fellowshiP IN CRITICAL CARE MEDICINE

Faculty
The Program Director of the Anesthesiology Critical Care Medicine (ACCM) Fellowship is Robert N. Sladen, MBChB, FCCM.  Dr. Sladen is Medical Director of the Cardiothoracic Intensive Care Unit (CTICU) and Surgical Intensive Care Unit (SICU) at Columbia University Medical Center (CUMC).  He is also Medical Director of Respiratory Therapy at CUMC.  Dr. Sladen is a Fellow of the American College of Critical Care Medicine (FCCM), and a Past-President of the Society of Critical Care Anesthesiologists (SOCCA) and the Association of Anesthesiology Subspecialty Program Directors (AASPD).

In addition to Dr. Sladen, the Department Critical Care Faculty include Drs. Tricia Brentjens, Martin Chen, Daniela Darrah, Brigid Flynn, Alan Gaffney, Sumeet Goswami, Jonathan Hastie, May Hua, Desmond Jordan, Steven Miller, Vivek Moitra, Teresa Mulaikal, Oliver Panzer, Joseph Rumley, Peter Salgo, Julia Sobol, Gebhard Wagener, and Hannah Wunsch.

Clinical Experience
Each year up to nine positions are available in this 12-month ACGME-accredited program.  It is designed to take the Fellows through increasing levels of experience and responsibility and prepare them for Board Certification in Anesthesiology Critical Care Medicine (ACCM).  The Fellows supervise and teach anesthesiology and surgery junior house staff and medical students under the direction and guidance of the ICU Faculty.

The Fellows’ year is organized into 13 four-week blocks.  During the first two months, every Fellow undergoes a one-week immersion in ultrasound, including an introduction to transthoracic echocardiography (TTE), hemodynamic transesophageal echocardiography (hTEE) and thoracic, abdominal and vascular ultrasound.  They have an additional one-week immersion in management of ventricular assist devices and extracorporeal membrane oxygenation.  During these introductory educational weeks Fellows are freed of clinical duties and overnight call.

About 50% of the year is spent as a key member of the ICU team on the Milstein CTICU (21 beds), Heart Center CTICU (10 beds) and SICU (16 beds).  Together, these units provide postoperative care for nearly 3000 patients each year.  The units are “closed”: all orders must be written by the ICU team, but there is close collaboration with the surgery, cardiology, pulmonary medicine and transplant services involved.  Strong emphasis is given to the importance of a multidisciplinary approach to critical care involving colleagues from other services, nursing staff, pharmacists, respiratory therapists, physical therapists, nutritionists, medical social workers as well as palliative care and ethics services.

The CTICU admits patients following heart or lung transplantation, ventricular assist device (VAD) insertion, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), coronary revascularization and valve surgery, aortic reconstructive surgery, minimally invasive valve surgery and pulmonary thrombo-endarterectomy.  We have a very close relationship with the heart failure teams (VAD and heart transplant) and every morning at 9 am there is a VAD round in which members of the VAD cardiac surgery, cardiology and CTICU teams round together on VAD patients in CTICU to plan strategy and exchange ideas.

The SICU supports a very busy liver, kidney-pancreas and multi-organ transplantation service; an acute care surgery service; major thoracic and vascular surgery and a wide variety of general and subspecialty surgical procedures.  CUMC is also a referral center for high-risk obstetric cases such as placenta previa.  There is a similarly close collaborative relationship with the Liver Transplant Team, as well as Attendings, Fellows and residents on all surgical services.

About 25% of the year is spent on 2-4 week elective rotations tailored to the individual Fellow’s interests.  Choices for electives include rotations on the Medical ICU, Coronary Care Unit, Neuroscience ICU or Pediatric ICU, as well as preceptorships with specialists in infectious disease, nutritional support, dialysis, liver transplantation, palliative care and ethics.  In addition, all Fellows spend at least 2 weeks on the VAD service as a member of their team.

About 25% of the year is spent as the “TrUE” Fellow, which stands for Triage, Ultrasound and Education.  During these weeks, Fellows provide critical care consultation outside the ICU and assist in triage; receive hands-on experience in TTE, hTEE and thoracic, abdominal and vascular ultrasound; and have the opportunity to engage in clinical, quality improvement or research projects.

Our goal is to give our Fellows exposure to a wide variety of ICU problems and a progressive level of responsibility.  Call is organized into a 12-hr night float rotation (Sunday-Thursday and Friday-Saturday), with one Fellow on SICU and one Fellow on CTICU.  As such, there is no disruption of the daytime unit rotations, electives or TrUE rotation by overnight call.  The call pool is expanded beyond the fellowship group by Adult Cardiothoracic Anesthesiology Fellows on rotation as well as PGY-4 anesthesiology or surgery residents doing electives in critical care.  As the year progresses the ICU Fellow takes increasing responsibility for the conduct of rounds and decision-making, while the ICU Attending remains available for backup and support as appropriate.

ICU Medical Direction and Teaching Experience
The ICU Fellows have an office with computer support and sleeping facilities directly adjacent to the CTICU and SICU.

