ECU Health serves as a major referral center for hospitals throughout Eastern North Carolina, offering a wide range of specialized medical services. For those pursuing advanced training in critical care, the Ecu Surgical Critical Care Fellowship provides an unparalleled opportunity to gain comprehensive experience across diverse intensive care settings. This fellowship is meticulously structured to equip future critical care specialists with the expertise and skills necessary to excel in this demanding field.
Diverse ICU Rotations
Fellows in the ECU Surgical Critical Care Fellowship will participate in rotations across five distinct Intensive Care Units (ICUs), each offering unique patient populations and learning opportunities. These rotations are designed to provide a well-rounded and in-depth understanding of critical care medicine.
Medical Intensive Care Unit (MICU)
The Medical Intensive Care Unit (MICU) is a 24-bed closed unit managed by a dedicated team of experts. This team comprises two attending physicians specializing in Pulmonary and Critical Care Medicine (PCCM), two fellows, two senior residents, and four to five junior residents or interns. Within this structured environment, fellows play a crucial role in leading daily teaching rounds, disseminating essential knowledge of critical care medicine to the resident team.
Fellows in the MICU actively supervise and mentor residents, providing guidance on patient care and overseeing procedural training. This hands-on experience includes active participation in patient assessment and critical decision-making processes. The MICU manages a high volume of critically ill and often medically complex patients, providing fellows with extensive exposure to conditions requiring Continuous Renal Replacement Therapy (CRRT), mechanical ventilation, and bedside ultrasonography and echocardiography. MICU fellows take a leading role in performing a wide array of procedures, including advanced airway management, bronchoscopy, central and arterial line placement, and chest tube insertion, among many others, honing their procedural skills in a high-acuity setting.
Cardiology Intensive Care Unit (CICU)
The Cardiology Intensive Care Unit (CICU) is a 24-bed closed unit where PCCM faculty serve as the primary attending providers, managing critically ill patients with cardiac conditions. The CICU also accommodates general medical patients when the MICU reaches capacity, making it a high-acuity environment with a diverse patient population. Fellows rotating through the CICU will gain practical experience in managing patients requiring advanced interventions such as Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO), CRRT, and cardiac mechanical support. Furthermore, they will participate in and observe other high-risk procedures managed by intensivists, developing expertise in the critical care of cardiac patients and the application of advanced life support technologies. Fellows on this service collaborate closely with a team of advanced practitioners, enhancing their interprofessional teamwork skills.
Neuroscience Intensive Care Unit (NSICU)
The NeuroScience Intensive Care Unit (NSICU) is a 24-bed closed unit dedicated to the care of critically ill patients with neurological and neurosurgical conditions. Fellows in this rotation work alongside attending neurocritical care physicians, gaining exposure to a specialized patient population. This includes patients with diverse neurologic disorders, those recovering from neurosurgical procedures, and individuals undergoing endovascular cerebral procedures. The NSICU rotation provides fellows with focused experience in the nuances of neurocritical care management, allowing them to develop expertise in this subspecialty area. Similar to other specialized ICUs, fellows primarily manage patients in conjunction with a team of advanced practitioners, fostering a collaborative and supportive learning environment.
Surgical and Trauma Intensive Care Unit (SICU/TICU)
The Surgical and Trauma Intensive Care Unit (SICU/TICU) is a 24-bed closed unit catering to critically ill patients with surgical and traumatic injuries. ECU Health is designated as a Level 1 Trauma Center, and the SICU/TICU is expertly managed by Surgical and Trauma Critical Care Surgeons. Fellows rotating through this service will acquire essential knowledge and skills for managing the unique challenges presented by patients in the surgical intensive care setting. As integral members of the Surgical Critical Care/Trauma Team, fellows participate in bedside teaching and procedural training during daily work rounds. This rotation is crucial for developing competence in managing post-operative complications, trauma-related critical illnesses, and the specific critical care needs of surgical patients.
