metabolic and Endocrine Abnormalities in the ICU
8. Specialized Nutritional Support in the ICU
9. Obstetrical Critical CareGroup
10. Ethics/End of Life Issues
11. Psychiatric Problems in the ICU
12. Administration/Management of the ICU

To apply, please submit the following documents IN ELECTRONIC FORMAT ONLY:

1. Completed Application Coversheet
2. Curriculum Vitae
3. Personal Statement
4. Report of USMLE scores and in-training scores
5. ECFMG Certificate (if applicable)
6. Three Letters of Recommendation

Note: Starting in 2014 the Critical Care Fellowship will take part in the San Francisco Match.

 Karen Granquist
 Program Coordinator, Critical Care Fellowship
 Beth Israel Deaconess Medical Center
 One Deaconess Road, CC-470 West Campus
 Boston, MA 02215  
 (617) 754-2670

Contact Information

Anesthesia Fellowship Program
Beth Israel Deaconess Medical Center
West Campus/Clinical Center 470
1 Deaconess Road
Boston, MA 02215