Surgical Critical Care Fellowship Program

Select a unit below to learn more.

• Surgical/Trauma Intensive Care Unit (9 Months)
• Cardiothoracic Intensive Care Unit (2 Weeks)
• Burn Surgery Intensive Care Unit (2 Weeks)
• e-ICU (2 Weeks)
• Anesthesia (2 Weeks)
• Vacation (4 Weeks)

Nine months of the fellowship program will be devoted to rotating in the trauma intensive care unit (TICU) and the surgical intensive care unit (SICU) where fellows will become competent in the skills required to function as a surgical intensivist. Fellows are exposed to a wide variety of trauma and general surgery (emergency general surgery, vascular, transplant, bariatric, hepatobiliary, urology, plastic surgery, ENT) pathology with patients of high complexity and acuity. There is also a close working relationship with neurosurgery and orthopedic divisions. Each of these units is staffed by a double-board certified surgical intensivist on a weekly basis (seven days).

Fellows will be supervising a combination of surgical house-staff; rotating house-staff from the departments of anesthesiology, emergency medicine, neurosurgery and orthopedics, as well as physician extenders (physician assistants and nurse practitioners).

Fellows are expected to function at the level of a junior attending and will be responsible for leading daily multidisciplinary work rounds, creating daily care plans and goals for individual patients and supervision of house staff and physician extenders and the performance of all bedside procedures (including bronchoscopies, tracheostomies, chest tubes, arterial lines, pulmonary artery catheterization and central venous line catheterizations). Cases such as open tracheostomies and percutaneous endoscopic gastrostomies are expected to be staffed by the fellow taking junior residents through the procedures. The ultimate goal is for the fellow to learn how to manage and direct a surgical intensive care unit.

The duties of the fellow on-call will be serving as the trauma team leader for the trauma activations and performing operative acute care surgery and trauma cases at the level of a junior attending/teaching assistant.

Two weeks of the fellowship program will be devoted to rotating through the Cardiothoracic Intensive Care Unit (CTICU) at Westchester Medical Center. The CTICU allows the surgical critical care fellows the opportunity to concentrate on mastering core principles of cardiovascular physiology and pathophysiology. In this unit, fellows are exposed to advanced modes of cardiac/pulmonary-specific critical care support such as extracorporeal membrane oxygenation, management of ventricular assist devices and intra-aortic balloon pumps. The unit is staffed by exceptional cardiothoracic surgeons with highly trained critical care nurses, physician extenders and rotating house staff.

The fellowship incorporates operative experiences throughout the year. Fellows will take junior attending call where they will take junior residents through a wide range of operative cases such as trauma laparotomies, thoracotomies, surgical stabilization of rib fractures as well as emergency general surgery procedures including exposure to robotic surgery. Our dual board-certified faculty is in-house 24 hours a day and operating whenever necessary. Fellows will have the opportunity to cannulate and manage patients for VA and VV ECMO as well as a robust experience with endoscopy/bronchoscopy, tracheostomies, feeding tube access as well as invasive lines/chest tubes

The Westchester Burn Unit is the region’s only burn center caring for both adult and pediatric burn victims. The unit is staffed by board certified burn/critical care surgeons specializing in plastic and reconstructive surgery. In addition to the specialized critical care of burn victims, fellows will be exposed to wound care (including performance of escharotomies, debridement, skin grafts and reconstruction) and burn prevention. The unit is staffed by highly trained critical care nurses, physician extenders and rotating house staff.

Westchester Medical Center Health Network has an advanced eHealth Program that uses the latest technology to monitor critically ill adult patients, regardless of where they are within our hospital network. The eHealth center is staffed by board certified intensivists and critical care nurses who provide patient-centered and quality-driven support. The eICU technology is driven by APACHE IV (Phillips), which is a severity-adjusted methodology that predicts outcomes for critically ill adult patients.

The eHealth Program has taken telemedicine one step further and has created a consultation program for trauma patients across the Westchester Medical Center Health Network. The evaluation of trauma patients via telemedicine allows for our trauma team to guide the management of trauma patients remotely in order to care for patients at their respective facilities, expedite and guide the transfer process and initiate treatment before and during the transfer process.

Two weeks of the fellowship program will be devoted to rotating through the Anesthesia service at Westchester Medical Center. The Anesthesia service allows the surgical critical care fellows the opportunity for numerous intubations (easily meeting surgical critical care board requirements) as well as in-depth learning of anesthesia physiology and medications. Fellows will also be exposed to advanced techniques such as performance and interpretation of transesophageal echocardiography. Knowledge and skills gained during this rotation will be invaluable during other ICU rotations and the care of critically ill patients. There will be ample opportunities to care for intensive intraoperative management of patients such as those seen during transplant, cardiothoracic and neurosurgical procedures.

2a. This fellowship has a robust didactic curriculum. On a daily basis, attending surgeons, fellows, house staff, medical students and allied health professionals attend morning report conference. During daily morning report, which is focused on the experience of the previous 24-hour call, consults, cases and overnight events are presented by house-staff for quality improvement purposes as well as education. Faculty actively teach house staff and fellows during these sessions with respect to surgical decision making, operative technique, perioperative management and surgical critical care decision making.

2b. Weekly departmental academic grand rounds along with departmental morbidity and mortality conferences, as well as Trauma Program Operational Committee/Performance Improvement & Patient Safety (TPOC/PIPS) also provide opportunities for learning. The ultimate goal is to teach fellows how to run a trauma program and surgical intensive care unit.

2c. A weekly ACS/Trauma/Critical Care lecture series is held where landmark papers are presented and discussed in a multidisciplinary fashion with protected time for fellows. In addition, there is a weekly didactic session covering a variety of topics in surgical critical care including lectures by our expert colleagues in other fields (orthopedics, neurosurgery, nephrology, infectious disease, etc.) A variety of textbooks designed for critical care board preparation are used. Fellows will be expected to participate in these weekly didactics, including a journal club aimed at covering landmark critical care papers.

2d. Fellows will also have the ability to prepare lectures during the course of the year to teach and present at these sessions which are directed towards the education of surgical residents. This is a chance for fellows to have the experience as educators for residents during Monday morning lecture series.

2e. Several times throughout the year, a hands-on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) course is held. A critical care ultrasonography course with a state-of-the-art simulator is offered with potential for SCCM critical care ultrasound certification. In conjunction with New York Medical College, a cadaver-based course teaching operative exposures for trauma is performed yearly with trauma faculty instructing fellows and chief residents.