Which CCM fellowships have CC fellow as primary airway?

[Laufcra]

Either I'm no good with the search function or no one has yet addressed this:

Which critical care medicine fellowships make the CC fellow primary with intubation?

I have been told that at Stanford and Northwestern its anesthesia's territory and that CC fellows are not allowed. Can we get a list started?

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[CCM-MD]

I haven't heard of a critical care fellowship that doesn't train fellows in intubation.

 

[grt398]

UW reportedly gets limited exposure b/c it's anesthesia primary and they have to ok the fellows doing it, but I don't have direct experience. I would suggest asking how many intubations, and specifically ICU intubations, the fellows graduate with...ideally directly from the fellows b/c we all keep case logs for credentialing purposes, but if that's not viable, at least from the program. Be wary of places that have most intubations coming from the OR if you're thinking of going into community practice...OR intubations for elective ortho surgeries/chole's etc are dramatically different than your average ICU intubation

 

[Laufcra]

UW reportedly gets limited exposure b/c it's anesthesia primary and they have to ok the fellows doing it, but I don't have direct experience. I would suggest asking how many intubations, and specifically ICU intubations, the fellows graduate with...ideally directly from the fellows b/c we all keep case logs for credentialing purposes, but if that's not viable, at least from the program. Be wary of places that have most intubations coming from the OR if you're thinking of going into community practice...OR intubations for elective ortho surgeries/chole's etc are dramatically different than your average ICU intubation

This is what I was asking, I should have titled the post better. I changed the title to ask which programs have the CC fellow as primary. At OSU the PCCM fellow does the tube and can call anesthesia if they choose to, I would think that this model is the preferred by most.

 

[Siggy]

My fellowship program in Southern Florida essentially had all airways in the ICU, rapid responses, and floor codes go to the crit care fellow unless the fellow felt help was needed for a difficult airway. I walked out of fellowship with well over 100 intubations in 2 years.

 

[gro2001]

Mount Sinai has all ICU and RRT airways (if there is a fellow on RRT) go to CCM fellows.

Word on the street is that Yale, Hopkins, and MGH all have anesthesia as primary with CCM fellows participating on an ad hoc basis.

 

[Doctor Bob]

Either I'm no good with the search function or no one has yet addressed this:

Which critical care medicine fellowships make the CC fellow primary with intubation?

It should be 100% of the programs. Sadly it isn't.

At AdventHealth Orlando, CCM fellows are primary intubators for all ICU patients and codes outside the unit.

 

[Laufcra]

Thanks for the replies, it would be best if we had a list of these programs as this is a significant factor as to whether I'll even apply.

 

[tpsreport]

Mount Sinai has all ICU and RRT airways (if there is a fellow on RRT) go to CCM fellows.

Word on the street is that Yale, Hopkins, and MGH all have anesthesia as primary with CCM fellows participating on an ad hoc basis.

We're primary on everything. Anesthesia stays in the OR.

Second that on MGH at least. One of our new attendings is from there and has fewer than 50 intubations from 3 years of fellowship. Not sure about the others.

 

[coffeebythelake]

It should be 100% of the programs. Sadly it isn't.

At AdventHealth Orlando, CCM fellows are primary intubators for all ICU patients and codes outside the unit.

I take note of your word "Sadly".. well i think that depends on whose perspective you are looking from. The CC trainee or the patient's. Doing an ICU intubation on a patient in physiological extremis, would you want someone more or less experienced to do it?

 

[CCM-MD]

I take note of your word "Sadly".. well i think that depends on whose perspective you are looking from. The CC trainee or the patient's. Doing an ICU intubation on a patient in physiological extremis, would you want someone more or less experienced to do it?

With that logic all procedures should be done by the most experienced operator, no trainees. As those experienced individuals leave practice, we won't have anyone trained. Perfect!

 

[coffeebythelake]

With that logic all procedures should be done by the most experienced operator, no trainees. As those experienced individuals leave practice, we won't have anyone trained. Perfect!