Cardiovascular Intensive Care Unit (CVICU)
The Cardiovascular Intensive Care Unit (CVICU) specializes in the care of critically ill patients undergoing advanced cardiac surgery, including Coronary Artery Bypass Grafting (CABG) and valvular repair or replacement, as well as patients requiring Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO). Fellows rotating in the CVICU collaborate with attending physicians who are cardiac surgeons, providing a unique perspective on the perioperative management of complex cardiac surgical patients. Fellows participate in daily rounds and contribute to patient management alongside a team of advanced practitioners, gaining specialized experience in the critical care aspects of cardiothoracic surgery and the management of patients requiring advanced cardiac support.
Inpatient Consultation Rotations
Beyond ICU rotations, the fellowship includes valuable experience in inpatient consultation services, expanding the scope of fellows’ critical care expertise.
Inpatient Pulmonary Consultation Rotation
Fellows undertake a rotation on the pulmonary consultation service, where they are responsible for managing all inpatient pulmonary consult requests within the hospital. This service is staffed by an attending physician, three fellows, and a variable number of internal medicine residents. During a typical four-week rotation, the service handles between 100 and 150 new consultation requests. Fellows are tasked with evaluating all new patients, formulating assessments and plans, and presenting cases to the attending physician during teaching rounds. They also play a vital role in teaching and supervising residents rotating on the service.
A key responsibility of the fellow is the interpretation of all pulmonary function tests (PFTs) under the guidance of the attending physician. Fellows also perform all inpatient bronchoscopies with direct faculty supervision, enhancing their procedural skills in pulmonary diagnostics and therapeutics. Furthermore, fellows perform procedures such as thoracentesis and tube thoracostomy, or supervise and instruct residents in performing these procedures. The rotation also emphasizes learning ultrasound-guided techniques for thoracentesis and other pleural procedures, including the use of chest tubes, Pleur-x catheters, and pigtail catheters, providing comprehensive training in pulmonary procedural skills.
Inpatient Critical Care Consultation Rotation
The critical care consultation service rotation focuses on the management of critically ill patients located outside of the ICUs within the hospital. Fellows on this service are responsible for triaging admissions from the Emergency Department and stabilizing critically ill patients in general and intermediate care floors. Additionally, they provide ongoing management and consultation for patients with tracheostomies on long-term ventilators or those undergoing ventilator weaning outside of the ICU setting. Fellows take a primary role in managing ventilators and tracheostomies, including procedures such as tracheostomy exchange, upsizing/downsizing, and decannulation. Crucially, fellows serve as the primary responders for all code blue/cardiac arrest events occurring outside of the ICU, developing critical leadership and rapid response skills in emergency situations.
Electives and Required Rotations
To further enhance the fellowship experience and cater to individual interests, a range of elective and required rotations are incorporated into the curriculum.
Required Rotations:
- Research: Fellows dedicate 3-4 blocks to research activities, fostering academic inquiry and contributing to the advancement of critical care medicine.
- VV-ECMO: This rotation provides comprehensive education in VV-ECMO, including hands-on experience with daily patient management and on-call responsibilities with the ECMO team for consultations and cannulations.
- Thoracic Surgery: Fellows participate in a consult service with the Thoracic Surgery team, gaining insights into the surgical management of thoracic diseases.
- Advanced Heart Failure: A consult service rotation with the Advanced Heart Failure team provides specialized experience in the critical care management of patients with advanced heart failure.
- ECHO: Advanced Echocardiography training includes didactic sessions and hands-on practice, developing fellows’ expertise in cardiac imaging.
- Transplant Elective: An external elective in lung transplant offers exposure to the specialized field of transplantation and the critical care of lung transplant recipients.
- Simulation Lab: Regular simulation lab sessions provide education, procedural practice, and teaching opportunities, enhancing fellows’ skills in a controlled environment.
The ECU Surgical Critical Care Fellowship offers a robust and diverse training experience, preparing fellows for successful careers in critical care medicine. Through a combination of intensive ICU rotations, consultation service experience, and specialized electives, fellows gain the comprehensive knowledge, procedural skills, and clinical judgment necessary to excel as leaders in the field of surgical critical care.
