Critical Care fellows may choose to participate in a number of Critical Care electives that will further their education based on their career goals, and they include but are not limited to, the following. These electives are offered to all fellows (Anesthesia-based, Internal Medicine-based, and Emergency Medicine-based) some may be more appropriate as specific instruction for Fellows from backgrounds that need supplemental training for developing skills not learned in the core residency program.
Advanced Airway elective
Major goals of the advanced airway elective include the opportunity to gain knowledge and experience in airway management in the operating room setting; difficult airway algorithms; airway examination in predicting difficulty; laryngeal mask airway use and alternative airway devices; video laryngoscopy, fiber optic bronchoscopy, and intubation, exposure to double lumen endotracheal tubes and their management; emergency airway management; anesthetic drugs and their indications; extubation in the operating room, and airway skills used in the post-extubation setting.
Critical Care Nutrition elective
Specific goals include understanding the principles of protein, energy, macronutrient and micronutrient metabolism in health, specific nutrient deficiencies, protein-energy malnutrition, and obesity; understanding the principles of water and electrolyte balance in health and gastrointestinal disease; and the delivery of appropriate, cost-effective parenteral (TPN) and enteral nutrition.
The major goals of the renal elective are to gain experience in the evaluation of patients with a range of renal and fluid and electrolyte disorders, gain experience and expertise in the evaluation of acute renal failure, gain experience and expertise in various forms of renal replacement therapy, including hemodialysis and CVVHD and to acquire increased knowledge and understanding of renal and fluid and electrolyte physiology, which underlies the care of many critically ill patients.
Palliative Care elective
The major goals of the Palliative Care elective are to understand advance directives, principles of patient autonomy, and substituted judgment; understand palliative medicine and end-of-life issues; gain experience in defining patient preferences and goals of care; gain expertise in facilitating effective shared decision making for patients and/or their surrogate decision-makers when confronting serious illness; acquire experience and expertise in conducting family meetings; acquire experience and expertise in dealing with challenging end-of-life issues, including the approach to the patient with no advance directives and no surrogate decision make; learn how to approach the family that cannot agree on patient preferences and goals of therapy; learn how to approach counseling patients with severe pre-existent medical problems, such as advanced cancer or advanced dementia, about achievable medical outcomes; understand ethical and legal issues related to withdrawal of life support and limitation of therapy; and increase knowledge of methods for treatment of distressing symptoms, including pain, air hunger (dyspnea), nausea, anxiety, and depression.
Cardiovascular Critical Care elective
The CVCC rotation provides Critical Care fellows postgraduate experience in perioperative cardiac surgical and medical critical care. It is designed for CCM fellows to collaborate in the care of critically ill cardiac patients in conjunction with the Anesthesiology and Cardiology based Attending staff physicians in the unit. The opportunity to assist with the complex care of ECMO patients exists in this unit.
Pediatric ICU elective
The PICU rotation has been developed in response to the desire by fellows for progressive experience in pediatric critical care. It is specifically designed for CCM fellows to collaborate in the care of critically ill pediatric patients. The range of disease encompasses all critically ill pediatric patients and includes patients with medical diseases such as sepsis and ARDS, intracranial and gastrointestinal bleeds, postoperative patients, trauma, and others with any life-threatening condition.
Respiratory Care elective
Provide a concentrated overview of the scientific basis of Respiratory Care — experience in practical aspects of Respiratory Care, including an understanding of different types of ventilators and other respiratory care equipment. Enhance the physician’s understanding of the role of the Respiratory Care practitioner and foster a collaborative relationship between physicians and Respiratory Care providers.
Interventional Radiology elective
The goals of the Interventional Radiology (IR) elective are to understand the pre-procedural issues particular to Vascular and IR patients; be familiar with the indications, risks, outcomes of interventional procedures the trainee may perform; be able to discuss the procedural approach and various options to secure central venous access.; be familiar with imaging options for directing fluid drainage procedures, including fluoroscopy, ultrasound, and CT; understand the basic principles of vascular ultrasound; review basics of iodinated contrast, including alternatives to standard agents; and be familiar with the basics of x-ray equipment (generators, intensifiers, DSA, etc) and radiation safety.
Pulmonary Care elective
The major goals of the pulmonary elective are to gain experience in the evaluation of patients with a broad range of respiratory disorders; acquire procedural expertise — specifically, the performance of bronchoscopy; gain experience and expertise in the interpretation of chest imaging studies; acquire expertise in the interpretation of pulmonary function tests; and increase knowledge of pulmonary physiology, which underlies the care of many critically ill patients.
The Critical Care Research elective is designed to assist faculty and/or other fellows with existing research projects and to participate in research study design, data collection, data analysis, data collections, and manuscript and abstract preparation and publication.
Fellowship training in Echo will include education in physical principles and instrumentation of ultrasound, 3-dimensional cardiac anatomy, physiology, and pathophysiology, and acquisition and interpretation of transthoracic, stress, and transesophageal echo images. Fellowship trainees will be required to perform echo/Doppler examinations themselves and to integrate echo findings with:
- Patient history and physical examination
- The medical and surgical management of patients
- The results of other imaging modalities (e.g. CXR, Catheterization, Nuclear, CT, MRI)