Clinical Training

The Surgical Critical Care Fellowship is a 1-year program which includes 12 months of direct patient care experience designed to provide exposure to a broad range of critically ill patients. Nine of the 12 months are reserved for ICU training, including the 40-bed Surgical/Trauma Intensive Care Unit (SICU), the 32-bed Cardiac/Cardiothoracic ICU, and the 16-bed Neuro/Neurosurgical ICU. Additional rotations beyond the ICU setting include Trauma & Acute Care Surgery, Nephrology, Airway/Anesthesiology, and Nutrition. The competency-based educational curriculum, simulations, structured teaching experiences, scholarly activities, and supervision and mentorship by experienced faculty complete the fellow experience.

Fellows have access to the Henry Ford Hospital Simulation Training Center, an American College of Surgeons accredited Level 1 Comprehensive Education Institute. This 12,000sq ft state-of-the-art center fosters advancements in simulation, education, and research. Various educational activities, including the Ultrasound & ECMO curriculum, SCCM Fundamental Critical Care Support (FCCS), International POCUS, and Focused Echo courses are conducted in the simulation center.

Core Rotations & Educational Objectives

• Surgical ICU: This 40-bed unit is the primary ICU training base for the surgical critical care fellows. The SICU serves patients from various surgical specialties, including Trauma & Acute Care, Transplant, Vascular, Surgical Oncology (including HIPEC), Thoracic, Colorectal, General/Endocrine, Plastic & Reconstructive, Otolaryngology, Urology, Obstetrics & Gynecology, and Orthopedic Surgery. Beyond exposure to this vast array of surgical patients and pathologies, the fellow will develop clinical expertise in invasive & noninvasive mechanical ventilation, placement and management of invasive catheters, diagnosis and management of sepsis, fluid and hemostatic resuscitation, recognition and treatment of renal and hepatic dysfunction, ethical aspects of critical care, and principles of ICU administration. The fellow is responsible for the SICU team, leading multidisciplinary rounds daily and participating in educational activities and quality initiatives.
• Cardiothoracic/Cardiovascular ICU: This 32-bed unit allows the fellows experience in the management of general complex cardiac cases, in addition to acute myocardial disease, advanced heart failure, heart and lung transplantation, extracorporeal membrane oxygenation (ECMO), left ventricular assist devices (LVADs), and intra-arterial balloon pumps (IABP). The fellow will develop clinical expertise in pharmacologic and mechanical circulatory support, and the interpretation of pulmonary arterial catheters, electrocardiograms, and echocardiography.
• Neuro ICU: Fellows will have exposure to a wide variety of primary brain and spinal cord pathology in this 16-bed unit. The fellow will develop clinical skills in performing a complete neurologic examination, evaluation of central nervous system dysfunction, the performance of complete neurologic examinations, use of intracranial pressure monitoring techniques and of the electroencephalogram to evaluate cerebral function, and interpretation of relevant laboratory results.
• Trauma & Acute Care Surgery: This rotation offers exposure to a complex acute care surgery and trauma surgery population, with the fellow taking in-house trauma/ACS call serving in the junior faculty role, with a senior staff member present as a back-up. As such, the fellow will develop clinical expertise in the assessment, triage, and resuscitation of injured patients; operative and nonoperative management of trauma, complex acute care, and general surgery patients. The fellow will be exposed to a wide array of operative procedures, including both elective and emergent general surgery.
• Nephrology Consults: The fellow will have exposure to and develop clinical expertise in recognition and treatment of acute renal dysfunction, the principles of various modes of hemodialysis and ultrafiltration (conventional and CRRT), and knowledge of the indications for and complications of dialysis.
• Airway/Anesthesiology: The fellow will learn fundamentals of airway assessment, preparation/maintenance, and post-intubation management, and will develop skills in laryngoscopy and intubation under the direct supervision of anesthesiologists.
• Nutrition: The fellow will develop clinical expertise in nutritional assessment, enteral and parenteral nutrition formulas, and fluid and electrolyte management.
• SICU Endoscopy: This is a year-long service for bedside percutaneous tracheostomy & PEG procedures run by the SICU fellows, in collaboration with TACS staff & residents

Administrative Responsibilities

Administrative responsibilities include maintenance of work hours, attending required weekly didactics, monthly evaluations of faculty and residents, maintaining case logs of ICU patients managed and procedures/operations performed, leading multidisciplinary daily rounds, giving lectures to residents on ICU topics, and participation in our monthly SICU collaborative meeting and weekly SICU Quality Rounds.

The fellow will interact with residents and medical students on the SICU team, as well as general surgery residents on both the TACS rotation and the trach/PEG service; as such, the fellow is expected to participate in teaching opportunities in the daily care of patients and during procedures.