EM Grads approved for Anesthesia Critical Care

[castaway]

Got word from ABEM that the American Board of Medical Specialties has approved a track for EM grads to train in anesthesia critical care and sit for the boards (which are administered by the American Board of Anesthesiology). This decision was just made at the end of last week. Cannot get any more details from anyone. If you have any details, please post. Thank you!!!!

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[gro2001]

Got word from ABEM that the American Board of Medical Specialties has approved a track for EM grads to train in anesthesia critical care and sit for the boards (which are administered by the American Board of Anesthesiology). This decision was just made at the end of last week. Cannot get any more details from anyone. If you have any details, please post. Thank you!!!!

Still waiting to hear whether the original proposal of 1 year fellowship for 4 year program grads and 2 year fellowship for 3 year program grads will stand. A 2 year fellowship would be a deal breaker for me.

 

[pseudoknot]

No, it will be two years for all, like the other two pathways. http://www.theaba.org/Home/notices

 

[gro2001]

No, it will be two years for all, like the other two pathways. http://www.theaba.org/Home/notices

Darn. Also the FAQ says that the applicant must be an 'ABEM Diplomate'. Does this mean you have to be board certified, not just board eligible?

 

[pseudoknot]

That's what it sounds like. I think that just means for CCM board certification, so you can't get a subspecialty board without a primary.

 

[inspirationmd]

Dissapointing. No 1 year path. Requires 3 months of Surgery within the first 6 months. Only allows 2 months research over 2 years. At least EM is able to certify through all the disciplines though. At least one can train in whatever discipline suits the personality best.

 

[jdh71]

I'm just not sure what makes you guys thinks you should simply do one year.

 

[pseudoknot]

I'm just not sure what makes you guys thinks you should simply do one year.

Hey, we don't all think that! The new ABA requirements look pretty reasonable to me. I think if anything the IM programs are starting to look a little light by comparison, with a second year that's mostly research. But really, I think critical care should be unified into a five year categorical residency.

 

[jdh71]

Hey, we don't all think that! The new ABA requirements look pretty reasonable to me. I think if anything the IM programs are starting to look a little light by comparison, with a second year that's mostly research. But really, I think critical care should be unified into a five year categorical residency.

Most of the second year at most places is actually filled with elective critical care months and not sitting around doing research. Few places can really afford to have critical care fellows just ganging out in a lab or consenting patients for studies.

I personally think critical care is best as a fellowship. I think it's important for intensivists to have the original residency context outside of the unit. It makes for a better unit doc because its important.

 

[gro2001]

I'm just not sure what makes you guys thinks you should simply do one year.

EM and anesthesia have the same RRC requirements for critical care months (4 months over the course of the residency). Between electives and mandated ICU time, someone graduating from my program could have 7 months of dedicated ICU time, in addition to seeing critically ill people every day for 4 years and exclusively critically ill people for an entire year as a PGY 3. Other than intubations which anesthesia obviously does a lot more of, we have similar graduating requirements in terms of other core procedures (vascular access, pacing, etc). We also, like anesthesia, have a broad clinical exposure to surgery, medicine, pediatrics, neurology. We, like anesthesia, have a broad and early exposure to bedside sonography and some of our residents graduate with RDMS certification. 4 year programs also usually have a fair amount of elective time, which could be directed to covering any gaps the ABA could see to make EM residents eligible to do a 1 year track. You can mandate that elective time must be spent, say, on extra rotations on surgical services, or in the OR with anesthesia, or whatever gaps in EM education the ABA could identify.

 

[jdh71]

EM and anesthesia have the same RRC requirements for critical care months (4 months over the course of the residency). Between electives and mandated ICU time, someone graduating from my program could have 7 months of dedicated ICU time, in addition to seeing critically ill people every day for 4 years and exclusively critically ill people for an entire year as a PGY 3. Other than intubations which anesthesia obviously does a lot more of, we have similar graduating requirements in terms of other core procedures (vascular access, pacing, etc). We also, like anesthesia, have a broad clinical exposure to surgery, medicine, pediatrics, neurology. We, like anesthesia, have a broad and early exposure to bedside sonography and some of our residents graduate with RDMS certification. 4 year programs also usually have a fair amount of elective time, which could be directed to covering any gaps the ABA could see to make EM residents eligible to do a 1 year track. You can mandate that elective time must be spent, say, on extra rotations on surgical services, or in the OR with anesthesia, or whatever gaps in EM education the ABA could identify.

Seeing critically ill people in the ED is not "doing" critical care.

 

[jdh71]

Most of the second year at most places is actually filled with elective critical care months and not sitting around doing research. Few places can really afford to have critical care fellows just ganging out in a lab or consenting patients for studies.

