PURPOSE:To see if one-year postgraduate Critical Care Medicine (CCM) fellowship training is sufficient, and to assess what experience/exposure does a fellow gain during his training.
METHODS:Data was collected prospectively from all (12) fellows. This was divided into On-call (Consult days) and off-call (Routine) days. The following was recorded: demographics, response time (in minutes), referring unit (Floor etc), Medical and surgical sub-specialties (respiratory, ID etc), disposition (step down (SDU) etc or expired), Shock (& subtypes). During routine days each fellow recorded patients in the rotating unit.
RESULTS:Total of 6778 consults were seen. Of these 4192 patients were reviewed during On-call days (Average 10 patients per call) and 2586 (average 7.2 patients per fellow) patients were reviewed during Off-call days. Average age was 63 years (56% female, 44% males). Of the On-call patients, average response time was 5.35 minutes, referred by (40%) ED, (43%) floors, (17%) PACU. 3288 (78%) patients were seen from the following medical subspecialty: (17 %) Respiratory, (16%) GI, (12%) ID, (11%) Lines, (10%) Neurology, (10%) Heam/Oncology, (8%) Nephrology, and others (5%) or less. 904 (22%) patients were seen from the following surgical subspecialty: (36%) General, (26%) Vascular, (10%) Orthopedics, (8%) each from Obg/Gyne and Urology, others (5%) or less .1150/4192 (28%) were in shock, (56%) septic, (28%) hemorrhagic, (6%) Cardiogenic, (0.3%) Neurogenic shock. The disposition was: Floor (42%), MICU (33%), SDU (11%), SICU (4%). 3% of patients expired.
CONCLUSION:Our study showed that fellows were exposed to a wide variety of critically ill patients during their one-year training. Respiratory, ID and GIT sub-specialties form the bulk of medical consults. Our fellows were also exposed to variety of surgical patients. Our average response time for each consult was low. During Off-call days, fellows were in addition exposed to a variety of issues which were not quantified (e.g., heart transplant patients, LVAD, application of Ethical Principles and dealing with end of life issues etc).
CLINICAL IMPLICATIONS:Orientations and critical care training can be geared towards the type of exposure that is anticipated. We believe that CCM training in our institution is sufficient and adequate exposure is acquired in one year to learn cognitive, practical and technical aspects of CCM and to become a competent intensivist.
DISCLOSURE:Amir Khan, None.