Clinical Training - Critical Care Medicine Fellowship

Our Critical Care Medicine clinical curriculum is designed to train clinicians skilled in caring for all critically ill patients. Accordingly, our fellows rotate through a diverse set of critical care settings including medical, surgical, trauma, cardiothoracic, and neurological ICUs.

Clinical Rotations

UMMC and Midtown MICU (6-8 months)

The UMMC MICU is a 29-bed state-of-the-art facility. As a quaternary referral center, the MICU is one of the highest acuity units in the United States. Fellows are responsible for the care of all patients admitted to the MICU, including performing procedures (e.g. endotracheal intubation, bronchoscopy, pulmonary artery catheter placement, critical care ultrasound). They learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system diseases, as well as the "art of triage." The unit is staffed 24/7 by both attendings and fellows along with a team of residents, interns, and APPs.

While rotating in the UMMC MICU fellows will also have the opportunity to perform triage. In this role, fellows work side by side with an attending physician to determine the flow of patients into the ICU from the ER, the hospital wards, and referring outside hospitals.

The Midtown MICU is a community MICU located 1.0 miles away from the downtown campus within the University of Maryland Midtown Medical Center. This is a 18 bed ICU where fellows are responsible for the comprehensive care of critically ill patients. This unit is staffed during the daytime by the pulmonary and critical care attending and fellow, and at night by a team of residents and interns with backup coverage by tele-medicine and an in-house resource intensivist.

UMMC SICU (2 months)

The UMMC SICU is a 19-bed state-of-the-art facility. As a quaternary referral center, fellows care for post-op patients including patients who are status post liver transplant, pancreas transplant, kidney transplant, complex vascular emergencies, and lumbar drains. They also oversee surgical and anesthesia residents. Fellows cover the unit at night with at home back up coverage by the attending physician.

Trauma ICU (1-2 months)

The R Adams Cowley Shock Trauma ICU is a 24-bed ICU. Here fellows care for patients who are admitted after experiencing a motor vehicle collision, gunshot wounds, blunt or penetrating traumas. Fellows manage patients receiving Molecular Adsorbent Recirculation System (MARS) therapy for liver failure and gain comfort with Airway Pressure Release Ventilation (APRV).

Cardiac Surgery ICU (1 month)

The Cardiac Surgery ICU is a 24-bed intensive care unit which manages patients who have undergone cardiac surgical procedures such as valve replacement and CABG. Fellows also gain experience managing VA ECMO and mechanical support devices such as LVADs in this unit. Fellows work under the leadership of an intensivist and alongside cardiothoracic surgery and surgery residents as well as advanced practice providers.

Neuro ICU (2 months)

The Neuro ICU is a 22-bed intensive care unit which manages patients with subarachnoid hemorrhage, intracerebral hemorrhage, ischemic strokes, in status epilepticus, post-op neurosurgical patients, and patients with neuromuscular disorders. Fellows work with a neuro-critical care fellow, neurology, and neurosurgery residents in this unit, under the leadership of a neuro-critical care attending physician. While rotating in the Neuro ICU, fellows will also see the status epilepticus patients and the post-cardiac arrest patients located in other units in the hospital.

Introductory Didactic block (1 month)

During the first month of their training, fellows participate in a unique training course that covers the fundamentals of a broad range of core critical care topics and skill sets. Together with fellows from Washington Hospital Center, NIH, Georgetown and the Walter Reed National Medical Center, fellows participate in lectures as well as hands-on simulated training sessions in ventilator management, ultrasonography, bronchoscopy, tube thoracostomy and other procedural skills.

Research/Electives (6-7 months)

In addition to completing required rotations, fellows have time to explore independent interests during their training. Below is a representative list of possible electives, though fellows may participate in others as well.

Research – There are many opportunities to engage in research within the Pulmonary & Critical Care Division and in other Critical Care subspecialty divisions.

Critical Care Anesthesia – During this rotation, fellows learn basic and advanced airway management skills under the direct supervision of an Anesthesiologist. Most of our fellows who have participated in this rotation have performed 30-40 intubations in this one-month time frame. This rotation creates a foundation of airway management skills upon which fellows can build during their subsequent critical care rotations.

Critical Care Resuscitation Unit (CCRU) - This is a novel resuscitation unit for critically ill non-trauma adult patients who are transferred from outside hospitals in need of specialty care at the University of Maryland Medical Center (UMMC). The CCRU, located in the Shock Trauma Critical Care Tower of the R Adams Cowley Shock Trauma Center, is staffed 24/7 with experienced critical care attending physicians and advanced practice providers. The CCRU is designed to collaborate with referring facilities and pre-hospital transport providers, facilitate prompt transfer of patients requiring specialized care to UMMC, and deliver immediate resuscitation to patients with time-sensitive emergencies.

The CCRU is capable of advanced resuscitation, rapid initiation of invasive hemodynamic monitoring and complex supportive therapies including but not limited to ECMO cannulation and management, massive transfusion, Intra-Aortic Balloon Pump (IABP), and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) insertion.

Fellows work with the CCRU attending to provide high-quality, fast-paced resuscitation to some of the sickest patients within the hospital.

Critical Care Ultrasound – Bed-side ultrasound has become an integral part of the assessment and care of critically ill patients, making it important for fellows to attain competency in basic ultrasonographic and echocardiographic skills. During this rotation, fellows train with intensivists certified in ultrasonography and echocardiography to develop and hone their own skills in this modality.

Interventional Pulmonology - The Interventional Pulmonology (iPULM) program at UMMC is an integral part of our Division. Fellows participate in the evaluation and management of pleural disease and benign and malignant airway disease. They learn to perform ultrasound-guided assessment and interventions of the pleural space, such as thoracenteses, pigtail catheters, and tunneled pleural catheters. Procedural experience includes endobronchial ultrasound and advanced diagnostic and therapeutic bronchoscopy.

Burn ICU – Fellows may rotate at the 10-bed Burn ICU at Johns Hopkins Bayview Medical Center, the regional burn center for all of Maryland and surrounding states, to further their knowledge of and experience in the management of burn victims.

Pulmonary Hypertension – This elective gives fellows the opportunity to develop proficiency in managing pulmonary hypertension and to gain significant experience in performing right heart catheterizations.

Radiology – Fellows may spend time with our radiologists to develop their skills at interpreting chest radiographs and CTs.

International Critical Care – Haiti, South Africa, Zambia, Argentina, among others

Critical Care Infectious Disease, Critical Care Nephrology, and/or other medical subspecialties – Fellows may spend time with ID and nephrology teams dedicated to the MICU to deepen their knowledge of these respective fields.

Cardiac Care Unit as well as other/additional ICU rotations as desired

A sample critical care fellow schedule is below. Each year is divided into 13 blocks: