SCC and ACS Fellowship – Message from Program Leadership

Prospective Fellows,

We are honored to serve as the Program Directors for the Surgical Critical Care and Acute Care Surgery Fellowships at The Brody School of Medicine at East Carolina University. When Dr. Eric Toschlog created the original program in 2003, we could not have envisioned the growth and success that we have achieved. We began as a one-year Surgical Critical Care Fellowship with a single position.

In 2012, we became the 9th American Association for the Surgery of Trauma Acute Care Surgery Fellowship program. We have since expanded to two positions per year. The fellowship is a mandatory two-year program with the first year being an accredited ACGME Surgical Critical Care Fellowship and the second year being an AAST certified Acute Care Surgery Fellowship. Fellows at East Carolina University are expected to complete both years.

ECU Health Medical Center, the 1,000-bed teaching affiliate of the Brody School of Medicine, is the sole tertiary care medical center east of Raleigh, serving the entirety of eastern North Carolina and the Outer banks. The service area includes twenty-nine counties and is the fourth largest regional advisory committee in the United States of America. The medical center is the only ACS verified Level 1 adult trauma center in the region. Of note, in 2024, ECU Health Medical Center was verified by the ACS as a Level I Pediatric Trauma Center, advancing from its previous Level II designation.

The program has become a national model for pediatric trauma training, as Acute Care Surgery fellows participate in pediatric trauma activations throughout both years of fellowship, gaining longitudinal experience in pediatric trauma resuscitation, critical decision-making, and operative management across the full spectrum of injury severity. ECU Health also supports the region through the system’s emergency medical service, EastCare.  These ground and flight crews are supplied with blood products and other adjuncts to ensure effective resuscitation of injured and critically ill patients.

We believe the fellowship has many strengths. The foundational strength of the program is undoubtedly the teaching faculty. We have assembled a diverse group of surgeon educators trained at the best fellowships in the country. They are excellent clinicians, decorated educators and dedicated researchers.

The Division Chief, Dr. Eric Toschlog, serves as the Chair of the North Carolina Committee on Trauma which speaks to the service of our faculty and allows for unique opportunities for fellows. The Acute Care Surgery Fellowship Program Director, Dr. Nicole Garcia, is the Vice Chair for the AAST Program Directors Committee. Our other faculty are nationally involved including committee representation amongst key organizations in our field including EAST, AAST, SCCM and ACS.

A second clear strength is the training.  The imparted volume and acuity of ECU Health Medical Center offers a perfect training environment. In that environment, we believe that we have remained at the forefront of state-of-the-art trauma, surgical critical care and emergency general surgery care. We ensure not only skill maintenance but operative advancement of our first-year fellows by allowing them to participate in trauma call including any associated operations.

In the past few years, our first-year fellows have averaged 150 cases in their surgical critical care year alone. In the second year of fellowship, fellows are averaging between 500-600 total operative cases. Our emergency general surgery service line is unique in the fact that we have a dedicated operating room for cases 7 days/week. In the last years, we have incorporated robotic surgery as a key component of our emergency general surgery service line which has facilitated minimally invasive options for patients requiring emergency surgery.

With a penetrating trauma rate of 15% in adult and pediatric patients, fellows gain robust exposure to both blunt and penetrating trauma. Trauma resuscitation and training at ECU Health includes advanced aspects of trauma care including thromboelastography, REBOA and whole blood. As a division, and also training center, for fellows, we pride ourselves on being whole body surgeons that are comfortable operating in the chest, abdomen, extremities and head/neck. We enjoy collegial relationships with surgical subspecialists and incorporate them into patient care as needed. Please see the SCC year and ACS year pages for further details about training.

Our program has many additional attributes detailed on this website, including a robust educational program geared specifically for the fellows, embedded formal leadership training and a diverse selection of research opportunities.

Simply stated, we feel strongly that graduates of our program are fully prepared for all clinical and leadership aspects of acute care surgery. There are many programs that have outstanding one-year SCC fellowships or strong ACS years. I would challenge anyone to find a program that offers the breadth and scope of training in both the SCC and ACS years, with the mentorship and camaraderie of one of the finest group of surgical educators in the country.

Candidates often ask what the program seeks in prospective fellows. The answer is very simple. We are looking for candidates who model the attributes of the teaching faculty; surgeons who demonstrate clinical and teaching excellence, are affable and of high character, consider our profession a true vocation, and who came to eastern North Carolina to serve our very important missions.