Surgical Critical Care Fellowship

Thank you for your interest in our American Board of Surgery accredited Surgical Critical Care Fellowship at University of Medicine & Dentistry of New Jersey (UMDNJ), Robert Wood Johnson Medical School (RWJMS) at Camden. This program offers a one year ACGME fully accredited fellowship in Surgical Critical Care. The section of Surgical Critical Care is a component of the Division of Trauma in the Department of Surgery at Cooper University Hospital Medical Center.

Cooper University Hospital is the largest academic medical center and the only Level I Trauma Center in Southern New Jersey. The medical center serves the needs of a broad patient population consisting of primary, secondary and tertiary medical care. There are 78 critical care beds divided among Medical/ Surgical ICU (32), Trauma ICU (16) Cardiac Care Unit (16) Trauma Stepdown Unit (9), Stroke Unit (4) & Pediatric ICU (5).

As a busy Level I Trauma Center the emphasis of our Surgical Critical Care fellowship is on the evaluation, resuscitation and management of the acute trauma patient and its related critical care. However, each Fellow may tailor his or her fellowship to individual goals and clinical needs. Also, our fellows have the added benefit of working with some leading medical academic critical care intensivists during their medical/surgical ICU rotations.

The critical care faculty are a well integrated tri-divisional (Surgical Critical Care, Medical Critical Care and Pediatric Critical Care) group of board certified physicians, extremely dedicated and committed to the delivery and teaching of Critical Care.

CLICK HERE to view the complete Surgical Critical Care fellowship brochure

Contact Information

Director: Steven E. Ross, M.D., FACS
Associate Director: Lars Ola Sjoholm, M.D.
Contact: Carol Reilly, Coordinator
Phone: (856) 342-3341
Fax: (856) 342-2817
E-mail: reilly-carol@cooperhealth.edu
Address: Cooper University Hospital, Office of Surgical Education, Three Cooper Plaza, Suite 411, Camden, NJ 08103

Program Description

The surgical critical care fellowship is based at Cooper University Hospital Medical Center, a core teaching hospital of UMDNJ. Cooper is a 554- licensed bed not for profit academic center, dedicated to the treatment of the critically ill and critically injured patient.

The duration of the surgical critical care fellowship is one academic year. The surgical critical care Fellow will be required to spend 7 months in the trauma ICU, 2 months rotating through medical/surgical ICU, and 1 month in PICU. Two months will be spent on elective rotations, which may include but not limited to, anesthesia, neonatal ICU, cardiovascular ICU, or further rotations in the medical/surgical ICU, trauma unit or PICU.

The educational philosophy of this surgical critical care fellowship program is to provide a strong foundation of advanced Surgical Critical Care knowledge and skills upon which a scientifically sound systematic approach to the management of critically ill patients can be developed. This program provides trainees with an advanced level of specialized skills required to attain a mastery of all aspects of surgical critical care for patients of all age groups. Trainees will be afforded the opportunity to become specialists in the clinical management of critically ill patients, in teaching Surgical Critical Care, in critical care research, and in the administration of surgical critical care units.

The Surgical Critical Care Fellow will take in house call while rotating through trauma and medical-surgical ICU. While on trauma, the Fellow will take call 1:4 nights. Being that the trauma service teams rotate 1:3, this will allow the Surgical Critical Care Fellow the opportunity to take call and work with all 3 trauma teams made up of surgical/ER residents/students on an on going monthly basis. The Fellow will operate only on-call after hours in order to assure compliance of the 25% operative time allotment regulation. Except for post-call hours, the Fellow will be required to attend morning report, trauma ICU rounds and conferences Monday-Friday.

While on the medical-surgical ICU rotation, a shift system is in place. The fellow will take call in rotation with the medical CC fellows. Both trauma and medicalsurgical ICU rotation working hours adhere to ACGME compliance with no greater than 80-hr/week duty hours.

A log of the hours, procedures and patients cared for will be kept by the fellow and submitted monthly to the program director.

Curriculum

Fellows are allowed 4 weeks of vacation per year. In addition, one week of educational leave may be approved.

The Surgical Critical Care Fellowship goal is to train surgeons in the subspecialty of Surgical Critical Care. This fellowship will prepare the graduating fellows to function in either an academic center or in a community hospital environment. This will be accomplished by exposing the Surgical Critical Care Fellow to a multitude of clinical aspects of critical care, teaching, administration and research. The specific educational objectives of this fellowship program in Surgical Critical Care are to enable fellows to investigate and evaluate, teach, and apply clinically the fundamental principles of critical care.

