The Stanford Medical-Surgical ICU service stands as a cornerstone for comprehensive Adult Critical Care Medicine Training Programs. Situated primarily within the E2-Medical-Surgical ICU, a 36-bed multispecialty unit, the program extends its reach to critically ill patients across various locations, including the PACU, ED, and alternate units, adapting to patient needs. This expansive approach enables fellows to gain substantial experience, often managing between 15 to 30 patients, and cultivates a profound understanding of diverse pathophysiologies and disease states encountered in adult critical care medicine.
The program boasts a distinguished faculty of 14 attending physicians, with backgrounds in Anesthesia, Internal Medicine, and Emergency Medicine, all of whom possess specialized training in Critical Care Medicine. This expertise is channeled through a team-based structure, where each team comprises an attending, a fellow, and four residents from Anesthesia, Medicine, and Emergency Medicine. Medical students participating in the Critical Care Core Clerkship further enrich these teams, creating a dynamic learning environment essential for an effective adult critical care medicine training program.
The initial phase of clinical training serves as an immersive introduction to adult critical care medicine within the Stanford Medical-Surgical ICU. The first month is carefully designed as a transition, integrating fellows into the Stanford Healthcare system and nurturing their evolution into specialists in critical care medicine. Fellows dedicate a minimum of two weeks to primary patient-care duties within a team, undertaking call responsibilities, admitting patients, meticulously documenting within the EMR system, reporting to senior fellows, and participating in the resident-call schedule, typically every fourth night. The subsequent two weeks of this initial rotation involve fellow-level ICU shifts under the direct guidance of experienced fellows. This structured approach facilitates a smooth transition into the fellow role before independent call duties commence. This foundational month also incorporates an introduction to mechanical ventilation through weekly bedside ventilator rounds, practical procedural and ultrasound workshops, and engagement in the morning lecture series tailored for residents on fundamental topics in adult critical care medicine.
Over the ensuing 2-3 months, fellows progress to a junior fellow role, where they contribute to supervising resident and student performance in collaboration with ICU attending physicians. Night call responsibilities during this period and for the remainder of the year average 7-8 times per month. During these calls, fellows are accessible (though not necessarily in-house) to the on-call house staff for consultation, support, and supervision. To ensure prompt availability, fellows taking call from home are required to reside within a 15-minute radius of the hospital. Importantly, fellows are supported by backup from ICU faculty. As the training year advances, fellows transition to senior fellow activities, which include leading rounds intermittently during the week and on weekend call days, delivering lectures, and taking on increased responsibilities within the adult critical care medicine training program.
Fellows gain diverse exposure through rotations at various esteemed institutions. The Medical-Surgical ICU at the Palo Alto Veterans Administration Medical Center offers a parallel experience to Stanford, providing further expertise in post-operative general surgical and cardiac surgical critical care. Rotations on the Stanford Cardio-Thoracic ICU service provide invaluable experience with complex open-heart procedures, major vascular interventions, and the management of heart, lung, and heart/lung transplant patients. Additional breadth is achieved through rotations at the Santa Clara Valley County hospital in their Medical ICU, enriching their understanding of adult critical care medicine across different patient populations and healthcare settings.
Towards the culmination of the first year of clinical training, fellows undertake a month-long role as junior attending on the service. In this capacity, they assume responsibility for all facets of patient care and teaching activities. Throughout this period, an ICU faculty physician is readily available and frequently present to evaluate and provide feedback on the fellow’s performance and to ensure the highest standards of patient care are maintained. The remaining duration of the fellowship offers flexibility, encouraging fellows to pursue elective months in areas such as Echocardiography/ultrasound, Airway management (for non-Anesthesia fellows), or various medical or neurological specialties. Participation in research or academic endeavors related to critical care is a core expectation of each fellow. The program provides access to facilities for clinical physiology studies, including a well-equipped laboratory with technical, financial, and computer support. The diverse research interests of the faculty offer fellows opportunities to develop a broad spectrum of investigative skills within the realm of adult critical care medicine.
For applicants seeking a more detailed insight into the program, an in-depth review published on the Society of Critical Care Anesthesiologists (SOCCA) website in 2012 provides valuable information. While the program has evolved significantly since this publication, the review remains representative of the core learning environment of this adult critical care medicine training program. The leadership continuously strives to enhance the program annually, ensuring it remains at the forefront of critical care education.