I agree everyone has to learn somewhere. I point out that learning on ubersick patients isnt a good place to start. You could always learn by spending some time in the ORs on healthy elective cases. I thought that seemed an obvious logical solution.

 

[CCM-MD]

I agree everyone has to learn somewhere. I point out that learning on ubersick patients isnt a good place to start. You could always learn by spending some time in the ORs on healthy elective cases. I thought that seemed an obvious logical solution.

Sure start in the OR but don't stop there. Intubating a critical patient =/= intubating a healthy elective OR patient. Critical care fellows need to be regularly intubating critically ill "ubersick" patients that they are going to be taking care of for the rest of their career. Fellowship programs that don't provide this training are doing a disservice to the fellows and their future patients.

 

[Doctor Bob]

I take note of your word "Sadly".. well i think that depends on whose perspective you are looking from. The CC trainee or the patient's. Doing an ICU intubation on a patient in physiological extremis, would you want someone more or less experienced to do it?

Sure, there are times when I look at a situation and tell the fellows "uh uh... not this time. I'm doing this one"; usually because my spidey sense says this case is likely to go very bad very quickly. And that's attending perogative.
But the default condition should be intubations are done by the critical care fellows.

 

[2010houston]

As an anesthesiologist - it’s insane that any program would NOT have CCM fellow as primary. I am sometimes called to our ICUs as backup if there’s a concerning airway or whatever - and am always more than happy to supervise the CCM fellow while they intubate. I think it’s very short-sighted when programs do not provide every opportunity for CCM (and EM) trainees to intubate. The few times I have said no to the fellow, it’s bc instead the patient needed to go the OR for intubation there with ENT.

 

[the argus]

I think this is a perfect example on why it's important to know what your professional goals are and to go to a training program that is designed to prepare you accordingly.

We often say its Hopkins, MGH, Stanford, etc, so those must be the best training programs. Those programs are designed to train people that are going to work at Hopkins, MGH, Stanford, etc. If you're doing 4-8 weeks of critical care per year as an attending, and always work somewhere that has robust 24 hour anesthesia coverage, why does it matter if you learn how to intubate as a fellow?

Thats completely different than someone working in the community doing 20 weeks of critical care per year at a shop with less procedural coverage. They better learn how to intubate during fellowship, and just going to "the best" fellowship program would be a mistake.

Prospective fellows need to figure out what they want their career to be, and make sure they interview at programs that provide appropriate training.

 

[Mad Jack]

Mount Sinai has all ICU and RRT airways (if there is a fellow on RRT) go to CCM fellows.

Word on the street is that Yale, Hopkins, and MGH all have anesthesia as primary with CCM fellows participating on an ad hoc basis.

Can confirm that Yale had anesthesia as primary for airways everywhere except the ER when I was last working there, which admittedly was some time ago. They weren't exactly known for rapid culture change so I'm sure that's still the case less than a decade out.

 

[Laufcra]

I think this is a perfect example on why it's important to know what your professional goals are and to go to a training program that is designed to prepare you accordingly.

We often say its Hopkins, MGH, Stanford, etc, so those must be the best training programs. Those programs are designed to train people that are going to work at Hopkins, MGH, Stanford, etc. If you're doing 4-8 weeks of critical care per year as an attending, and always work somewhere that has robust 24 hour anesthesia coverage, why does it matter if you learn how to intubate as a fellow?

Thats completely different than someone working in the community doing 20 weeks of critical care per year at a shop with less procedural coverage. They better learn how to intubate during fellowship, and just going to "the best" fellowship program would be a mistake.

Prospective fellows need to figure out what they want their career to be, and make sure they interview at programs that provide appropriate training.

This is what I was getting at with this post. I'm sure Stanford has a great program, but I will not be applying there nor any other place like it.

 

[Hamhock]

OP: That is the wrong question.

Rather, I would, as a non-anesthesiologist, ask which programs offer excellent "airway experience".

If programs cite a large percentage of ICU intubations (rare), but do not describe the training program (including controlled airways in the OR >50), reconsider the potential training.

HH