Overview

The Emergency Medicine Critical Care Fellowship offers a range of clinical, didactic, and research training opportunities.

Clinical critical care training is based in three intensive care units at the University of Iowa: the 36-bed Surgical and Neurosciences Intensive Care Unit, the 26-bed Medical Intensive Care Unit, and the 24-bed Cardiovascular Intensive Care Unit. Rotations are also available in other clinical units and services at the University of Iowa.

• Surgical and Neurosciences Intensive Care Unit (SNICU) – The 36-bed SNICU is the largest intensive care unit in Iowa. As an American College of Surgeons-designated Level 1 Trauma Center and a Joint Commission-accredited Comprehensive Stroke Center, the SNICU cares for patients with critical traumatic injuries, general surgery, neurosurgery, otolaryngology, transplant, neurology, and stroke patients. Residents from emergency medicine, anesthesia, general surgery, neurosurgery, neurology, family medicine, otolaryngology, orthopedic surgery, and oral surgery rotate through the SNICU.
• Medical Intensive Care Unit (MICU) – The 26-bed MICU is the largest medical ICU in Iowa, and it provides comprehensive medical care for critically ill medical patients. Emergency Medicine and Internal Medicine residents rotate through the MICU, and this unit manages most V-V ECMO for severe respiratory failure at the University of Iowa.
• Cardiovascular ICU – The 24-bed CVICU was opened in April 2014, and provides care for patients with acute coronary syndrome, heart failure, and surgical patients after cardiac, thoracic, and vascular surgery procedures. Two physician teams provide comprehensive critical care for patients with both medical and surgical emergencies. As the only Joint Commission-certified Ventricular Assist Device Program in Iowa, patients are treated with a variety of mechanical cardiovascular support devices.

Curriculum

The comprehensive 24-month curriculum has been designed to provide fellows the most broad exposure to multidisciplinary critical care. The program was approved by the American Board of Anesthesiology to qualify graduates for board certification in the Anesthesiology Critical Care pathway through the American Board of Emergency Medicine.

The curriculum is arranged in 13 4-week blocks each year.

Year 1 (13 blocks)	Number of Weeks
Surgical Critical Care (within Surgical and Neuro ICU)	12 weeks
Cardiothoracic Critical Care (Surgical)	4 weeks
Neurological Critical Care (within Surgical and Neuro ICU)	8 weeks
Medical Critical Care	8 weeks
Surgical Selective	8 weeks
Cardiothoracic Surgery and Cardiac Anesthesiology	3 weeks
Fiberoptic Bronchoscopy and Chest Procedures, ICU Nutrition	3 weeks
Clinical Electives/Research	3 weeks
Vacation	3 weeks
Year 2 (13 blocks)
Surgical Critical Care (within Surgical and Neuro ICU)	12 weeks
Cardiothoracic Critical Care (Surgical)	8 weeks
Neurological Critical Care (within Surgical and Neuro ICU)	4 weeks
Medical Critical Care	8 weeks
Cardiac Critical Care	3 weeks
Critical Care Selective (SNICU, MICU, PICU)	4 weeks
Clinical Electives/Research	10 weeks
Vacation	3 weeks

Available Clinical Electives (not exclusive):

• Advanced echocardiography (including transthoracic echocardiography)
• Advanced inpatient trauma care
• Burn Surgery
• Extracorporeal life support (ECMO)
• Nutrition
• Pediatric critical care
• Pharmcology (with clinical pharmacists)
• Renal and hemodialysis medicine
• Rehabilitation medicine
• Transplant medicine (solid organ/bone marrow)
• Research
• Other rotations at discretion of program director
• Optional longitudinal electives

Fellows will participate in clinical and call activities in accordance with the ICU to which they are assigned. Fellows will have a co-supervisory role for residents and medical students assigned to ICUs in which they are rotating, and are expected to participate in resident and medical student teaching activities.

Fellows will be evaluated monthly by their supervising faculty using an online evaluation tool, and biannual summative evaluations with the program director will review ongoing progress toward preparation for independent critical care practice.

Education and Conferences

A wide variety of critical care didactic curricula are available for critical care trainees. Both medical and surgical ICUs have weekly didactic programs, and fellows are encouraged to participate in the didactic training of the unit where they are working. Didactic training covers the breadth of medical and surgical critical illness, journal clubs and evidence based-medicine, and case conferences and presentations. Fellows participate in a reading program with asynchronous resources available to supplement their critical care didactic program. Fellows are required to present cases and lectures in conferences.

Fellows are required to participate in two non-clinical projects during their fellowship: a scholarly activity and a quality improvement project. The academic project could be comprised of original research, writing, review articles or book chapters, or another contribution to the development or dissemination of critical care knowledge. The quality improvement initiative will take the trainee through the plan-do-study-act methodology of quality improvement to learn the methods of continuous improvement in large complex organizations.

Fellows have $2400/year in academic funds that can be used for conference travel, professional memberships, books, and other educational resources to supplement the educational program.

Teaching

One important aspect of development as a clinician-educator is learning how to teach effectively. Intensivists in academic practice clearly have a teaching component of their career, but community intensivists also fill an important niche in teaching nursing staff, allied health professionals, and colleagues. Fellows will refine their teaching activities through resident and medical student clinical teaching. In addition, the College of Medicine’s Office for Consultation and Research in Medical Education and the Fellows as Clinician Educators programs both support advanced training in clinical teaching.

Research

Faculty members at the University of Iowa are engaged in clinical, basic science, health services, and educational research. The Institute for Clinical and Translational Science is a resource for faculty and fellows pursuing research interests. A variety of ongoing projects are available for fellows to learn research methods, or fellows can create their own research project. Regular clinical release time is available for fellows to pursue academic activities, including research, writing, curriculum development, and other academic activities upon approval by the program director.