Year 1 block schedule

• Critical Care Medicine Unit (CCMU) days (12-14 weeks)
  • This is the home unit for EM-CCM fellows in the IM pathway. Fellows rotate along with their PCCM fellow colleagues in the 20-bed Critical Care Medicine Unit (Michigan’s Medical ICU). The CCMU is divided into two 10-bed services (Blue and Maize), each with one attending, one fellow, and house staff.
  • The objectives of this rotation include gaining expertise in the following areas: ventilator management, vasoactive medications, shock, point-of-care ultrasound, complications of advanced treatment options for malignancies including those of CAR-T therapy; and various procedures to include direct and video intubation, awake fiberoptic intubation, arterial and central lines, ultrasound-guided IVs, large bore and pigtail chest tubes, paracentesis, thoracentesis, and bronchoscopy.
  • The CCMU fellows from each team rotate taking “call,” which entails triaging admissions from the ED/EC3, the hospital floors, and from outside hospitals. Fellows work closely with the charge nurse and bed manager to ensure proper admission of critically ill patients.
• CCMU nights (4 weeks)
  • There is a dedicated night fellow each night from 7pm-7am. There is no 28-hour call.
• Neurologic ICU (NICU) (4 weeks)
  • CCM fellows obtain preliminary training and certification in Emergency Neurologic Life Support and are integrated into the Neuro ICU (NICU), acting as the NICU fellow under the supervision of the neurologic critical care attendings. During this rotation, fellows will gain experience in managing a broad spectrum of neurocritical care conditions including acute strokes, intracranial hemorrhage, elevated intracranial pressure, status epilepticus, neuromuscular failure, and post-operative care of neurosurgical patients. During this rotation fellows gain experience in bedside tracheostomies with the NICU attendings, management of ventriculostomy and intracranial catastrophes. Residents in this ICU are from anesthesia, neurosurgery, and neurology, and unit-specific APPs assist the team with workflow. In this unit, the fellow performs all procedures including intubations. The fellow does not work nights as nights are covered by the attending.
• Trauma-Burn ICU (TBICU) (4-6 weeks)
  • CCM fellows are integrated into the rotation and act in the capacity of a TBICU fellow under the supervision of surgery and emergency medicine attendings. Fellows are exposed to all facets of care for the critically ill burn patient and critically ill trauma patient. Residents from this unit are from emergency medicine, general surgery, and orthopedics.
• Cardiovascular ICU (CVICU) (2 weeks)
  • CCM fellows act as a secondary fellow in this rotation under the supervision of anesthesia, emergency medicine and surgery attendings. Fellows are exposed to all facets of care for pre- and post-op cardiac patients, including mechanical circulatory support to include VA/VV ECMO, VADs, and Impellas. Residents from this unit are from emergency medicine and anesthesia.
• Bronchoscopy (2-4 weeks)
  • CCM fellows have a dedicated rotation in the Medical Procedures Unit to learn bronchoscopy with a specific emphasis on the airway exam, mastery of manipulating the bronchoscopy and obtaining procedure log to meet CCM bronchoscopic requirement. Fellows can assist interventional pulmonology in the operating room during advanced and/or rigid bronchoscopy cases, should they choose. Pigtail chest tubes and thoracenteses are common during this rotation, and fellows can perform intubation at the start of cases.
• Emergency Critical Care Center (EC3) (4 weeks)
  • Fellows rotate through acting as primary provider on patients in the nation’s first ED-ICU, taking care of patients in the acute phase of illness from the main ED after initial stabilization. Patients include critically ill patients across the full spectrum of critical care including medical, cardiac, neurologic, burn, and trauma patients. Many patients improve during their EC3 stay and no longer require an ICU admission, while others are admitted to ICUs after a period of resuscitation in EC3.
• Critical Care Nephrology (2 weeks)
  • Fellows work with our nephrology ICU consult service to learn management of renal diseases in the critically ill patient, to include severe electrolyte disorders, AKI and/or established ESRD requiring CRRT / iHD.
• Palliative Care (2 weeks)
  • Fellows work with the palliative care consult team to gain experience in goals of care conversations, pain and symptom management, and end of life discussions.
• Critical Care Nutrition (2 weeks)
  • Fellows are embedded with our team of nutritionists to learn the nuances of managing nutrition in the critically ill patient.
• Electives (4 weeks)
  • Difficult Airway Course – Fellows have the opportunity to attend Rich Levitan’s cadaveric airway course. For more information on this course, please reference this link: https://www.airwaycam.com/texas
  • Foundations of Mechanical Ventilation – Fellows have the opportunity to attend this course developed and run by the NIH.
  • Research – Fellows can work with emergency medicine and critical care clinician researcher faculty on research projects that encompass translational animal models, clinical trials, health services research, medical education, data analytics, and device development. In addition, the Department of Emergency Medicine also houses the Weil Institute for Critical Care Research & Innovation, which brings together integrative teams comprised of world-class U-M scientists, clinicians, and engineers with industry partners and funding sources to develop and deploy cutting-edge solutions that elevate the care, outcomes, and quality of life of critically ill and injured patients and their families. There are ample research training and funding opportunities available during and beyond fellowship.
  • Advanced airway elective – Fellows are paired with an Otolaryngology attending specializing in advanced airway management to gain experience with difficult airways in the operating room.
  • ECMO
  • Perfusionist
  • Survival Flight
  • Lung Transplant
  • ECLS Simulation Course
  • Interventional Pulmonology
  • Pulmonary consults (general and transplant)
  • Infectious Diseases consults (general and transplant)
  • Chest Imaging
• Vacation (4 weeks)

Year 2 block schedule

Year 2 block schedule is more flexible and can be tailored to the individual fellow’s professional goals. An example of a 2nd year schedule is as follows:

• CCMU days (4-6 weeks)
• CCMU nights (4 weeks)
• SICU (4 weeks)
  • CCM fellows are integrated into the rotation under the guidance of surgery and anesthesia critical care attendings in the 20-bed SICU. CCM fellow act as the SICU fellow during their second year. Fellows are exposed to rich surgical pathology and gain expertise in the management of post-operative critically ill patients. This unit also houses VV ECMO patients, and fellows are invited to cannulate when opportunities arise. Residents in this ICU are from both anesthesia and surgery programs, and dedicated unit APPs assist the team with workflow.
• TBICU (2 weeks)
• CVICU (2-4 weeks)
• Emergency Critical Care Center (EC3) (8 weeks)
• Electives (~16-24 weeks)
• Vacation (4 weeks)