Best Critical Care Fellowship Programs: A Guide for Emergency Medicine Residents

Emergency Medicine (EM) physicians are uniquely positioned to excel in critical care medicine. Their front-line experience in managing acutely ill patients, coupled with their rapid decision-making skills, makes them highly sought-after candidates for critical care fellowships. If you’re an EM resident considering specializing in critical care, understanding the landscape of fellowship programs is crucial. This guide will navigate you through the Best Critical Care Fellowship Programs, helping you make informed decisions about your future career path.

Why Critical Care is a Natural Fit for Emergency Medicine

The synergy between emergency medicine and critical care is undeniable. EM physicians are adept at the initial resuscitation and stabilization of critically ill patients – skills that are fundamental in the intensive care unit (ICU). Your training in emergency medicine already provides a strong foundation for critical care, particularly in areas such as:

Resuscitation Expertise: EM training emphasizes rapid assessment and intervention in life-threatening situations, a core competency in critical care.
Management of Undifferentiated Patients: Your ability to quickly diagnose and manage complex, undifferentiated cases in the ED translates well to the diverse patient population in the ICU.
Technical Skills: Proficiency in procedures like intubation, central line placement, and chest tube insertion, honed in the emergency department, are essential in critical care settings.
Exposure to Diverse Emergencies: EM residents gain experience managing a wide spectrum of medical, surgical, and traumatic emergencies, providing a broad knowledge base applicable to critical care.

These inherent strengths make EM residents highly desirable fellows in critical care programs.

Pathways to Critical Care Certification for EM Physicians

For emergency medicine residents seeking board certification in critical care, several pathways exist, primarily through fellowships accredited by different boards:

Internal Medicine Critical Care Fellowships

Certification: Offered through the American Board of Internal Medicine (ABIM).
Fellowship Duration: Typically two years.
Eligibility: Open to Emergency Medicine residency graduates.
Grandfathering: While a grandfathering track existed in the past, it is no longer available.
Focus: Provides a strong foundation in medical critical care.

Surgical Critical Care Fellowships

Certification: Offered through the American Board of Surgery (ABS).
Fellowship Duration: Two years, including a year of rotating surgical experience.
Eligibility: Available to Emergency Medicine residency graduates since 2012.
Grandfathering: No grandfathering track is available.
Focus: Emphasizes surgical aspects of critical care and trauma management.

Anesthesia Critical Care Fellowships

Certification: Offered through the American Board of Anesthesiology.
Fellowship Duration: Two years.
Eligibility: Welcomes Emergency Medicine residency graduates.
Focus: Provides expertise in perioperative critical care, hemodynamic management, and ventilator management.

The Association for Emergency Medicine-Critical Care Medicine Program Directors (AEMCCMPD) (http://www.emccmfellowship.org/) is an excellent resource for further information and program listings.

What to Look for in the Best Critical Care Fellowship Programs

Choosing the right critical care fellowship program is a significant decision. Here are key factors to consider when evaluating programs:

Program Accreditation and Board Certification Pathway: Ensure the program offers a clear path to board certification in your desired specialty (Internal Medicine, Surgery, or Anesthesia).
Program Reputation and Faculty Expertise: Look for programs with established reputations and faculty who are leaders in critical care medicine, actively involved in research and education.
Clinical Exposure and Case Diversity: A strong program will offer diverse clinical experiences across medical, surgical, cardiac, neuro, and trauma ICUs, providing exposure to a wide range of critical illnesses.
Research Opportunities: If you are interested in academic critical care, prioritize programs with robust research infrastructure and mentorship opportunities.
Fellow Support and Mentorship: A supportive learning environment with strong mentorship is crucial for fellow development. Look for programs that prioritize fellow well-being and career guidance.
Program Culture and Fellow Community: Consider the program culture and the sense of community among fellows. A positive and collaborative environment enhances the fellowship experience.
Location and Personal Preferences: Location, cost of living, and personal preferences should also factor into your decision.

