Philosophy

The care of the most severely ill or injured patients requires the cooperation of multiple specialties, but we believe that surgeons with advanced knowledge and training are the vital central element. The goal of this fellowship is to provide an intensive one-year experience in surgical critical care which will train surgeons to assume a leadership role in the care of critically ill patients and be prepared to assume an administrative role in managing a busy surgical intensive care unit. The specific goals in this regard are to obtain experience in the multidisciplinary care of sick surgical patients and have exposure to all elements of the domain of critical care knowledge and related procedures. This will form a focus of clinical material upon which to develop the basics of administrating a busy SICU and integrating multiple practitioners in this complex environment.

The educational philosophy is to teach not only the individual basics of care of sick surgical patients, but to teach the integration of care through multiple practitioners in the interdisciplinary process. Philosophically we maintain an open unit which is integrated with the primary surgeon and teaches the critical care fellows how to manage patients in this environment which is the most likely environment the fellow will encounter in their practice. An additional philosophic goal is to have exposure to all types of surgical critical care patients to maintain an expanded knowledge.

The initial year of the fellowship focuses on gaining advanced skills and knowledge in clinical aspects of patient care and the basics of surgical intensive care administration. This year is ACGME accredited and leads to Certification in Critical Care Surgery after examination by the American Board of Surgery. Candidates desiring to pursue a career in academic surgery or to obtain further clinical exposure may participate in an optional second year of training. Options include completing the American Association for Surgery of Trauma (AAST) Acute Care Surgery (ACS) Fellowship, or non-accredited Research + Clinical Fellowship which will offer the opportunity to focus on a specific area of scholarly pursuit while continuing to participate in clinical management. There are also options for international global trauma and acute care surgery electives, pediatric trauma and pediatric surgical care as well as a Burn Surgery Fellowship. Fellows are urged to make a decision regarding a second year of fellowship by December of their first year so that funding can be secured. More information on these second-year programs is available separately.

A surgical critical care fellow will be directly involved in all phases of care of critically ill surgical patients. The focus of the clinical experience will center around the 20-bed combined surgical intensive care unit at Hillcrest, with additional rotations to include the 8 bed burn unit, the Jacobs 3G ICU with 12 beds, and the Sulpizio Cardiovascular Center CVICU with 12 beds. The case mix on the intensive care units includes approximately 50% trauma patients, 30% general surgery and transplant patients, 10% burn patients, and 10% cardiothoracic surgery. In addition, subspecialty admissions in other surgical subspecialties are admitted to this unit. The trauma resuscitation area is a physical part of the surgical intensive care unit. Initial resuscitation management of trauma patients is a unique and integral part of the training in surgical critical care offered in this fellowship. Trauma resuscitation may involve emergency surgical procedures required for stabilization but will not involve surgical procedures done on an elective or semi-elective basis.