Our program is enhanced by offering the fellow several areas of subspecialty concentration, including the following:
The weekly on-line tool curriculum is a schedule of surgical readings, clinical cases and board style MCQs keyed to essential elements of critical care surgery which benefit fellows, MD and others who care for the surgical patient
Additional experiences may be created per fellows needs and program director’s discretion.
The rotations through the TICU are characterized by progressive knowledge acquisition and progressive responsibility during the course of the year. The first three months should be spent acquiring essential critical care procedural skills under the direct supervision of the attending Intensivist and assimilating core medical knowledge relevant to the practice of surgical critical care. During the first three months of the year, the fellow is expected to actively participate in daily rounds, but not necessarily lead them
The next six months of the year are spent in a number of rotations including the TICU. The fellow should have attained the self-confidence to be able to teach procedures and skills they have mastered to the house staff and medical students. The fellow is expected to take an active role in didactic and evidence-based teaching of junior house staff and students. The fellow should be able to critically analyze pertinent literature and start to develop a practice pattern that is fundamentally sounds, evidence-based and effective
The final three months of the year should witness the transformation of the fellow into a team leader and master of surgical critical care. The fellow should lead rounds, under the supervision of the attending Intensivist, formulate patient care plans, and obtain advanced knowledge in critical care. By the end of the year, the fellow is expected to have demonstrated sufficient competence to enter practice as a surgical Intensivist without direct supervision
During the TICU rotation, the fellow will attend ICU administrative meetings at which the planning, staffing and administrative aspects of ICU management are considered. This will fulfill the requirements of the fellow to gain experience in the administration of an ICU
Skills and Simulation resources are a very important component of a surgical resident’s education today and has been shown to be a very effective method of teaching. The STAR Center of Allegheny Health Network is located at our West Penn Hospital and offers a wide variety of equipment to help our residents become skilled surgeons. In addition, a curriculum has been prepared for each PGY level to progressively hone their skills so they may become proficient in laparoscopic and endoscopic surgery. Certification through FLS and FES is now required to sit for American Board of Surgery exams and the STAR Center is a great place to acquire the skills need to pass those exams!
Our Fellowship Program includes rotations at Allegheny General (AGH) and West Penn (WPH) hospitals in Pittsburgh
Allegheny General Hospital - 23 main operating rooms and integrated minimally invasive suite, 4 specialized operating rooms, and 7 Ambulatory Surgery Center operating rooms; 24-bed surgical/trauma intensive care unit, 32-bed cardiothoracic intensive care unit, and 32-bed neurosurgical intensive care unit. The hospital was first in the state to open a dedicated trauma ICU and is a Level I Regional Resource Center for Trauma that annually admits more than 2,000 patients to the Division of Trauma Surgery. Our air ambulance service, LifeFlight, introduced in 1978, was the first aeromedical emergency transport system in the northeastern United States. Five LifeFlight helicopters transport more than 200 patients per month within a 150-mile radius of Pittsburgh.
West Penn Hospital - academic medical center regionally and nationally recognized for excellence in nursing (first in the region designated Magnet by the American Nurses Credentialing Center and first to achieve second designation, in 2012), West Penn Burn Center is the region's first and only burn center verified by the American Burn Association/American College of Surgeons Commission on Trauma for both pediatric and adult burn care. Emergency Medicine services include a completely renovated Emergency Department with dedicated state-of-the-art X-ray room, 128-slice computed tomography (CT), and ultrasound equipment.
The Department of Surgery has monthly Grand Rounds consisting of multidisciplinary internal and external speakers. This conference runs from September through May.
Weekly, year round, (in months with five Tuesdays, Multidisciplinary M&M will be held) the Department of Surgery has a Morbidity and Mortality Conference. Cases discussed include general surgery, trauma and ICU. As the SCC service has been involved in the care of many of the patients discussed, the fellow will be expected to attend.
The ACS Section has a monthly journal club. Articles discussed include one from trauma, one from critical care, one from emergency general surgery and one-two others from any of those areas. The fellow will be expected to present the articles related to critical care.
There is a weekly trauma/ICU M&M. Morbidity and mortality related to trauma patients, ICU patients and SCC patients are discussed. The fellow will be expected to present the complications directly related to the ICU service.
There is a monthly Trauma M&M with the medical examiner, who reviews the autopsy findings of some of these patients. As some of these patients die in the ICU, the fellow will be expected to attend this very educational and interesting conference.
Year round, there is a bi-weekly Acute Care Surgery Conference. The ACS conference covers topics related to trauma, ICU and emergency general surgery. The fellow will be expected to attend. The fellow will be expected to present six (6) of these conferences a year.
The fellow will meet weekly with the TICU attending or the Program Director for a one-on-one educational session.
The ACS section has a monthly M&M which occurs the first Thursday of every month. ACS patients are discussed and the fellow will be expected to present.
One purpose of the fellowship is to teach the fellow the organizational and administrative issues related to an ICU. The goal is for the fellow to become a medical director of an ICU during their career. Participation in unit based and hospital wide committees will foster this educational goal.
Trauma Liaison Committee is a multidisciplinary group that meets monthly. Included are attending representatives from many services (trauma, orthopedics, ICU, neurosurgery, nursing, emergency medicine, anesthesia, and physiatrist). The purpose is to provide forum for system issues related to the care of our patients. The fellow is expected to attend to learn how to address system issues related to patient care.
The AGH Critical Care Committee meets monthly. Attending are medical directors from each of the ICU’s, nursing, patient safety, administration and pharmacy. The fellow will be expected to attend these meetings to learn how to address critical care issues throughout the system. The fellow will also learn how to design and implement hospital wide policies that benefit all critically ill patients.
The purpose of this meeting is to review issues related to patient safety in the TICU: Head of Bed (HOB), Ventilator-associated Pneumonia (VAP), Central line Associate Bacteremia (CLAB), Urinary Tract Infection (UTI), hand washing, protocol compliance. The fellow is expected to attend and review the data related to the TICU, and participate in discussions to improve compliance and patient care.
There are a variety of other committees in which the fellow may participate depending on their area of interest.
The fellow is expected to complete one research project during the year. The fellow will have access to the Trauma Registry to allow for a retrospective chart review. The goal is for the fellow to submit an abstract, and a paper related to the research project. This project will allow the fellow to learn many things related to research: hypothesis driven idea, background. IRB application, literature search, data collection, data analysis, abstract writing, paper writing.