Program Design

Rotations for Anesthesiology 1 Year Fellowship

• 12 weeks of Cardiovascular ICU (3 rotations, 4 weeks/rotation)
• 8 weeks of Surgical ICU (2 rotations, 4 weeks/rotation)
• 6 weeks of Neurology/Neurosurgery ICU ( 1 rotation, 6 weeks/rotation)
• 4 weeks of Medical ICU (1 rotation)
• 4 weeks of Burn ICU (1 rotation, 4 weeks/rotation)
• 4 weeks of Echocardiography (1 rotation, 4 weeks/rotation)
• 2 weeks of Huntsman Cancer Center ICU (1 rotation, 2 weeks/rotation)
• 2 weeks of Surgical ICU at the VA (1 rotation, 2 weeks/rotation)
• 6 weeks of electives (3 rotations, 2 weeks/rotation)
• 4 weeks of vacation

Optional elective opportunities

• Rotations with palliative care, nephrology, transfusion medicine, infectious disease, critical care transport/flight medicine, cardiology.  Ability to propose own elective based on specific interests and availability.

Sample Block Schedule for Emergency Medicine 2 Year Fellowship

Clinical Practice

As a regional tertiary care center, Level 1 Trauma Center, Stroke Center of Excellence, and National Cancer Institute designated Comprehensive Cancer Center, the University of Utah and its affiliated hospitals care for a wide range of critically ill patients.  The University of Utah Medical Center and School of Medicine is the only academic medical system in the state of Utah and serves a large area of the Mountain West.  It provides patient care for the people of Utah, Idaho, Wyoming, Montana, western Colorado, and much of Nevada.

Our fellows have the opportunity to participate in intensive care delivered across a diverse range of critical care units.  The following is a brief description of each of the intensive care units the fellow will be rotating through and the types of patients they will encounter in each.

The Surgical ICU is responsible for care of trauma patients as well as critically ill patients from general surgery, urology, orthopedics, obstetrics and gynecology, ENT, plastic surgery, and abdominal solid organ transplant surgery. It is a 12-bed unit that is staffed by specialists from trauma surgery and anesthesiology. 

The Cardiovascular ICU cares for cardiac, thoracic, and vascular surgery patients, as well as thoracic transplant surgery patients and patients receiving care with mechanical circulatory support systems (MCS) including a high volume of extracorporeal membrane oxygenation (ECMO) therapy. The 18-bed unit is staffed by specialists from CT surgery, anesthesiology, and emergency medicine.  As a tertiary heart failure surgery center, our patients undergo a variety of complex cardiac interventions including coronary artery bypass grafting, heart valve repair and replacement, trans-catheter aortic valve replacement (TAVR), pulmonary thrombo-endarterectomy, septal myectomy, and left ventricular assist device (LVAD) implantation. We additionally care for patients receiving MCS for acute respiratory distress syndrome, pulmonary embolism, end-stage heart failure, and prolonged cardiac arrest after myocardial infarction. Our hospital is the only lung transplant center in the state and one of two heart transplant hospitals in Utah.

The Neurology/Neurosurgical ICU cares for both neurology and neurosurgical patients. As a Level 1 Trauma Center and accredited comprehensive stroke center, the NCC cares for patients after a variety of neurologic emergencies including ischemic stroke and intracranial hemorrhage. This 23-bed unit is staffed by a multidisciplinary team with providers from anesthesiology, emergency medicine, neurology, and neurosurgery.

The Huntsman Cancer Center ICU is a mixed medical-surgical ICU specializing in the care of oncologic patients. As a Comprehensive Cancer Center, the Huntsman Cancer Institute cares for patients suffering from a wide variety of oncologic processes. In the HICU our patients present with diseases as varied as blast crisis, tumor lysis syndrome, intracranial hemorrhage, and acute organ failure. This 16-bed unit (soon to expand to 25 beds) is attended by specialists from pulmonology and anesthesiology, collaborating with colleagues from hematology, oncology, bone marrow transplant, and a variety of surgical specialties. 

The Veterans Affairs Surgical ICU is located at the George Wahlen VAMC adjacent to the University of Utah campus. This VA hospital cares for patients living in over 20% of the continental US land mass and is a national VA referral center for heart failure surgery including LVAD and heart transplantation. The 10-bed unit is staffed by physicians from anesthesiology, general surgery, and emergency medicine.  

Taking all our ICUs into account the University of Utah offers approximately 125 ICU beds.  Last year we had a total of 7,045 admissions with an average daily census of approximately 90 patients. 

• CVICU- 20 beds, Medical Director- Sean Overton, MD, Anesthesiology
• SICU- 12 beds, Medical Director- Jason Young, MD- Surgery
• NCCU- 23 beds, Medical Director- Sarah Menacho, Neurosurgery
• MICU- 25 beds, Medical Director- Estelle Harris, MD- Medicine
• VA SICU- 10 beds, Medical Director- Ted Kimball, MD- Emergency Medicine

Clinical Educational Objectives

At the completion of the Anesthesiology CCM Fellowship the expectation is that each fellow will become a consultant in the field of critical care medicine.  For our program this would include the following:

            Understanding the role of a critical care intensivist in the setting of a multi-disciplinary ICU team and demonstrating leadership abilities not only in delivering high quality critical care but also in leading and resolving conflict within a care team model.

            Showing professionalism and competency in all aspects involved in the management of critical care patients.