I personally think critical care is best as a fellowship. I think it's important for intensivists to have the original residency context outside of the unit. It makes for a better unit doc because its important.

Though I think I'd generally be ok with some kind of integrated residency/fellowship in 5 years if done right. Critical care really isn't something different as much as an extension of the primary pathways to get to critical care.

 

[gro2001]

Seeing critically ill people in the ED is not "doing" critical care.

And managing cases in the OR is not doing critical care either. But there is some skill translation that happens. Resuscitating people in the ER and caring for them for hours to days (at some places in NYC) must teach at least something about the care of the critically ill. And also, you will notice, that was not my only argument. That was in ADDITION TO: same amount of ICU months, similarly broad clinical exposure, procedure proficiency, and opportunity to make up gaps with elective time. Do you think it's only ICU months that should count? We have the same basic requirement as anesthesia residency in that case. And I can have 7 months of ICU time if I so choose by the end of residency.

 

[jdh71]

And managing cases in the OR is not doing critical care either. But there is some skill translation that happens. Resuscitating people in the ER and caring for them for hours to days (at some places in NYC) must teach at least something about the care of the critically ill. And also, you will notice, that was not my only argument. That was in ADDITION TO: same amount of ICU months, similarly broad clinical exposure, procedure proficiency, and opportunity to make up gaps with elective time. Do you think it's only ICU months that should count? We have the same basic requirement as anesthesia residency in that case. And I can have 7 months of ICU time if I so choose by the end of residency.

I don't know what to tell you. It appears they think your experience and their experience is different enough they want some extra time. Though I've always been a little horrified by anesthesias usual (over) confidence in their skill set. If you're not sure if they are good or not all you need to do us ask them. They will tell you. Heh. Gas has always kind of seemed like the bros specialty of choice. Perhaps that has permeated here. Sorry. Beggars can't really be choosers. It seems to me that it is the ABA, ABS, and ABIM are doing you guys the favor. I don't understand all of the unappreciative nonsense. No one made you or anyone else go into EM.

 

[gro2001]

I don't know what to tell you. It appears they think your experience and their experience is different enough they want some extra time. Though I've always been a little horrified by anesthesias usual (over) confidence in their skill set. If you're not sure if they are good or not all you need to do us ask them. They will tell you. Heh. Gas has always kind of seemed like the bros specialty of choice. Perhaps that has permeated here. Sorry. Beggars can't really be choosers. It seems to me that it is the ABA, ABS, and ABIM are doing you guys the favor. I don't understand all of the unappreciative nonsense. No one made you or anyone else go into EM.

Don't get me wrong, I am very appreciative of the opportunity to do the fellowships and sit for their exams. I am very grateful to ABIM, ACS, and ABA, as well as to ABEM for advocating for us. I am also not saying that its either wrong or somehow unjust to make EM residents, whether 3 year grads or 4 year grads, do 2 year CCM pathways. It's their board, they get to choose who has to do what for them to give their stamp of approval. I am just saying that an argument could be made (and was made, by ABA in the initial proposal to ABMS) that 4 year grads may be eligible for a 1 year pathway because in the things that matter to CCM, our training is not that different. And we are also the 'bro specialty of choice'

 

[inspirationmd]

I'm just not sure what makes you guys thinks you should simply do one year.

I don't think that it should be 1 year for all EM grads but I was speaking about those that do 4 years of EM residency with additional critical care time as gro2001 has said. I respect their decision and recognize they are doing EM a favor.

I agree that two years of fellowship is reasonable for a 3 year primary residency. I do wonder if an integrated pathway will come down the pipeline or if the IM-Hospitalist track will ever get approved given the critical shortage now that is only going to get worse in the next 10 years. Going to be interesting to watch over the next few years.

 

[Bostonredsox]

I don't think that it should be 1 year for all EM grads but I was speaking about those that do 4 years of EM residency with additional critical care time as gro2001 has said. I respect their decision and recognize they are doing EM a favor.

I agree that two years of fellowship is reasonable for a 3 year primary residency. I do wonder if an integrated pathway will come down the pipeline or if the IM-Hospitalist track will ever get approved given the critical shortage now that is only going to get worse in the next 10 years. Going to be interesting to watch over the next few years.

I think it will. 75% of hospitalists are routinely practicing CCM in a daily basis. 3 years IM residency with 3 years of experience as a hospitalist caring for CC patients should get you one of those 2 years. Well see how it plays out over the next few years

 

[Stank811]

Awesome...there is enough room for all of us out there. An IM, EM, surgical, or anesthesia trained intensivist all bring different strengths to the table.