Educational Overview

The educational program is multifaceted. In keeping with the Accreditation Council for Graduate Medical Education (ACGME) core competencies, training is provided at the bedside, in didactic lectures, in seminar-type conferences, and in other settings.

The Critical Care Fellowship program at Dartmouth Hitchcock Medical Center focuses on a multi-disciplinary approach to providing and delivering care to critically ill patients. Our focus is to provide the fellow with a broad-based approach using diverse Faculty, patient, and colleague experiences to enrich the fellows’ education and provide the necessary environment for rapid maturation toward independent practice.

The Section of Critical Care Medicine provides 2 ACGME-accredited fellowship programs: Internal Medicine Critical Care and Critical Care Anesthesiology. We also provide opportunities for individuals who are BC/BE in general surgery to obtain critical care certification from the American Board of Surgery. In addition, we work closely with the Section of Pulmonary Medicine to provide critical care medicine training for Pulmonary/Critical Care Medicine fellows.

Education and goals

The Critical Care Fellowship is designed to foster both the clinical and the leadership skills necessary to develop and promote a multi-disciplinary approach to critical care medicine.

The specific goals of the program are to:

  • Understand the physiology and pathophysiology of critical illness
  • Evaluate and manage the critically ill patient
  • Advanced airway simulation within the Dartmouth Patient Safety and Training Simulation Center
  • Manage critically ill patient flow within the confines of a limited resource within a health care region
  • Certification in the Lean Six Sigma process of quality improvement and engage in a project within the Intensive Care Unit (ICU)
  • Understand administrative aspects of ICU management
  • Develop the procedural skills necessary for the care of the critically ill
  • Develop the skillset for Point of Care/Critical Care Ultrasound
  • Neuro-specialty critical care
  • TeleICU care delivery within the Connected Care Center at DHMC
  • Cardiovascular Critical Care Unit including ECMO
  • Working with health care extenders within the practice of critical care
  • Supervise and teach interns, residents, and Geisel School of Medicine students
  • Understand ethical and legal aspects of Critical Care Medicine
  • Understand research design and data interpretation

We have been very successful in recruiting highly qualified fellows to all our Critical Care Medicine programs. Since 1980, the Dartmouth Anesthesia Critical Care program has graduated over 54 fellows. Since 1996, the Dartmouth Critical Care Internal Medicine Program has graduated over 26 fellows. This underscores our long history and commitment to training new generations of multidisciplinary Critical Care Faculty.

Concurrent with increased clinical activity, the Critical Care Fellowship educational program has developed and expanded over the years. Our fellows have successfully collaborated on research projects with close mentoring from our Faculty as well as have received training in Critical Care Ultrasound or Point of Care Ultrasound (POCUS) including trans-thoracic echocardiography and transesophageal echocardiography).

The fellows also provide ongoing bedside teaching to interns and residents and other fellowships throughout the Graduate Medical Education programs that interface directly with Critical Care. In total, there are 20 different Residency programs and 27 fellowship programs offered at DHMC.

The Department of Anesthesiology at DHMC has a vibrant Residency program and the fellow can take advantage of the educational infrastructure provided including the TEE Lecture Series, Regional Lecture Series, and Grand Rounds Lectures.

Critical care ultrasound experience

The practice of critical care ultrasound is a core requirement that we teach. Currently, we utilize Sonosim a Critical Care didactic and ultrasound simulator for early fellow education and practice of initial probe orientation and basic hands-on skills.

We also have dedicated Echocardiography rotations with the Department of Cardiology’s ECHO-Lab offering intensive supervision and instruction on Transthoracic and Transesophageal Echocardiography.

Our up-to-date ultrasound equipment for imaging assists the trainee to acquire the best images possible as they learn. Our Critical Care Faculty Mentors also provide ongoing quality assurance and feedback utilizing QPATH software that provides a database to store and review Critical Care ultrasound patient examinations. A Critical Care POCUS lecture and case-based teaching lecture series are offered on alternate Fridays providing ongoing didactic and case-based discussion. Acquiring exams during training is a requirement for graduation from the program.

Fellowship didactic lecture series

We provide a highly regarded, CME-accredited Critical Care Lecture Series on Tuesdays and Thursdays presented by fellows and faculty based on core critical care lecture topics as well as Critical Care Case Conferences, Journal Clubs, and Morbidity and Mortality Conferences.

Fellows are also required to go through DMAIC-based training and become Yellow Belt certified. Involvement and or completion in a new or ongoing Q/A project is also a graduation requirement of the program.

Critical Care, Telehealth, eICU

At DHMC, Critical Care Medicine is provided to our patients in a 24-bed Medical Intensive Care Unit (MICU), and 22-bed Surgical Intensive Care Unit structure (SICU). The MICU is a newly designed state-of-the-art ICU. The recently remodeled SICU continues to offer unsurpassed post-operative intensive patient care directly across from the main operating rooms at DHMC.

The strength of our program lies in the combined fellowship structure rotating through and working within all the Intensive Care Units (MICU, SICU, Neuro, PICU) within our institution during monthly rotations, and while on-call for the ICU.

Fellows learn from a diverse training experience offered by both our highly trained faculty and by working directly and seamlessly with each other. Our program is hands-on but also affords a lot of time for exposure to various electives offered within the tertiary care medical center.

Telehealth and eICU is an emerging technology and practice pattern within Critical Care that current fellows must have experience with to be competitive in the current workforce. There is a known and predicted workforce shortage of Critical Care physicians within the country.

Fortunately, Dartmouth Hitchcock Medical Center has an active TeleICU program that covers over 50 different hospitals and 240 beds nationwide. This is a unique experience that offers our fellows' exposure into the current industry and how this type of care is delivered regionally, nationally, and within our institution.

Skiing, culture, and kayaking

As a critical care fellow here, you will train at a prestigious highly ranked academic center with all of the benefits but without the hassles/expense of traffic and city living. This affords you the opportunity for improved quality of life and health benefits unique to this region.

At your doorstep, you will discover the beauty of the Northern New England region with its pristine lakes, meandering rivers, and premier ski resorts like Killington, Stowe, Kingdom Trails, Lake Sunapee, and Lake Champlain near Burlington, Vermont. Boston, New York City, and Quebec, Canada are within driving distance. In addition, you will enjoy all the benefits that the Dartmouth College community has to offer — Dartmouth Outing Club, Hopkins Center for the Arts, Hood Museum, plus so much more.

Thank you for your interest in our Critical Care Anesthesiology Fellowship program, we hope you will apply to our program as we are most proud of our reputation, and all the best with your fellowship pursuit!