Perceptions and Attitudes of Critical Care Training and Careers among United States Surgical Residents: Who Wants to be a Surgical Intensivist?

Cohn, Stephen M.; Price, Michelle; Stewart, Ronald M.; Pruitt, Basil A.; Dent, Daniel L.

doi:10.1177/000313480707300502

Cited by 19 publications

(7 citation statements)

References 9 publications

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“…Demand for critical care services is increasing even as a shortage of intensivists exists, 1 and interest in critical care fellowship training among trainees is low 2–4 . In 2005, a consensus paper endorsed by the Society of Critical Care Medicine (SCCM) and multiple emergency medicine (EM) societies called for establishing access to formal critical care medicine (CCM) training and certification for emergency physicians (EPs) and noted that dual‐trained EM‐CCM physicians would not only help address the intensivist shortage, but also strengthen critical care delivery in the emergency department (ED) and facilitate coordination between EDs and intensive care units (ICUs) 5 …”

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confidence: 99%

Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United States

Mayglothling

Gunnerson

Huang

2010

Academic Emergency Medicine

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Objectives: Critical care medicine (CCM) is of growing interest among emergency physicians (EPs), but the number of CCM-trained EPs and their postfellowship practice is unknown. This study's purpose was to conduct a descriptive census survey of EPs who have completed or are currently in a CCM fellowship. Methods:The authors created a Web-based survey, and requests to participate were sent to EPs who have completed or are currently in a CCM fellowship. Responses were collected over a 12-month period. Physicians were located via multiple whom electronic mailing lists, including the Emergency Medicine Section of the Society of Critical Care Medicine, Critical Care Section of the American College of Emergency Physicians, and the Emergency Medicine Residents' Association. The authors also contacted CCM fellowship coordinators and used informal networking. Data were collected on emergency medicine (EM) and other residency training; discipline, duration, and year of CCM fellowship; current practice setting; and board certification status, including the European Diploma in Intensive Care (EDIC).Results: A total of 104 physicians completed the survey (97% response rate), of whom 73 had completed fellowship at the time of participation, and 31 of whom were in fellowship training. Of those who completed fellowship, 36 ⁄ 73 (49%) practice both EM and CCM, and 45 ⁄ 73 (62%) practice in academic institutions. Multiple disciplines of fellowship were represented: multidisciplinary (39), surgical (28), internal medicine (16), anesthesia (14), and other (4). Together, the CCM fellowships at the University of

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confidence: 99%

Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United States

Mayglothling

Gunnerson

Huang

2010

Academic Emergency Medicine

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“…12 Unfortunately, surgical resident interest in the specialty of trauma and critical care seems to be declining. 13 Surgeons want to operate, and residents consistently cite the lack of OR exposure as a reason for disinterest in trauma care. 14,15 Further complicating the future of trauma care are new restrictions on resident work hours.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Violence: Implications for Resident Trauma Operative Experiences

Watkins

Feingold

Hashimoto

et al. 2012

The American Surgeon™

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Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010 at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 AM on weekends ( P < 0.05). Also, the period from midnight to 6 AM on weekends showed a significantly increased proportion of penetrating trauma ( P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 AM on weekends when compared with any other time period ( P < 0.01). In a southern Level I trauma center, patient volume varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 AM, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.

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“…Outside of academia, demand for critical care specialists exists is anticipated to remain high given concerns about a national intensivist shortage . Further, some data suggest that interest in critical care practice among many IM, surgery, and anesthesiology residents has waned . One barrier to joining private practice critical care groups is that many of these groups also provide inpatient and outpatient pulmonary medicine services at their affiliated hospitals.…”

Section: Career Considerationsmentioning

confidence: 99%

The Transition From Emergency Medicine Resident to Critical Care Fellow: A Road Map

Johnson

Maher

Badulak

et al. 2017

AEM Education and Training

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Emergency medicine (EM) residents now have a number of opportunities for fellowship training in critical care medicine (CCM). The aim of this review is to help EM residents navigate the application process, transition to fellowship, and start planning their careers beyond fellowship. Pathways to advanced training in CCM available for EM residents include internal medicine-CCM, anesthesiology-CCM, surgical critical care, and neurocritical care. Each has unique prerequisites, application timelines, and training requirements. EM residency graduates generally already have well-developed crisis management and team leadership skills and excel with procedures such as airway management, vascular access, and bedside ultrasound. Potential areas for growth for EM trainees include critical care physiology, end-of-life care, longitudinal inpatient care, and perioperative medicine. Career opportunities for physicians trained in EM and CCM are diverse and include options in community or academic settings. Some choose EM or CCM exclusively or engage in a mix of both. Academic positions with joint opportunities in EM and CCM are desirable, but can be challenging to negotiate. Many EM-CCM physicians serve as topic experts in their respective groups for clinical care, quality improvement, education, or research involving the interface between the ED and intensive care unit. As career paths in critical care continue to grow in popularity, EM residents, as well as CCM faculty and program directors, should be aware of the available fellowship options, as well as training and career development needs specific to EM residents. E mergency physicians (EPs) are experts at resuscitating critically ill patients. 1 On this foundation, many graduates of emergency medicine (EM) residency programs have developed an interest in critical care beyond the walls of the emergency department (ED). 1-3 The reasons for this, while varied, likely include a desire to engage in longitudinal care and delve more deeply into critical care pathophysiology. In the past, some EPs pursued training via combined EM-internal medicine (IM) pathway or certification by sitting for the European Diploma of Intensive Care. Others trained via unaccredited paths and lobbied for years for defined training and certification opportunities. 1,3,4 Because of these efforts, over the past 5 years, a number of training and board certification opportunities have become available.In this article, we describe a road map for EM residents who are interested in pursuing critical care training and for faculty who might advise them. We begin by reviewing steps for preparation for critical care medicine (CCM) fellowship during residency training, including rotation selection, scholarly work, and mentorship. We also discuss the various training pathways, including prerequisites and application timelines. We review the limited available literature, supplemented with the experiences of our trainees and faculty. We then examine some special considerations for the EM-trained CCM fellow, ...

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Perceptions and Attitudes of Critical Care Training and Careers among United States Surgical Residents: Who Wants to be a Surgical Intensivist?

Cited by 19 publications

References 9 publications

Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United States

Current Practice, Demographics, and Trends of Critical Care Trained Emergency Physicians in the United States

Nocturnal Violence: Implications for Resident Trauma Operative Experiences

The Transition From Emergency Medicine Resident to Critical Care Fellow: A Road Map

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