Perspectives on Pursuing an Anesthesiology Fellowship in Critical Care Medicine

It is an exciting time to pursue an anesthesiology fellowship in critical care medicine (CCM). As we emerge from COVID-19, there is a renewed energy for scientific investigations, making connections, and integrating wellness strategies to mitigate burnout. Technological advances in hemodynamic monitoring, the use of artificial intelligence or data analytics, and application of novel biomarkers are all captivating areas of investigation. Moreover, the integration of bedside point-of-care ultrasound (POCUS) continues to grow and offers opportunities to be at the forefront of clinical care. If you’ve had a chance to attend recent regional or national anesthesiology or CCM meetings, you have likely noticed expanded opportunities to network and for mentorship at all stages of training. There has been a palpable energy around these connections and a desire to collaborate. It has been a real pleasure to connect with former colleagues, meet new friends and learn from a diverse collection of experts in the field.

While historically common to staff an ICU with one intensivist per week, there is significant heterogeneity in staffing models and a growing trend of flexible work schedules that aim to improve work-life balance and mitigate burnout. For example, splitting the week into day and night coverage with multiple intensivists or decreasing the consecutive days of coverage. As Drs. Hennessey and Fiza suggest in a recent SOCCA article on the state of anesthesia critical care fellowship programs, re-evaluating traditional month-long resident ICU rotations to mirror these novel faculty staffing models might similarly improve resident and fellow well-being and improve specialty recruitment.^[1]

In speaking with Dr. Lopez, a current CCM fellow, he notes his interest in pursuing a career that blends anesthesiology and critical care medicine began while completing his PhD research. “It provides a unique opportunity to bring the skills learned in the operating room to the ICU and apply the knowledge obtained from the ICU to those critically ill patients requiring anesthesia care”. He goes on to note that a career in CCM provides “a lifelong intellectual challenge” and allows for opportunities to “improve leadership and interdisciplinary teamwork, diversify skills and overall play a larger role in the care of patients”. He advises future applicants to seek out fellowships that offer a “diverse critically ill patient population, opportunities to learn alongside CCM fellows from other specialties, strong training in POCUS and cardiac support devices, and a curriculum with diverse didactic opportunities”. Thankfully, he found it “challenging” to narrow his top programs, as so many offered not only robust CCM curriculums, but also featured topics in leadership, education and administration. He envisions a future career that “blends anesthesiology, critical care, research, and other academic endeavors”, and recognizes opportunities to do so in both academic and private settings.

As Dr. Nowak, immediate past CCM fellow and current cardiothoracic (CT) fellow notes, “I toyed with doing either or both cardiac and critical care fellowships until the middle of my Clinical Anesthesia-2 year, when I finally decided the compliment was superior”. “Rather than responding only in the microcosm of the operating room (OR), I pictured OR and ICU care as smaller pieces in the larger painting of the patient’s hospital stay, with each location affecting the other”. For example, “I am thoughtful about re-dosing paralytic medications at the end of an OR case given the timing efforts of the ICU team to liberate the patient from invasive mechanical ventilation”.  Dr. Nowak goes on to discuss how she is more mindful when it comes to vascular access, hemodynamic management, and perioperative pain control, and has “greater confidence in caring for very sick patients”.

In terms of choosing where to do a CCM fellowship, Dr. Nowak considered several priorities: “relationships with intensivist faculty and ICU nurses from residency, a learning environment that balanced clinical load with didactic opportunities, a diverse patient population, and flexibility for both ICU and non-ICU rotations”.  Upon completion of her CTS fellowship, Dr. Nowak anticipates pursuing an academic position that allows her to best utilize her dual training.

Now that we have piqued your interest in this diverse and fulfilling field, it is time to become a member of the Society of Critical Care Anesthesiologists (SOCCA) and prepare your CV! Membership is complimentary for medical students, residents, and fellows, with further information to be found at https://socca.org/socca-membership/. CCM fellowship applicant registration for 2025 positions open on November 1, 2023 at https://sfmatch.org/registration/applicant. Best of luck, and hope to see you around.

References

[1] Hennessey E and Fiza B. An Introspective Reflection on the State of Anesthesia Critical Care Fellowship Programs from the Program Director’s Advisory Council (PDAC). SOCCA Drip. 2023: 34(2).

Authors

Beth M. Teegarden, MD, FASA

SOCCA Membership Committee–Resident & Medical Student Subcommittee; SOCCA Service Chiefs’ Advisory Council (SCAC)

Associate Professor, Department of Anesthesiology; Division Chief, Critical Care Medicine; Medical Director, Surgical Intensive Care Unit

The University of Texas Medical Branch

Galveston, Texas

Ernesto Lopez Valencia, MD, PhD

Critical Care Fellow

Department of Anesthesia, Critical Care and Pain Medicine

Massachusetts General Hospital

Boston, Massachusetts

Lindsay D. Nowak, MD

Cardiothoracic Anesthesiology Fellow

Department of Anesthesiology

University of Utah

Salt Lake City, Utah