Twice weekly the ICU Fellow leads multidisciplinary bedside rounds attended by the ICU nurse manager, social worker, respiratory therapist, physical therapist and representative of the Ethics Committee.  The goal is to formulate joint strategies for family support and discharge planning of long-term ICU patients.  Every ICU Fellow is a member of the CTICU-SICU Multidisciplinary Quality Improvement Committee, which meets monthly and includes the ICU Faculty, Patient Care Directors and senior nursing staff, and representatives from Step-down units, Respiratory Therapy, Physical and Occupational Therapy, Pharmacy, Palliative Care, Social Services, Nutritional Support, Laboratory and Hospital Quality Assurance.

One of our recent graduates, Lance Retherford MD, initiated the Multidisciplinary Action Group (MAG) that coordinates activities of the Multidisciplinary Committee.  This is an example of the kind of initiatives that can be taken by our Fellows.

The ACCM Fellows, together with the Faculty, give lectures at the ICU Teaching Conference (ICU 101) for medical students and residents, as well as their own Fellowship seminars (see below).  They are responsible for coordinating our monthly Morbidity and Mortality Rounds.  During the year Fellows, together with an ICU Faculty mentor, provide presentations at Department of Anesthesiology Grand Rounds and at Critical Care Grand Rounds.

Our Fellows are encouraged to attend major critical care meetings such as the Society of Critical Care Anesthesiologists (SOCCA) or the Society of Critical Care Medicine (SCCM).  The Department of Anesthesiology provides $1,600 each year toward academic support and activities for each Fellow.

Academic Activities
Every Fellow is expected to complete an academic project and present an abstract and poster at the Department of Anesthesiology Annual Academic Meeting at the end of May each year.  These may include a research project (e.g. a retrospective data analysis or small prospective observational study), case report, literature review or quality initiative (QI) project.  In 2013, every one of our nine ACCM Fellows had one or more posters at our Academic Evening; two ACCM Fellows had abstracts in the top five clinical research presentations; and one of our ACCM Fellows won the prize for the best of 35 case reports. 

Monthly ICU Research Meeting

Venue: SICU Conference Room, Milstein Hospital 4th Floor.
Preceptors: Hannah Wunsch MD, MSc

Each month, Dr. Wunsch mentors presentations by ACCM Fellows of their ongoing and developing research projects in the Division. It is an opportunity for ICU Fellows to learn about projects that they may be interested in joining, present their own ideas as well as updates on their projects.

Critical Care Medicine Submissions to Academic Evening, 2013

Teaching Conferences

ICU Teaching Conference (ICU 101):

Every Monday, Tuesday, Friday 1:30 - 2:30 p.m.
Venue: SICU Conference Room, Milstein Hospital 4th Floor
Conference Coordinator: Julia Sobol, MD

Three days a week a one-hour tutorial is presented to the ICU residents, medical students, physician assistants and nurse practitioners. It provides didactic coverage of the ICU Core Curriculum to supplement rounds and bedside teaching by the ICU Faculty, pharmacists and nutritionists. In the second half of the year the ACCM Fellows take over many of the lectures themselves and so have the opportunity to hone their didactic teaching skills.

Transesophageal Echo (TEE) Fellows’ Lecture:

Every Wednesday 1:00 - 2:00 p.m.
Venue: SICU Conference Room, Milstein Hospital 4th Floor
Lecturer: Jack Shanewise, MD (Chief, Division of Cardiothoracic Anesthesiology)

Dr. Shanewise gives a weekly lecture on TEE to the combined group of ACCM and ACTA (Adult Cardiothoracic Anesthesiology) Fellows. This is a unique opportunity to receive what is essentially a one-year course on TEE delivered by an acknowledged expert.

Critical Care Fellows’ Journal Club / M & M Conference:

Every Wednesday 2:00 - 3:00 p.m.
Venue: SICU Conference Room, Milstein Hospital 4th Floor
Journal Club Coordinator: Hannah Wunsch, MD, MSc and Gebhard Wagener, MD

These conferences alternate between Journal Club, M & M Conference and Research (see above).

In Journal Club, presentation assignments are rotated among the ICU Fellows. The goal is to stimulate interactive discussion on a wide range of topics in critical care medicine between Fellows and Faculty. These include “classic” critical care papers, recent therapeutic advances, evidence based medicine, ethics, medico-legal issues, and other issues pertinent to organization and medical direction of an ICU. At M&M Conference, Drs. Wunsch and Wagener select one or two cases representing sentinel events or major morbidity for presentation by the ACCM Fellows and discussion with the Faculty.

On the last Wednesday of each month we host a Multidisciplinary CCM Journal Club that combines Faculty and Fellows from CTICU, SICU, Medical ICU and Neurosciences ICU. Our Fellows alternate presentations of journal articles with the Pulmonary Medicine Fellows and Neurointensive Care ICU Fellows. The joint ICU Faculty leads discussion.

