SCC and ACS Fellowship – First Year: Surgical Critical Care

Rotations

Fellows will rotate in the Surgical Intensive Care Unit (SICU) within the first two blocks of the Surgical Critical Care (SCC) Fellowship. The remainder of the year, fellows are divided between the SICU and off-service rotations. Per ACGME requirements, a minimum of 9 months must be direct critical care rotations.

Rotations include:

  • Surgical Intensive Care Unit (7 blocks)
  • Neurosurgical Intensive Care Unit (1 block)
  • Medical Intensive Care Unit (1 block)
  • Cardiac Intensive Care Unit (1 block)
  • Pediatric Intensive Care Unit (1 block)
  • Anesthesia (1 block)
  • Critical Care Ultrasonography (1 block)

Veno-venous ECMO patients are housed in the CICU. Fellows will gain exposure to ECMO through their CICU rotation. Additionally, ECMO experience is also incorporated into the fellow’s anesthesia, ultrasound and PICU blocks.

Goals and Objectives

Specific goals and objectives exist for each rotation. Fellows meet with the program leadership and rotation liaisons to review them prior to each rotation.

The Surgical Intensive Care Unit

As noted above, the Surgical Intensive Care Unit is the home unit for Surgical Critical Care Fellows. This unit is staffed by faculty from the Division of Acute Surgery solely. The Surgical Critical Care Fellowship Program Director, Dr. Christina Regelsberger-Alvarez, is the Medical Director of the SICU. Dr. Sejul Chaudhary serves as the Assistant Medical Director of the SICU.

The SICU is a 24 bed unit that houses a breadth of surgical patients including trauma, general surgery, plastic surgery, urology, OBGYN, vascular surgery and more surgical subspecialties. The unit is split into two rounding and provider teams: Purple SICU and Gold SICU. Each team includes a dedicated Surgical Critical Care faculty, residents, advanced practice providers and students.

Each day begins with SICU Morning Report which includes a brief review of overnight events, new admission and patient updates from the last 24 hours. After this, multidisciplinary rounds commence which involve the bedside nurse, charge nurse, pharmacist, dietitian and respiratory therapist. While the Surgical Critical Care Fellow is primarily responsible for their team, they are expected to have a comprehensive understanding of the entire SICU census.

Operative Experience

A concerted effort is made by the program leadership to ensure that fellows get to the operating room without encroaching on their critical care training. Fellows are responsible for operative trauma cases when on-call and any bedside ICU procedures. Fellows enter cases into the ACGME case log system. In recent years, the first year fellows average 150 index cases during the SCC year.

Call Schedule

The program abides strictly by duty hours defined by the ACGME. Fellows take 24 hour call approximately every 5 days. There is no fellow on call on Wednesday nights to protect fellow education which occurs on Thursday afternoons. The 1st year fellow will cover the SICU and trauma services (including operative cases) when on call.

Supervision Policy

The Surgical Critical Care Fellowship has a supervision policy compliant with that of the ACGME requirements.