Critical Care Division
|Representing EMRA Residents in Critical Care (firstname.lastname@example.org)
Danish Malik, MD
St. Luke's Roosevelt Hospital
Jenelle Holst Badulak, MD
Abdullah Bakhsh, MD
Joshua Glick, MD
University of Pennsylvania Medical Center
|Board Liaison, RC-EM Liaison
Leonard Stallings, MD
Research Liaisons: Chris Caravanos, MD (St Luke’s-Roosevelt Hospital Center) & Clark Owyang, MD (Mt. Sinai)
Social Media Liaisons: Jonathan Jaffe, MD (Wellspan York Hospital), Yanika Wolfe, MD (Albert Einstein Healthcare Network)
Fellowship Database (EMRA Match) Liaison: Iain Jeffery, DO (The Brooklyn Hospital Center)
|Join our Division! Join Us on Twitter using #EMRACritCare!
|"We have defined 'critical care medicine' as the triad of 1) resuscitation, 2) emergency care for life-threatening conditions, and 3) intensive care; including all components of the emergency and critical care medicine delivery system, prehospital and hospital." -Peter Safar
EMRA Critical Care Division Objectives
• Represent the interest of emergency medicine residents who are interested in critical care.
• Improve membership awareness of post-residency critical care training opportunities.
• Encourage involvement of emergency medicine residents in critical care scholarly activities and projects.
• Provide critical care resources to the membership.
• Submit monthly articles to EM Resident.
• Maintain EMRA's PressorDex publication.
• Maintain a fellowship database
• Update the EMRA board regularly about current projects.
Training and Board Certification Opportunities
Internal Medicine-Critical Care Medicine (IM-CCM)
In 2011, the American Board of Emergency Medicine (ABEM) and the American Board of Internal Medicine (ABIM) agreed to co-sponsor board certification in IM-CCM for EPs. This pathway requires two years of training, with a minimum of 12 months dedicated to clinical experiences (six of these months must involve caring for critically ill medical patients). The remaining 12 months can be used for additional clinical training or academic development.
EPs entering this pathway must complete at least six months of direct patient care experience in internal medicine, of which at least three months must be in a medical intensive care unit. This may be completed either prior to entering fellowship (i.e., during residency) or during the first year of fellowship before the EP-fellow is allowed to supervise IM residents. Many IM-CCM programs accept applications via the Electronic Residency Application Service (ERAS) with a deadline of July 1 (during the year prior to matriculation). Not all programs participate in ERAS, so it is important to check with each program individually. IM-CCM does not participate in a match, and programs typically notify candidates on a rolling basis. A grandfathering option exists for EPs who have completed a two-year ACGME-accredited IM-CCM fellowship and meet certain practice requirements.
Surgical Critical Care (SCC)
In 2012, the American Board of Surgery broadened its eligibility criteria to allow EPs board certification in SCC. This pathway also requires two years of training. The first year is a “preparatory year as an advanced preliminary resident in surgery” during which the EP will gain expertise in the management of surgical patients. The exact composition of this year is at the discretion of SCC program directors, so it is important to check with each program individually. The second year is a traditional SCC fellowship, during which eight months must take place in a surgical critical care unit.
Currently, for EPs, many SCC programs accept applications on a rolling basis beginning in the spring or summer in the year prior to matriculation. The process varies among programs, so it is important to check with each program individually about application requirements and deadlines. No grandfathering option exists for this pathway.
Anesthesiology-Critical Care Medicine (A-CCM)
A-CCM is the newest pathway to board certification in critical care for EPs; it was approved in 2013. For EPs entering fellowship after July 1, 2014, two years of training are required. At least 12 months must involve the care of surgical patients, and the first six months of an A-CCM fellowship for EPs must include three months of rotations with a surgical emphasis. Research electives are limited to no more than two months.
A notable prerequisite is that EPs must have completed four months of critical care training during residency. A-CCM programs participate in the San Francisco (SF) Match (www.sfmatch.org).
Neuro-Critical Care (N-CC)
The United Council for Neurologic Subspecialties (UCNS) has long allowed for board certification in N-CC for EPs, and a number of fellowship programs have a history of training EPs. This pathway is two years in length and provides for core critical care knowledge and skill acquisition with a heavy emphasis on the care of those with critical illnesses or injuries to the central or peripheral nervous system. This often includes training in neurovascular emergencies (i.e. stroke). Some programs offer a one year pathway to those with prior critical care training. The UCNS maintains a fellowship database (https://www.ucns.org/apps/directory/). Most programs participate in the San Francisco (SF) Match (www.sfmatch.org).
Emergency Medicine/Internal Medicine (EM/IM) Pathway
EPs who have trained via the combined EM/IM pathway are eligible for any of the above critical care fellowships, as well as any IM-based fellowship such as Pulmonary-Critical Care. In addition, there are several combined six-year EM/IM/CC throughout the country.
Resuscitation and Research Fellowships
These fellowships offer focused clinical training of care of the critically ill patient in the Emergency Department. Many emphasize research in resuscitation and offer advanced degrees in research. These fellowships are best suited for EPs who want to maintain a clinical practice solely in emergency medicine with an academic or research emphasis in resuscitation and/or ED-based critical care. These vary from 1-2 years and are currently not ACGME board eligible.
Critical Care Fellowship Application Timeline
Critical Care Tracks during Residency
Recent literature has shown that resident interest in pursing a critical care fellowship after finishing EM residency has grown exponentially. It is an exciting time now that an EM resident can become board certified through IM, anesthesia or surgery critical care pathways. There are also resuscitation fellowship opportunities for those EM physicians who love critical care but do not necessarily wish to be an ICU physician and other opportunities for those interested in a neuro-ICU fellowship. With this growing interest, we would like to suggest considering completing a "critical care track" during your three or four year residency. Many residency programs are implementing these "tracks" to help foster individual niche's and passions. These tracks typically consistent of attending national meetings, becoming involved by writing activities/projects in the critical care world, developing research projects, participating in interactive group discussions about critical care topics, participating in critical care clinical rotations etc. We strongly encourage you to considering developing a track within your own residency; however, individual residents can also use these ideas as well.
Below are two links to help you establish and participate in a critical care track. The first link discusses more about the utility of a critical care track, why it is beneficial and how to establish such a track in your institution. The second is an example track that was developed by residents and is currently being utilized at one of the EM programs in PA. We would love to hear from you about your success stories in either establishing or following a critical care track! Please email us with any questions and also with your stories.
"On Track: Creating the Critical Care Track in Your EM Residency" by Jenelle Holst, MD
Example of a Critical Care Track from a Residency in PA
Important Links for EM Critical Care
• Apply for an EMF/EMRA Research Grant
• C3MED Message Board
• Critical Care Perspectives in EM
• Critical Care Forum
• Academic Life in EM
• Society of Critical Care Anesthesiologists
• Surgical Critical Care Program Directors
• Eastern Association for the Surgery of Trauma
• United Council of Neurologic Subspecialties
EM Resident Magazine Critical Care Articles