“Carving out” your own CCM fellowship?

[Doc Doc Doc Goose]

I have heard distant fables of residents or fellows that essentially made their own fellowship or “combined residency” at a particular program that did not/does not actually have that official fellowship or combined residency program.

For example, an individual convincing their home program to allow them to “create” their own EM/IM program just for them, though the program doesn’t officially have an established combo EM/IM residency. I recognize such examples are likely (very?) rare and case-by-case basis with many factors and variables involved. Nonetheless, I was wondering:

Let’s say you’re an EM resident (or even EM/IM resident) that desires to to persue a CCM fellowship. However, your home program does not have such a fellowship; only a Pulm/CC program (obviously through IM) is established. Since the rotations, training sites, etc. are already in place in terms of critical care training, how feasible would it be for the EM (or EM/IM) resident to “carve out” a CCM fellowship for themself? What would this entail in terms of acquiring funding , certification, etc? Is this remotely possible or just a mythical unicorn?

Any insight would be appreciated!

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[Doc Doc Doc Goose]

I have heard distant fables of residents or fellows that essentially made their own fellowship or “combined residency” at a particular program that did not/does not actually have that official fellowship or combined residency program.

For example, an individual convincing their home program to allow them to “create” their own EM/IM program just for them, though the program doesn’t officially have an established combo EM/IM residency. I recognize such examples are likely (very?) rare and case-by-case basis with many factors and variables involved. Nonetheless, I was wondering:

Let’s say you’re an EM resident (or even EM/IM resident) that desires to to persue a CCM fellowship. However, your home program does not have such a fellowship; only a Pulm/CC program (obviously through IM) is established. Since the rotations, training sites, etc. are already in place in terms of critical care training, how feasible would it be for the EM (or EM/IM) resident to “carve out” a CCM fellowship for themself? What would this entail in terms of acquiring funding , certification, etc? Is this remotely possible or just a mythical unicorn?

Any insight would be appreciated!

i know my OP was winding, cloudy, and hard to follow. So, a little hypothetical, that hopefully helps to clear things up, but very well may just serve to further confuse:

So lets say I’m an EM resident at Awesomeville Médical Center; I want to do a CCM fellowship; I don’t want to have to move for fellowship (because of spouse, kids, etc), but there is no CCM fellowship established at AMC currently; there is a Pulm/Crit fellowship for the guys who did IM residencies established. Is it possible to/how hard would it be to make a fellowship for myself at AMC??

 

[RustedFox]

i know my OP was winding, cloudy, and hard to follow. So, a little hypothetical, that hopefully helps to clear things up, but very well may just serve to further confuse:

So lets say I’m an EM resident at Awesomeville Médical Center; I want to do a CCM fellowship; I don’t want to have to move for fellowship (because of spouse, kids, etc), but there is no CCM fellowship established at AMC currently; there is a Pulm/Crit fellowship for the guys who did IM residencies established. Is it possible to/how hard would it be to make a fellowship for myself at AMC??

 

[Doc Doc Doc Goose]

Not possible ?

 

[The Knife & Gun Club]

So getting accepted to a fellowship that doesn’t usually take EM people is possible. It’s happened at our program and some others I know of.

However I’m not an authority on how it is accomplished or just how difficult this can be. As I’m sure you know there are virtually no stand alone EM/CCM fellowships, almost all are through anesthesia, surgery, or medicine.

I’d imagine it will largely depend on the institution and leadership at a given program..and their opinion of EM as a field.

 

[SpacemanSpifff]

The first, and most important, question: who are you going to convince to pay your salary?

 

[Dr Mantis Toboggan]

The first, and most important, question: who are you going to convince to pay your salary?

Yeah plus make sure you’ll be able to sit for the boards.

 

[RustedFox]

Not possible ?

You can't just "make your own fellowship".
If you could, I'd have a fellowship in classic gaming and grunge rock.

While you're at it: make your own residency wherever you want. Oh, wait... HCA...

 

[Doc Doc Doc Goose]

You can't just "make your own fellowship".
If you could, I'd have a fellowship in classic gaming and grunge rock.

While you're at it: make your own residency wherever you want. Oh, wait... HCA...

Would that fellowship be through interventional cards or IR??

 

[Doc Doc Doc Goose]

The first, and most important, question: who are you going to convince to pay your salary?

