Curriculum

The two-year critical care fellowship for graduates of Emergency Medicine residency programs is designed to provide a comprehensive education in multidisciplinary critical care education. The training program is compliant with ACGME and American Board of Anesthesiology (ABA) guidelines and graduates are eligible for critical care board certification from the combined ABA and American Board of Emergency Medicine. The two-year fellowship will be divided into 26 four-week blocks and is designed to complement core residency education and prepare graduates to work in a variety of critical care settings.

The curriculum includes 17 blocks of core critical care training and is designed to provide fellows with an extensive experience in several subspecialized critical care units. All critical care teams at University of Colorado Hospital are led by an attending intensivist and team members include fellows, residents, advanced practice providers, nurses, respiratory therapists, registered dieticians, pharmacists, physical and occupational therapists, and social workers. The Swedish Hospital rotation provides fellows win an experience in community practice intensive care within a large multispecialty intensive care unit.

Rotations are divided as follows:

• 4 blocks Cardiothoracic Intensive Care (CTICU)
• 4 blocks Surgical-Trauma Intensive Care (STICU)
• 4 blocks Medical Intensive Care (MICU)
• 4 blocks Neurological/Neurosurgery Intensive Care (NeuroICU)
• 1 block Burn Intensive Care (BurnICU)

Non-core ICU rotations are designed to supplement critical care fellowship education and include the following rotations:

• 0.5 block Trauma & Acute Care Surgery
• 0.5 block Acute Pain
• 1 block Ultrasound and Echocardiography
• 2 blocks Academic Medicine / Research
• 2 blocks total (2 weeks/rotation): Palliative Care, Nutrition, Infectious Disease, Nephrology & Dialysis

The remaining 3 blocks are elective and can be used for an additional ICU rotations, additional transesophageal echocardiography experience, subspecialty rotations (we have an extensive list of elective rotation offerings), or additional dedicated research time.

Detailed information on core ICU and non-ICU rotations are listed below:

Cardiothoracic Intensive Care Unit (CTICU)

The University of Colorado CTICU is a 17-bed unit admitting patients from cardiac and thoracic surgery services. The unit is directed by Dr. Breandan Sullivan from the Department of Anesthesiology. Patient care is managed by a multidisciplinary critical care team, led by an attending intensivists from the Department of Anesthesiology or Surgery.

The CTICU population includes patients undergoing heart and lung transplantation, placement of durable mechanical circulatory support devices, coronary revascularization, valve repair or replacement, aortic reconstructive surgery, pulmonary thromboendarterectomy surgery, and major open thoracic surgery including tracheal resection and esophagectomy. The CTICU is also home to all patients managed with veno-venous and veno-arterial extracorporeal membrane oxygenation (ECMO).

Surgical-Trauma Intensive Care Unit (STICU)

The STICU is a 24-bed unit admitting patients from multiple surgical services including: general surgery, surgical oncology, trauma and acute care surgery, transplant, ENT, orthopedics, plastics, gynecologic oncology, and vascular surgery services. The unit is co-directed by Dr. Ben Scott from the Department of Anesthesiology and Dr. Frank Wright from the Department of Surgery.

The STICU population most commonly includes patients undergoing trauma resuscitation and emergency surgery, transplant surgery, major oncologic surgery, and those with severe perioperative complications. Patients in fulminant hepatic failure are also managed in the STICU. University of Colorado Hospital is a verified Level 1 Trauma Center and is home to the largest liver transplantation program in the region.

Medical Intensive Care Unit (MICU)

The MICU is a 24-bed unit admitting critically ill patients from all medical services. The unit is directed by Dr. Katherine Meyer from the Division of Pulmonary Critical Care in the Department of Medicine. Patient care is managed by a multidisciplinary critical care team, led by an attending intensivist from the Division of Pulmonary Critical Care Medicine.

The MICU population includes a diverse pulmonary critical care and subspecialty medical critical care patient population.

Neurology/Neurosurgery Intensive Care Unit (NeuroICU)

The NeuroICU is a 24-bed unit admitting critically ill patients with primary neurological illnesses and those from the neurosurgical service. The unit is directed by Dr. Robert Neumann from the Department of Neurosurgery. Patient care is managed by a multidisciplinary critical care team, led by an attending intensivist from the Department of Neurosurgery.

