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Critical Care Training

Critical care training is a major emphasis of the training program and qualifies fellows to take the ABIM Critical Care Medicine certification examination.

During the first year of clinical fellowship, the fellows consult on critically ill patients in ICUs in all three hospitals and rotate through the closed units at the SF Vererans Affairs Medical Center and at San Francisco General Hospital. During the second year Fellows spend 6 months on critical care rotations including 4 months in the Medical-Surgical ICU at MLH, 1 month in the Surgical ICU at SFGH, and 1 month in the Operating Room at MLH. The latter provides supervised training in intubation and airway management in routine and complicated patients. Also, the fellows become more familiar with a wide variety of surgical patients and have the opportunity to increase their skill in placement of systemic arterial, central venous, and pulmonary arterial catheters and management of anesthetics, sedative/hypnotics, and pressors.

The ICU patient population at MLH includes patients that have undergone major vascular and cardiac surgery, as well as heart, lung, liver, bone marrow, and kidney transplantation. In addition, there are patients from the general medical and surgical services with the usual spectrum of pulmonary and non-pulmonary problems resulting in respiratory, cardiac, and other organ systems failure. A number of these patients require arterial venous hemofiltration, intra-aortic balloon pump management, and ECMO.

At SFGH, trauma is the major reason for ICU admission. The fellows have an opportunity to increase their skills in the diagnosis and management of these complex patients with an emphasis on skills related to mechanical ventilation, hemodynamic monitoring, management of simple and complex cardiac arrhythmias, and procedures such as chronic arterial venous hemofiltration and intra-aortic balloon pump management.