Critical Care Medicine Training

Columbia University Medical Center has 70 Intensive Care Unit beds, not including Pediatric and Neonatal ICUs.  The major allocation of the fellow’s time is devoted to the Medical Intensive Care Unit (6 months), which are comprised of two active 12-bed units (MICU-A and MICU-B). Fellows also spend time on our critical care consult/intermediate-care unit, other subspecialty ICUs at Columbia (CTICU, SICU, and NICU) and an anesthesia rotation.  The patient population in our MICUs is diverse, both a busy inner-city MICU where patients are admitted from the surrounding neighborhoods and a tertiary referral MICU for complicated, critically ill patients including patients with refractory hypoxemic respiratory failure on ECMO.  Columbia University has extensive programs in transplant medicine including lung, liver, and kidney for which we provide the pre-transplant care.

During these rotations fellows are trained in critical care ultrasound, u/s guidance of critical care procedures, endotracheal intubation and ECMO.

Medical Intensive Care Unit (MICU) –A

MICU-A is a 12-bed, staffed by full-time nurse practitioers and also houses our medical ECMO program. The fellow is responsible for NP education, a responsibility that is shared with the attending. The fellow also shares responsibility for NP supervision and is expected to be involved in all aspects of medical decision-making and patient care during the time that they are assigned clinical responsibility. MICU-A offers a unique opportunity for fellows to manage patients on ECMO and the complications of ECMO.” Medical Intensive Care Unit (MICU) - A.

Medical Intensive Care Unit (MICU) – B

MICU-B is a 12-bed unit, staffed by internal medicine residents. Under the supervision of the ICU attending, the fellow cares for critically ill patients, supervises procedures, and is actively involved in education of the residents through didactic teaching sessions and bedside teaching. Night coverage of the unit is provided by in-house critical care attending faculty, allowing for protected time for the fellow.” Medical Intensive Care Unit (MICU) - B.

Critical Care Consult Service

Fellows spend 3 months rotating through the ICU consult rotation, during which the fellow provides critical care consultative service to all patients in the medical intermediate care unit, as well as pulmonary and medical critical care consults in non-medical intensive care units. During this rotation, the fellow becomes proficient in diagnosing and managing hospitalized patients with the full range of critical illness in multiple different settings. Please visit our Critical Care Consult Service.

Extracorporeal Membrane Oxygenation (ECMO) Program

As part of the Center for Acute Respiratory Failure, our adult ECMO program is one of the largest in the world.  We apply ECMO for acute respiratory failure, and will also transfer patients from outside hospitals on ECMO.  The fellow as they rotate through MICU-A serves as part of the team to help screen potential outside hospital ECMO transfers as well as take care of the daily management of our medical ECMO patients.Please visit our ECMO Program.

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In addition to Medical Critical Care Rotations, fellows spend time rotating through the other state-of-the-art subspecialty intensive care units at our institution to learn all aspects of critical care medicine.

  • Cardiothoracic Intensive Care Unit (CTICU)
  • Surgical Intensive Care Unit (SICU)
  • Neurologic Intensive Care Unit (NICU)

Anesthesia Rotation

First year fellows have a two-week rotation on the anesthesia service where  they learn endotracheal intubation by direct laryngoscopy and laryngeal mask airway placement in a controlled environment. To supplement the two-week rotation during first year, many fellows use elective time to partake in our advanced anesthesia rotation as a second year fellows. During this rotation, fellows perform endotracheal intubations in high risk patients, including difficulty airways under the supervision of the anesthesia service.

Right Heart Catheterization Rotation

Second year fellows spend two weeks in the right heart catheterization lab with our interventional cardiologists. During this rotation, fellows become proficient in the insertion of- and interpretation of pulmonary artery catheters.