As the year continues, fellows progress to senior fellow activities which include running rounds intermittently during the week and on weekend call days, lecturing, etc.įellows will also rotate to the Medical-Surgical ICU at the Palo Alto Veterans Administration Medical Center. The fellow, in turn, is backed up by one of the ICU faculty.
In order to take call from home the fellow must reside within 15 minutes of the hospital. Night call during this time and for the rest of the year is 7-8 times per month, during which the fellow is available (not necessarily in-house) to the on-call house staff for advice, assistance and supervision. The next 2-3 months the fellow works as a junior fellow supervising resident and student performance along with the ICU attendings. This month also includes an introduction to mechanical ventilation through weekly bedside ventilator rounds, hands-on procedural and ultrasound workshops, and participation in the morning lecture series provided for the residents on basic critical care medicine topics. This allows the fellow to transition into the fellow role prior to taking call solo. The subsequent two weeks in the first rotation are spent taking fellow-level ICU shifts under direct supervision of experienced fellows. During that time, he or she takes call and admits patients, completes detailed documentation within the EMR, reports to a supervising senior fellow, and participates in the resident-call schedule (approximately taking call every fourth night. The fellow completes a minimum of two weeks of primary patient-care duties on one of the teams. The first month provides a transition to providing care within the Stanford Healthcare system and assuming the role as a specialist in critical care medicine. The clinical training in Critical Care begins with an introduction to critical care medicine in the Stanford Medical-Surgical ICU. Medical students as a part of the Critical Care Core Clerkship are also active members of the teams. The service is divided into two teams each consisting of an attending, fellow, and four residents from Anesthesia, Medicine and Emergency Medicine. All the attendings have completed specialized training in Critical Care Medicine. The service is composed of a faculty of 14 attendings trained in Anesthesia, Internal Medicine, and/or Emergency Medicine. The fellow is exposed to a broad scope of pathophysiology and disease states. This allows the fellow to provide coverage and assume primary responsibility for the management of 15 - 30 patients. Patients are located in the E2-Medical-Surgical ICU, a 36-bed multispecialty unit, however the team provides care to critically ill patients in remote areas (PACU, ED, alternate units) as needed.
The Stanford-Medical Surgical ICU service is considered the primary service for the training program.
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