Hmmm, perhaps the Pulm/Crit department? Maybe the EM department can chip in a bit??

 

[Doc Doc Doc Goose]

Yeah plus make sure you’ll be able to sit for the boards.

What would prevent you from being able to sit for the CCM board? You mean like fulfilling the needed requirements?

 

[turkeyjerky]

What would prevent you from being able to sit for the CCM board? You mean like fulfilling the needed requirements?

You need to complete an accredited fellowship.

It seems like many centers that have a PCCM fellowship also offer a stand-alone CCM fellowship, or have a 1 year CCM 'add-on' option to other fellowships. You would probably have to talk with the program individually to see if they could accommodate it.

If you're asking about whether you can create a CCM fellowship 'out of the blue' at an institution that doesn't already have one, the answer is no, in this day and age. (I don't think you're asking this question though)

 

[dadaddadaBATMAN]

I have heard distant fables of residents or fellows that essentially made their own fellowship or “combined residency” at a particular program that did not/does not actually have that official fellowship or combined residency program.

For example, an individual convincing their home program to allow them to “create” their own EM/IM program just for them, though the program doesn’t officially have an established combo EM/IM residency. I recognize such examples are likely (very?) rare and case-by-case basis with many factors and variables involved. Nonetheless, I was wondering:

Let’s say you’re an EM resident (or even EM/IM resident) that desires to to persue a CCM fellowship. However, your home program does not have such a fellowship; only a Pulm/CC program (obviously through IM) is established. Since the rotations, training sites, etc. are already in place in terms of critical care training, how feasible would it be for the EM (or EM/IM) resident to “carve out” a CCM fellowship for themself? What would this entail in terms of acquiring funding , certification, etc? Is this remotely possible or just a mythical unicorn?

Any insight would be appreciated!

This would be way more difficult by comparison to just finding an established fellowship.

Essentially the difference between publishing a case report with a well established mentor and funding a multi center randomized control trial with your pocket change.

 

[DeadCactus]

It's relatively easy to carve out a non-ACGME accredited fellowship. I guarantee you RustedFox could find someone happy to pay him $100/hr to work in the ED and be called the "Classic Gaming & Grunge Fellow".

If it's an ACGME fellowship, starting one from scratch is a painful, long, and tedious even if most of the infrastructure is there. No one is going to do that just to train a single person. Now you've got to convince an entire institution to start and fund a new training program, hope it's running and ACGME approved by the time your application cycle comes up, and then apply. Hopefully if you were instrumental in starting the program, they would take you (even if better applicants applied) but bigger dick moves have happened in academics.

If it's an existing ACGME fellowship that EM qualifies for then none of this would come up unless the program just doesn't want to train EM residents. Then you need to convince them to reconsider which could be easy to impossible. An institution with a Pulm-CCM fellowship would fall under this category, they already have a CCM fellowship they just need to be willing to take you. This could be easy or challenging depending on how their schedule is designed to integrate the pulmonary training and how the absence of a "pulmonary fellow" would affect their work-load. The easiest answer is probably to recruit their entire cohort of Pulm-CCM fellows, apply for an expanded class-size, and take an extra EM fellow with the ED covering part of their salary. A lot of bureaucracy to overcome if they aren't into the idea.

If it's an existing ACGME fellowship that EM does not qualify for, then you're basically back to point one where plenty of people would be happy to take advantage of you.

 

[Doc Doc Doc Goose]

You need to complete an accredited fellowship.

It seems like many centers that have a PCCM fellowship also offer a stand-alone CCM fellowship, or have a 1 year CCM 'add-on' option to other fellowships. You would probably have to talk with the program individually to see if they could accommodate it.

If you're asking about whether you can create a CCM fellowship 'out of the blue' at an institution that doesn't already have one, the answer is no, in this day and age. (I don't think you're asking this question though)

I guess I was sort of asking that since the CCM accreditation portion (and “curriculum”) is already in place for the pulm/crit fellows. As I understand it, the two accreditations, pulm and CCM are separate. I recognize that it’s not the same as having a stand-alone CCM fellowship already established.

Can’t blame an ignorant med student with a passion for CCM, for wanting to train at their home school/residency program. Appreciate all the responses.

 

[Doc Doc Doc Goose]

This would be way more difficult by comparison to just finding an established fellowship.

