The Stanford Medical-Surgical ICU is central to its renowned Critical Care Medicine Fellowship Programs, offering an unparalleled training environment. Situated in the 36-bed multispecialty E2-Medical-Surgical ICU, the program extends its reach to critically ill patients in various locations, including the PACU, ED, and alternate units. This expansive approach ensures fellows gain comprehensive experience, managing a diverse caseload of 15 to 30 patients and encountering a broad spectrum of pathophysiologies and disease states.
The program boasts a distinguished faculty of 14 attending physicians with backgrounds in Anesthesia, Internal Medicine, and Emergency Medicine, all board-certified in Critical Care Medicine. The service is structured into two teams, each comprising an attending, a fellow, and four residents from Anesthesia, Medicine, and Emergency Medicine. Medical students participating in the Critical Care Core Clerkship further enrich the team dynamics, fostering a collaborative learning atmosphere.
Clinical training within these critical care medicine fellowship programs commences with an immersive introduction to critical care at Stanford Medical-Surgical ICU. The initial month serves as a crucial transition, integrating fellows into the Stanford Healthcare system and establishing their role as critical care specialists. Fellows spend at least two weeks engaged in primary patient care, admitting patients, meticulously documenting within the EMR system, reporting to senior fellows, and participating in the resident call schedule, typically every fourth night. The subsequent two weeks of the first rotation involve fellow-level ICU shifts under the direct mentorship of experienced fellows. This structured progression facilitates a smooth transition into the responsibilities of a fellow before independent call duties begin. This introductory month also incorporates essential elements such as weekly bedside ventilator rounds, hands-on procedural and ultrasound workshops, and participation in morning lectures on fundamental critical care medicine topics designed for residents, ensuring a solid foundation in mechanical ventilation and core critical care principles.
During the subsequent 2-3 months, the fellow advances to a junior fellow role, collaborating with ICU attendings in supervising residents and students. Night call responsibilities during this period and for the remainder of the year average 7-8 times per month. While on call from home (within a 15-minute radius of the hospital), the fellow provides guidance, support, and supervision to the on-call house staff, backed by ICU faculty. As fellows progress through the year, they undertake senior fellow responsibilities, including leading rounds intermittently during the week and on weekend call days, delivering lectures, and taking on increased leadership roles within the team.
A significant aspect of these critical care medicine fellowship programs is the exposure to diverse clinical settings. Fellows undertake rotations at the Medical-Surgical ICU at the Palo Alto Veterans Administration Medical Center, gaining additional expertise in post-operative general surgical and cardiac surgical critical care in a different patient population. Rotations at the Stanford Cardio-Thoracic ICU provide invaluable experience in managing complex open-heart surgery, major vascular procedures, and heart, lung, and heart/lung transplant patients. Further broadening their experience, fellows also rotate through the Medical ICU at Santa Clara Valley County Hospital, exposing them to a county hospital environment and a different spectrum of critical illnesses.
Towards the culmination of the first year of clinical training in these critical care medicine fellowship programs, fellows serve a month as a junior attending physician. In this capacity, they assume responsibility for all facets of patient care and teaching activities, with a dedicated ICU faculty member present to evaluate their performance, provide constructive feedback, and ensure optimal patient care standards are maintained. The remaining portion of the fellowship offers flexibility, encouraging fellows to pursue elective months in areas such as Echocardiography/ultrasound, Airway management (for non-Anesthesia fellows), or various subspecialties within Medicine or Neurology, allowing for personalized learning and specialization. Furthermore, participation in research or academic work related to critical care is a core expectation. Stanford provides robust facilities for clinical physiology studies, including a well-equipped laboratory with technical, financial, and computer resources. The diverse research interests of the faculty offer fellows opportunities to develop a wide range of investigative skills, fostering academic growth and contribution to the field.
For applicants seeking a deeper understanding of these critical care medicine fellowship programs, an in-depth review published on the Society of Critical Care Anesthesiologists (SOCCA) website in 2012 provides valuable insights. While the program leadership continuously strives to enhance the curriculum and training experience, this review remains a relevant depiction of the immersive and enriching learning environment offered by Stanford’s critical care fellowship.
These critical care medicine fellowship programs at Stanford offer a comprehensive and rigorous training experience, preparing future critical care specialists for the challenges of modern intensive care medicine through diverse clinical exposure, expert faculty mentorship, and robust research opportunities.