Critical Care Fellows’ Core Lectures (CCFCL):

Every Thursday 1:00 - 2:00 p.m.
Venue: SICU Conference Room, Milstein Hospital 4th Floor
Coordinator: Julia Sobol MD, with Nina Patel MD (Pulmonary Critical Care Medicine)

These are multidisciplinary critical care lectures for our own ACCM Fellows together with the Pulmonary Medicine and Neurointensive Care Fellows. Lectures are given by ICU Faculty and non-ICU Faculty (surgeons, pulmonologists, cardiologists, ID specialists, nephrologists etc.), and Visiting Professors.

Anesthesiology Grand Rounds:

Every Thursday 7:00 - 8:00 a.m
Venue: Alumni Auditorium, Black Building
Coordinator: Vivek Moitra, MD

ACCM Fellows attend our weekly departmental Grand Rounds and have the opportunity to present cases 2-3 times per year.

Critical Care Grand Rounds (CCGR):

Every Thursday 3:00 - 4:00 p.m., September through June.
Venue: Heart Center, 1st Floor, Conference Rooms 1 & 2.
Conference Schedule Coordinator: Robert N. Sladen, MBChB, FCCM.

Critical Care Grand Rounds is a weekly conference open to all staff at CUMC; the common denominator is an interest in critical care medicine. The audience includes faculty and house staff, nursing staff, therapists, pharmacists and medical students. Columbia University Faculty and Visiting Professors who are experts in critical care and related fields present lectures. ACCM Fellows participate in giving ICU case presentations at Critical Care Grand Rounds 2-3 times each year.

In July and August CCGR gives way to the multidisciplinary introductory lectures (CCFCL).

Patient Care / Quality Improvement Conferences

Cardiac Surgery QI Meeting:

Every Monday 8:00-8:45 am.
Venue: Reemtsma Conference Room, Milstein 7-213 Hudson North

This is a multidisciplinary QI Meeting attended by the cardiac surgeons, ICU Faculty and Fellows, ACTA Faculty, nursing and many ancillary services. QI Indicators are reviewed, and our ACCM Fellows summarize goals for the long stay (> 1 wk) cardiac surgical patients in CTICU. There is an M&M discussion of all CTICU mortalities and re-admissions.

In addition, based upon their service rotation, Fellows may attend a case review meeting with the Liver Transplant team every Friday morning, a monthly M&M meeting with the Lung Transplant Team, and a weekly case review meeting with the VAD Team.

Multidisciplinary Meeting for SICU and CTICU:

One Wednesday each month, 1:30 – 2:30 p.m.
Venue: Heart Center Conference Room 3

This monthly multidisciplinary QI meeting is led by Dr. Sladen and addresses issues common to both ICUs. Members include ICU Faculty and Fellows, and senior leadership of nursing, pharmacy, physical therapy, nutrition, palliative care, respiratory therapy, physician assistants and nurse practitioners in SICU and CTICU. It is the most important venue for formulating and updating ICU policies, procedures and guidelines for our two units.

Division of Critical Care Faculty

Tricia Brentjens, MD
Martin Chen, MD
Daniela Darrah, MD
Brigid Flynn, MD
(Associate Medical Director, CTICU)
Alan Gaffney, MD
Sumeet Goswami, MD
Jonathan Hastie, MD
May Hua, MD
Desmond Jordan, MD
Steven E. Miller, MD
Vivek Moitra, MD
(Associate Medical Director, SICU; Associate Program Director, ACCM Fellowship)
Teresa Mulaikal, MD
Oliver Panzer, MD
Joseph Rumley, MD
Peter Salgo, MD
(Associate Medical Director, SICU and CTICU)
Robert Sladen, MBChB, FCCM
(Chief, Division of Critical Care; Medical Director, SICU and CTICU; Program Director, ACCM Fellowship)
Julia Sobol, MD
Gebhard Wagener, MD

Hannah Wunsch, MD, MSc

Anesthesiology Critical Care Medicine (ACCM) Fellows 2013-2014

Babar Fiza, MD
Dimitris Giannaris, MD
Gurwinder Gill, MD
Arun Jayaraman, MD
David Kiamanesh, MD
(Co-Chief Fellow)
Jennifer McDonald, MD
Amanda Powers, MD
(Co-Chief Fellow)
Joel Spencer, MD

Fellows Alumni List

Anesthesiology Critical Care Medicine Fellowship Administration:
Lisa A. Hasenbalg
Executive Assistant
Division of Critical Care
Department of Anesthesiology, PH 527-B
College of Physicians & Surgeons of Columbia University
630 West 168th St, New York NY 10032
lh2120@cumc.columbia.edu
Tel: 212-305-8633
Fax: 212-305-8287

Fellowship Application Checklist
Fellowship Application

Fellowship Applications
For more detailed information on the Fellowship and to initiate the application process, please e-mail Ms. Hasenbalg at lh2120@cumc.columbia.edu, or call him at 212-305-8633. Our fax number is 212-305-8287, and our mailing address is:

Robert N. Sladen, MBChB, FCCM
Program Director, ACCM Fellowship
Department of Anesthesiology, PH 527-B
College of Physicians & Surgeons of Columbia University
630 West 168th St,
New York NY 10032

 

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Columbia University Medical Center Department of Anesthesiology