Essentially the difference between publishing a case report with a well established mentor and funding a multi center randomized control trial with your pocket change.

Roger that. Guess I was a dreaming of a school/program wanting to keep a “great” resident they are familiar with, who’s good, and wishes to train and practice in the area.

 

[Doc Doc Doc Goose]

It's relatively easy to carve out a non-ACGME accredited fellowship. I guarantee you RustedFox could find someone happy to pay him $100/hr to work in the ED and be called the "Classic Gaming & Grunge Fellow".

If it's an ACGME fellowship, starting one from scratch is a painful, long, and tedious even if most of the infrastructure is there. No one is going to do that just to train a single person. Now you've got to convince an entire institution to start and fund a new training program, hope it's running and ACGME approved by the time your application cycle comes up, and then apply. Hopefully if you were instrumental in starting the program, they would take you (even if better applicants applied) but bigger dick moves have happened in academics.

If it's an existing ACGME fellowship that EM qualifies for then none of this would come up unless the program just doesn't want to train EM residents. Then you need to convince them to reconsider which could be easy to impossible. An institution with a Pulm-CCM fellowship would fall under this category, they already have a CCM fellowship they just need to be willing to take you. This could be easy or challenging depending on how their schedule is designed to integrate the pulmonary training and how the absence of a "pulmonary fellow" would affect their work-load. The easiest answer is probably to recruit their entire cohort of Pulm-CCM fellows, apply for an expanded class-size, and take an extra EM fellow with the ED covering part of their salary. A lot of bureaucracy to overcome if they aren't into the idea.

If it's an existing ACGME fellowship that EM does not qualify for, then you're basically back to point one where plenty of people would be happy to take advantage of you.

Wow thank you. This is very informative. Appreciate it

 

[inspirationmd]

There is an exception to the expansion rule where a program can expand to accommodate an occasional fellow. Ask the Pulm CCM to let you do it under the following exception.


“At all times, programs must stay within their approved complement of fellow positions. The RRC-IM will grant temporary increases (via Web-ADS) to accommodate an occasional additional stand-alone critical care medicine trainee. If the program offers more than an occasional stand-alone critical care medicine position (i.e., no more than one fellow every two years), then the program should request a permanent complement increase and obtain approval for a critical care medicine track.

Although this policy was developed for occasional stand-alone critical care training within pulmonary and critical care medicine programs, the same principles will apply to stand-alone pulmonary training within pulmonary and critical care medicine programs, as well as to stand-alone training in either specialty in combined hematology-oncology programs.”

Critical Care Medicine Policies | ABIM.org

Exam policy information for Critical Care Medicine

www.abim.org

 

[Doc Doc Doc Goose]

There is an exception to the expansion rule where a program can expand to accommodate an occasional fellow. Ask the Pulm CCM to let you do it under the following exception.


M

Although this policy was for occasional stand-alone critical care training within pulmonary and critical care medicine programs, the same principles will apply to stand-alone pulmonary training within pulmonary and critical care medicine programs, as well as to stand-alone training in either specialty in combined hematology-oncology programs.”

Critical Care Medicine Policies | ABIM.org

Exam policy information for Critical Care Medicine

www.abim.org

There is an exception to the expansion rule where a program can expand to accommodate an occasional fellow. Ask the Pulm CCM to let you do it under the following exception.


“At all times, programs must stay within their approved complement of fellow positions. The RRC-IM will grant temporary increases (via Web-ADS) to accommodate an occasional additional stand-alone critical care medicine trainee. If the program offers more than an occasional stand-alone critical care medicine position (i.e., no more than one fellow every two years), then the program should request a permanent complement increase and obtain approval for a critical care medicine track.

Although this policy was developed for occasional stand-alone critical care training within pulmonary and critical care medicine programs, the same principles will apply to stand-alone pulmonary training within pulmonary and critical care medicine programs, as well as to stand-alone training in either specialty in combined hematology-oncology programs.”

Critical Care Medicine Policies | ABIM.org

Exam policy information for Critical Care Medicine

www.abim.org

Well @RustedFox maybe there is hope for you and you grunge rock video game fellowship after all.

 

[Doc Doc Doc Goose]

Update: my home program just started a 2-year CCM fellowship; one of the fellows is an EM graduate