The NeuroICU population includes patients affected by neurologic conditions including hemorrhagic and non-hemorrhagic CVA, aneurysmal subarachnoid hemorrhage, meningitis and encephalitis, and postoperative patients following intracranial and major spine surgery. The NeuroICU also cares for patients with primary neurotrauma.

Ultrasound and Echocardiography Education

The ultrasound and echocardiography curriculum includes one block of time dedicated to point-of-care ultrasound education and a longitudinal curriculum extending throughout the fellowship. The curriculum is designed to provide formal training in point-of-care ultrasound, including both transthoracic and transesophageal echocardiography, lung and abdominal ultrasound, and ultrasound for procedural guidance. Education includes a didactic program, echocardiography simulator, and bedside application as well as monthly ultrasound conferences. Teaching is provided by board certified and expert faculty from the Departments of Anesthesiology, Emergency Medicine, and the Division of Cardiology.

Academic Medicine / Research Education

The academic block provides time for fellows to explore and develop a career plan in academic medicine. The block builds on the Career Development Curriculum outlined below and provides opportunities in medical education, quality improvement and patient safety, and research.

Intensivists from the University of Colorado Department of Anesthesiology and critical care colleagues from the Department of Surgery, Emergency Medicine, Neurosurgery, and Medicine have expertise and are national leaders in each of these academic foci.

For fellows interested in research, opportunities are available in basic, translational, and clinical research categories. The intensivist group within the Department of Anesthesiology has multiple funded researchers focused on post-operative pain, delirium, respiratory function, surgical outcomes, critical care quality improvement and patient safety. In the first month of the fellowship year, fellows will meet with the Program Director and Director of Research for the fellowship and be guided to a specific project and research mentor.

Career Development Curriculum

The fellowship includes an innovative career development curriculum designed to prepare fellows for a career in academic medicine. The longitudinal curriculum is targeted to three areas of focus: teaching and education, quality improvement and leadership, and research and scholarship. Each component will include didactic education and experiential learning. Teaching faculty include experts from the Academy of Medical Educators and Institute for Healthcare Quality, Safety, and Efficiency. Formal certifications and scholarship from this curriculum will be utilized to build a portfolio for faculty application and interviews.

The fellowship program provides a longitudinal curriculum for the critical care fellowship. These include:

• Morning Chalk Talks  - Didactics on core critical care topics in the STICU and CTICU. During the initial 6 months of the academic year, these talks are led by attending faculty. After January, these are led by our fellows to encourage development of teaching skills.
• Monthly Critical Care Grand Rounds – a collaborative venture with multiple institutions by experts in a variety of critical care topics, typically presenting leading innovations in their area of focus. This series provides an excellent opportunity for fellows to network with other institutions.
• Monthly Journal Club – focused on evaluating noteworthy articles in the recent critical care literature.
• Monthly Ultrasound Grand Rounds – lead by our fellows. Fellows will present 1-2 times/year, presenting a case-based ultrasound topic and reviewing the relevant findings, techniques, management principles and literature.
• Bi-Weekly Transesophageal Echocardiography Review Sessions – Fellows will review TEE images and findings with Advanced Perioperative Transesophageal Echocardiography Certified faculty. This provides both focused teaching on image interpretation, but extends to focus on management of post-operative care in the Intensive Care Unit based on TEE findings and also facilitates the requirements for certification in Perioperative Transesophageal Echocardiography.
• Multidisciplinary Collaborative Case Reviews – Quarterly in each the STICU and CTICU. Fellows participate in the Quality improvement process, identify areas for process improvement, and review management and relevant literature.
  

As leaders in anesthesiology critical care medicine, our faculty provide exceptional mentorship for our fellows as they look towards transitioning into the attending role. At the beginning of the academic year, fellows will meet with the Program Director or discuss career planning and mentorship opportunities, this functions in collaboration with the Career Development Curriculum.

As specific interests are identified, fellows will be connected with mentors who are leaders in their respective career pathways. Fellows will continue to meet with Program Leadership quarterly to discuss progress, career planning, and ongoing mentorship.