Upon completion of the Surgical Critical Care Fellowship, every physician will have developed:

• The ability to perform and teach critical care skills
• A strong foundation of knowledge related to surgical critical care
• The ability to demonstrate advanced decision making capability
• The ability to become the leader of the multidisciplinary critical care team (ie…administer the critical care unit
• The ability to disseminate the appropriate information to patients and to their families.
• The ability to analyze, evaluate and perform critical care research

Clinically the Fellow will be able to:

• Identify the indications for critical care admission and discharge
• Perform and provide appropriate resuscitation, utilizing advanced techniques to any patient sustaining a life threatening event
• Identify indications for mechanical ventilation, manage and wean patients from mechanical ventilation utilizing various techniques and ventilator modes
• Perform, instruct the theory and techniques of CPR
• Treat all forms of shock utilizing conventional and state of the art techniques
• Identify, treat and prevent multiple organ system failure
• Identify, treat and prevent all life threatening electrolyte acid-base disturbances
• Identify, treat and prevent malnutrition utilizing advanced nutritional supplement methodologies
• Perform and provide appropriate conscious sedation
• Perform, instruct the theory and techniques for appropriate pain management and advanced sedation strategies
• Perform, recognize the indications, contraindications and theories for invasive and noninvasive hemodynamic monitoring
• Titrate inotropic and vasopressor drips based on hemodynamic monitoring
• Initiate appropriate consultations with other specialists and construct a clinical plan for complex critical care problems
• Utilize medications safely and determine cost effectiveness of various therapeutic interventions
• Educate the health professional team, as well as, patients and patient families regarding critical care ethical issues
• Educate and communicate to patients and their families all treatment options, outcomes and patient prognosis
• Support emotionally, mentally, patients and their families through the trauma of critical illness
• Recognize, manage, and instruct the theories of acute and chronic renal failure
• Recognize, manage, and instruct the theories of coagulation disorders (acquired and congenital)
• Recognize, manage, and instruct the theories of acute and chronic neurologic disease and injury
• Recognize, manage, and instruct the theories of acute and chronic anemia
• Recognize, manage, and instruct the theories of GI disturbances such as GI hemorrhage, pancreatis, diverticulitis and cholecystitis.
• Recognize, treat and monitor hypertension
• Recognize, treat and monitor the theories on endocrine dysfunction related to DM, DI, adrenal and thyroid dysfunction
• Recognize, treat and monitor the theories on infectious disease, especially as it relates to critical illness
• Recognize, treat and monitor abdominal compartment syndrome.

Administratively, the Fellow will be able to:

• Triage critically ill patients appropriately
• Participate in quality assurance processes such as mortality and morbidity conference, performance improvement conference
• Develop patient safety monitoring and error restriction progress.

The achievement of these objectives is documented in several ways.

Each resident is required to keep a log of the critically ill patients that he/she has managed. Using this document, residents maintain a record of their clinical activities during the training period, including their roles in the management of each patient, and a listing of major procedures, such as insertion of hemodynamic monitoring devices, endotracheal intubation, and tube thoracostomy, among others.

Acquisition of the critical care cognitive skills will be assessed by the Fellow’s active participation in teaching rounds, didactic lectures, journal clubs and required formal presentations. The achievement of the educational goals of this Surgical Critical Care Fellowship will be documented also by the results of the Multidisciplinary Critical Knowledge Assessment Program (MCCKAP) which the Surgical Critical Care Fellow is required to take during their training year. The detailed report received clearly identifies objectively his/her strengths and weaknesses. This information is useful in identifying areas of each Fellow’s surgical critical care curriculum, which might benefit from directed reading and specifically concentrated training.

Eligibility

All PGY-5 surgical residents who will complete their general surgical residency by June 30th are eligible. Those surgical residents that have completed three years of surgical residency by June 30th, who are in a categorical surgical residency program expected to complete the program, are also eligible to apply.

How To Apply

Effective September, 2004, the Surgical Critical Care Fellowship Program will continue to accept universal applications and to participate in the NRMP match. We require receipt of the following information in order for your application to be considered:

1. Fellowship application – available at the following website: www.nrmp.org/res_match/about_res/univappl.pdf
2. Curriculum vitae
3. Three original letters of recommendation, one of which must be from your current or most recent training director
4. A statement describing your training goals and future career plans
5. A copy of your ECFMG certificate if you are a foreign medical graduate
6. A copy of your USMLE scores for Steps 1 and 2, as well as Step 3, if available

The Program Director and two additional faculty members will review applicant files. Invitation for interview will be based upon their recommendations.

Conference Schedule

The educational experiences included in the Surgical Critical Care Fellowship Program consist of formal and informal components. The formal components are primarily regularly scheduled conferences and daily teaching rounds. Less formal learning goes on constantly through the interactions between Fellows and faculty.

The Surgical Critical Care Conference Series is the backbone of the formal educational program. This conference will be divided between formal lecture presentation topics taken from the Core Curriculum and Journal Club topics of Surgical Critical Care interest. Pertinent clinical guidelines will also be reviewed during some of the Journal Club dates. Members of the Critical Care Faculty and other Cooper faculty will present the majority of the lectures. The Critical Care Faculty will be the moderators for Journal Club sessions. Each Surgical Critical Care Fellow will also be required to present three to four of these didactic lectures. Topics will be assigned to them by the Program Director.

Journal Club

Takes place twice a month; assignments are shared among Fellows and faculty. For each conference three to five articles and/or a clinical guideline are selected. Copies of each article should be distributed to all Fellows and pertinent faculty one week prior to the Journal Club. The Fellow should be able to concisely present the purpose and methods of the study. This should be followed by a review of the results and a discussion of the study, including a critique of the methods, results, and discussion. A critical care faculty member will act as moderator.

Morbidity and Mortality

Meeting is held monthly on the fourth Tuesday at 1:00 p.m. to review cases with unexpected outcomes (death, complications, etc.). The Fellow responsible for the patient at the time of the patient’s death must submit an M&M report using standard form kept in ICU in the critical care section office within 24 hours. For cases selected for review at M&M, that Fellow will make a formal presentation.