Recommended Critical Care Fellowship Programs for EM Residents

The following programs are known to actively welcome and value Emergency Medicine residents, offering excellent training in critical care:

Shock Trauma Center (Baltimore): Offers both Surgical and Medicine tracks, renowned for trauma and surgical critical care.
Indiana University (Anesthesia): Strong anesthesia-based critical care program.
University of Pittsburgh (Anesthesia and Medicine): Offers both Anesthesia and Medicine tracks, a highly respected and comprehensive program.
Henry Ford Hospital: Well-regarded program with a strong clinical focus.
Cooper University Hospital: Excellent program with a focus on urban critical care.
Beth Israel Deaconess Medical Center (Boston): Located in a major medical hub, offering diverse clinical experiences.
University of Alabama at Birmingham: Comprehensive program with strengths in various critical care subspecialties.
University of Michigan (Anesthesia and Medicine): Offers both Anesthesia and Medicine tracks, known for its academic rigor.
University of Iowa Hospitals and Clinics: Strong program with a focus on rural critical care delivery.
Stanford University (Anesthesia): Historically welcoming to EM residents, now encourages application through the Medicine track as part of a multi-disciplinary approach.
University of Washington (Anesthesia & Internal Medicine): Offers both Anesthesia and Internal Medicine tracks, expanding training pathways.
University of Nebraska Medical Center: Growing program with a dedicated critical care fellowship.
UC San Diego Health: Established program with a focus on innovation in critical care.
Geisinger Health: Community-based program with a strong emphasis on clinical training.
Emory University (Anesthesiology): Anesthesia-based program in a major academic center.
Hennepin Healthcare (Minneapolis): County hospital program with a focus on urban and underserved populations.
Washington University in St. Louis (Anesthesia): Actively recruits EM residents into its two-year anesthesia-based track.
University of Florida (Anesthesia): Two-year anesthesia track with a strong recruitment of EM residents.
Johns Hopkins Hospital (Anesthesia): Anesthesia program known to actively welcome EM applicants.

This list is not exhaustive, and further research is encouraged to find programs that best align with your individual career goals and preferences.

Career Opportunities After Critical Care Fellowship

Completing a critical care fellowship significantly expands your career opportunities. As a dually trained EM and critical care physician, you will be highly competitive for positions in:

Intensive Care Units (ICUs): Working as a full-time intensivist in medical, surgical, neuro, cardiac, or trauma ICUs in both academic and private practice settings.
Emergency Departments (EDs) with Critical Care Focus: Leading resuscitation teams, managing critically ill patients in the ED, and developing critical care protocols within emergency medicine.
Combined ED/ICU Roles: Practicing in both the ED and ICU, offering a diverse and balanced career.
Academic Medicine: Pursuing academic careers involving teaching, research, and leadership roles in critical care and emergency medicine.
Observation Units: Staffing and directing observation units, leveraging expertise in both acute care and critical care management.

The demand for intensivists is projected to grow, making critical care a promising and secure career path. The Leapfrog Group, a consortium focused on healthcare quality, advocates for intensivist staffing in all ICUs, recognizing the value of critical care-trained physicians, including those with emergency medicine backgrounds.

Resuscitation Fellowship: An Alternative Path

For EM physicians passionate about resuscitation and ED critical care, but not seeking ICU practice, a Resuscitation Fellowship can be an excellent alternative. Programs like the one-year advanced training in resuscitation at Stony Brook (http://resus.cc/fellowship/art/) offer focused expertise in resuscitation science and ED-based critical care.

Neurocritical Care Fellowships

Neurocritical care is another specialized area within critical care. While neurocritical care fellowships exist and have certified physicians from various backgrounds, including emergency medicine, it is important to investigate the current certification pathways and program availability. Historically, grandfathering options may have existed, but it’s crucial to confirm the latest certification requirements.

Preparing for Critical Care Certification Exams

Board certification exams in critical care are rigorous. Resources like the blog post discussing the British FFICM exam (http://oxicmblog.wordpress.com/2014/03/16/how-to-pass-the-fficm/) can provide insights into the exam preparation process and strategies.

Additional Resources

Association for Emergency Medicine-Critical Care Medicine Program Directors (AEMCCMPD): http://www.emccmfellowship.org/
Society of Critical Care Medicine (SCCM): https://www.sccm.org/

Relevant References

Tisherman S, Spevetz A, Blosser S, et al. A Case for Change in Adult Critical Care Training for Physicians in the United States: A White Paper Developed by the Critical Care as a Specialty Task Force of the Society of Critical Care Medicine. Crit Care Med. 2018;46(10):1577-1584. PubMed

This guide provides a starting point for your exploration of critical care fellowship programs. By carefully considering your interests, career goals, and program options, you can embark on a rewarding path to becoming a board-certified critical care physician with a strong foundation in emergency medicine.