SCC and ACS Fellowship – First Year: Surgical Critical Care

Program Mission

The Surgical Critical Care fellowship at Brody School of Medicine at East Carolina University is an immersive, comprehensive, and multidisciplinary educational experience that prepares fellows for all clinical aspects of surgical critical illness. The mission of the program is threefold:

  • To prepare graduates for clinical excellence in the entire breadth and scope of surgical critical illness.
  • To prepare graduates for leadership positions in surgical critical care, emergency general surgery and trauma.
  • To model graduates in the attributes of the teaching faculty, including professionalism, collaboration, compassion and wellness.

Facilities

Training occurs at ECU Health Medical Center, the 1,000-bed Level I trauma center and tertiary care teaching affiliate of East Carolina University. As the sole tertiary care teaching institution in the largest trauma catchment area in the state of North Carolina, ECU Health Medical Center serves the entirety of eastern North Carolina and the Outer Banks. The Trauma Center at ECU Health Medical Center is an American College of Surgeons verified and state of North Carolina accredited Level I trauma center, evaluating nearly 4,000 injured patients annually, with 2,600 patients admitted to the trauma service. Unique features of the trauma center at ECU Health Medical Center include a relatively high penetrating trauma rate (15%), long transport times given the austere catchment area, and a large breadth of injury mechanisms. Due to the rural nature of the trauma system and proximity to military bases and the Outer Banks, injuries include agricultural, military, hunting and ocean-related. The surgical critical care experience is concentrated in a 24-bed, state of the art, trauma and surgical intensive care unit (TSICU).

The Learning Experience

The curriculum is comprised of an innovative, multimodal educational approach emphasizing evidence based care. The learning experience produces graduating fellows that are intellectually and technically prepared for all aspects of surgical critical illness and ICU leadership. The foundation of learning is at the bedside, with hands-on teaching by faculty. Morning report, which meets daily at 8 a.m., includes a rich combination of didactic and socratic education based upon overnight admissions and events in the TSICU. The foundation of the didactic component of the curriculum is the weekly Fellow’s Conference (FC). Topics at FC are based upon a rubric which includes the Scientific American SCC curriculum topics and landmark evidence based articles. The conference is divided each month into four distinct presentations:

  • Journal club
  • Curriculum fellow based lecture
  • Curriculum core faculty lecture
  • Curriculum expert lecture

Additional conferences include the monthly Multidisciplinary Critical Care Conference as well as Multidisciplinary Trauma and Acute Care Surgery Conference, which also meets monthly. A variety of formal teaching and research offerings are available through the Office of Graduate Medical Education and the Brody School of Medicine. For aspiring ICU directors, the fellowship includes a leadership pathway for surgical critical care.

We are committed to ensuring our fellows finish the SCC year facile in any component of surgical critical illness.

Rotations

Both fellows traditionally begin in the TSICU. The remainder of the year, fellows are divided between the TSICU and off-service rotations. Per ACGME requirements, 10 months of the year involve critical care rotations, of which 9 months are spent in surgical critical care environments, including the TSICU as well as cardiothoracic and neurosurgical critical care. For the 10th month of critical care, fellows may choose between a variety of critical care rotations (see below). The final two months consist of electives which involve the care of critically ill patients.

Rotations include:

  • Trauma and Surgical Intensive Care Unit (7 months)
  • Cardiothoracic Intensive Care Unit (1 month)
  • Neurosurgical Intensive Care Unit (1 month)
  • Additional Critical Care
    • MICU
    • CICU
    • PICU
    • Additional time in CTICU or NSICU
  • Elective options include
    • Anesthesia (1 month)
    • Critical Care Ultrasonography (1 month)
    • Trauma Surgery (1 month)
    • Emergency General Surgery (1 month)

Operative Experience

A concerted effort is made by the program leadership to ensure that fellows get to the OR without encroaching on their critical care training. Fellows serve in the role of junior faculty when on call, supervised by in-house TACS faculty. Covering a busy Level I trauma center with a 15% penetrating rate affords SCC fellows the opportunity to participate in ample trauma resuscitations and operations. In addition, fellows are encouraged to participate in damage control part III for TSICU patients in addition to other TSICU procedures. Fellows enter cases into the case log system for the American Association for the Surgery of Trauma. From these data, first year fellows average 100 index cases during the SCC year. We are committed to appropriately balancing education versus service obligations for our fellows following ACGME guidelines with regards to call and work hour limits.