            Demonstrating competence in not only performing but also teaching critical care procedures including the following:

• airway maintenance and management including videolaryngoscopy and fiberoptic approaches to the airway for diagnostic and therapeutic purposes;
• bronchoscopy; placement of emergency airway devices; cricothyroidotomy;
• invasive and non invasive ventilatory support ;
• thoracentesis and tube thoracotomy;
• intra-aortic balloon pumps, placement of ECMO cannulas, management of mechanical circulatory support devices;
• placement and management of arterial, central venous, and pulmonary arterial catheters;
• placement of transvenous pacemakers;
• ultrasonography for transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), and facilitation of invasive catheter placement and diagnostic studies and therapeutic interventions relevant to the critically ill patient

Point of Care Ultrasound and Advanced Critical Care Echocardiography Training

            During the fellowship year each fellow will have the opportunity to take part in a 4-week rotation centered around echocardiography and ultrasound skills.  The echocardiography rotation will take place at the VA Medical Center echocardiography lab.  Of note, the echo lab at the VA is the only anesthesiologist-staffed full-service echo lab in the country, providing TTE, TEE, and stress echo services for our Veterans.  This is a fantastic opportunity for our fellows to receive world-class echocardiography education at the hands of our very own anesthesiology echocardiography faculty.  Of our nine anesthesiology intensivists, three have advanced training in echocardiography.  We will help fellows in their pursuit of preparing for the National Board of Echocardiography examinations including the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM), the Examination of Special Competence in Basic Perioperative Transesophageal Echocardiography (Basic PTEeXAM) and for those that have already passed the Basic PTEeXAM,  the Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography  (Advanced PTEeXAM).  We plan to provide the necessary teaching and didactics as well as case volume in order to be able to sit for these exams as the fellow chooses.  Sitting for the Perioperative Transesophageal Echocardiography exams may require the use of elective time for more experience. 

For more information visit the Division of Perioroperative Echocardiography and the VA echo lab.

Teaching Opportunities

A primary goal of the Anesthesiology CCM Fellowship is to help shape future educators in the field of critical care medicine.  As part of their training, fellows will be asked to participate in education opportunities during their training year.  This will include lecturing to residents and medical students.

The fellow will supervise residents during their CVICU, SICU, Burn ICU and NCC rotations.  They will work with advance practice clinicians while in the CVICU, VA SICU, NCC, Huntsman ICU and MICU.  They will lead rounds with the supervision of the attending on service during each of their ICU rotations.  They will participate in direct patient care evaluating patients at the bedside, interpreting laboratory data and imaging, coordinate patient care and helping residents formulate care plans for critically ill patients in the ICU’s through which they rotate.  

Didactics

The first two weeks of the Anesthesia CCM Fellowship will include daily hour long mid day education sessions led by a faculty intensivists.  This will serve as foundational didactic introduction to core critical care medicine topics including:

• Shock states, identification and management
• Respiratory failure and advanced ventilator management
• Renal failure
• Intravenous fluids and transfusion medicine
• Neurocritical care pearls
• Liver failure
• Bedside ultrasound
• Nutrition basics
• Mechanical circulatory support
• Pain and sedation management

Following the two week didactic sections the fellows will participate in weekly hour long didactic sessions that will include a monthly journal club and quarterly hour long simulation sessions.  

Research Opportunities and Academic Educational Objectives

            During the course of the year, fellows will be expected to participate in a scholarly research activity.  This could be in the form of initiation of a research project, mentorship of a resident during their research month, a QA/QI project, or presenting a departmental grand rounds. Other scholarly activities fulfilling the ABA requirement for critical care fellows may include collaboration on book chapters, review articles, presentation of abstracts at meetings, and similar activities. If a fellow wishes to pursue more involved research during the year there are many available mentoring opportunities throughout our department.

Mentorship and Supervision

            Fellows will be assigned a mentor from within the anesthesia critical care faculty for the duration of the year.  This mentor will be available for not only educational and research support but also for well-being, work/life balance and career advice.  The mentor will be present for the fellow’s quarterly review with the program director.  Fellow supervision in the clinical setting will be by the attendings on service during the fellow’s clinical rotation.  As most ICU’s rotate attending staff on a weekly basis the fellow can be supervised by up to 4 different attending staff during a 4-week rotation.  Each faculty supervising the fellow

Additional Fellow Benefits:

• Ability to access funds for purchasing POC surface echo probe (tablet or smart phone compatible)
• Opportunities to apply for additional fellowships including perioperative echocardiography or Cardiothoracic anesthesiology depending on candidate’s long-term goals.
• Education money fund of 1000 dollars for books and materials
• Meetings/conference/travel fund of 750 dollars to be used towards continuing education
• Internet service discount for the year with 360 dollar credit
• Option to purchase a department phone with cellular service included
• Option for weekend shifts during electives (internal moonlighting)
• August 1st start date. (to allow fellow time to prepare and sit boards and/or moonlight during the month of July to earn additional compensation.

Life in Salt Lake City

Utah is home to the Wasatch mountains in the Mountain West of the United States. Salt Lake City boasts a population of 200,000 people with more than 2 million people living across the Wasatch Front. Salt Lake City holds some of the most livable environments with affordable housing, family-friendly communities, and an active job market and industrial sector. The city is actively expanding with new businesses and new construction at an exponential rate.

Salt Lake City boasts easy access to six world-class ski resorts, with many more within a short drive. It is a skiing destination revered across the world amongst elite and recreational skiers alike. The mountains are host to one of the most complex mountain biking trail systems in the world, so you are guaranteed a new trail to ride or hike for the duration of your fellowship! Salt Lake City provides tons of amazing weekend destinations with renowned parks such as Yellowstone, Moab, Zion, Bryce Canyon, and Jackson Hole within a few hours’ drive.

https://uofuhealth.utah.edu/living_in_utah/

https://uofuhealth.utah.edu/why-utah.php