The Transition From Emergency Medicine Resident to Critical Care Fellow: A Road Map

Abstract

Emergency medicine (EM) residents now have a number of opportunities for fellowship training in critical care medicine (CCM). The aim of this review is to help EM residents navigate the application process, transition to fellowship, and start planning their careers beyond fellowship. Pathways to advanced training in CCM available for EM residents include internal medicine-CCM, anesthesiology-CCM, surgical critical care, and neurocritical care. Each has unique prerequisites, application timelines, and training requirements. EM residency graduates generally already have well-developed crisis management and team leadership skills and excel with procedures such as airway management, vascular access, and bedside ultrasound. Potential areas for growth for EM trainees include critical care physiology, end-of-life care, longitudinal inpatient care, and perioperative medicine. Career opportunities for physicians trained in EM and CCM are diverse and include options in community or academic settings. Some choose EM or CCM exclusively or engage in a mix of both. Academic positions with joint opportunities in EM and CCM are desirable, but can be challenging to negotiate. Many EM-CCM physicians serve as topic experts in their respective groups for clinical care, quality improvement, education, or research involving the interface between the ED and intensive care unit. As career paths in critical care continue to grow in popularity, EM residents, as well as CCM faculty and program directors, should be aware of the available fellowship options, as well as training and career development needs specific to EM residents. E mergency physicians (EPs) are experts at resuscitating critically ill patients. 1 On this foundation, many graduates of emergency medicine (EM) residency programs have developed an interest in critical care beyond the walls of the emergency department (ED). 1-3 The reasons for this, while varied, likely include a desire to engage in longitudinal care and delve more deeply into critical care pathophysiology. In the past, some EPs pursued training via combined EM-internal medicine (IM) pathway or certification by sitting for the European Diploma of Intensive Care. Others trained via unaccredited paths and lobbied for years for defined training and certification opportunities. 1,3,4 Because of these efforts, over the past 5 years, a number of training and board certification opportunities have become available.In this article, we describe a road map for EM residents who are interested in pursuing critical care training and for faculty who might advise them. We begin by reviewing steps for preparation for critical care medicine (CCM) fellowship during residency training, including rotation selection, scholarly work, and mentorship. We also discuss the various training pathways, including prerequisites and application timelines. We review the limited available literature, supplemented with the experiences of our trainees and faculty. We then examine some special considerations for the EM-trained CCM fellow, ...

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

“…Board certification (parameter B2), the third most frequently used parameter, lacks important detail because the studies using this parameter did not address certification status at the time of their study. Fellowship trained (parameter B1), the fourth most commonly used parameter, may also be associated with nuance especially in the complexities associated with fellowship training and certification of neurointensivists and emergency medicine intensivists (98, 119, 128, 129).…”

Disparities in employment outcomes among critical care graduates with different training backgrounds

“…Although some authors have laudably attempted to provide guidance to trainees pursuing CCM, [20,21] there are few high-quality data to inform recommendations. Although our study attempted to generate such data, its significant limitations beg for further studies to better counsel trainees on the limitations they may face when entering the workforce.…”

Critical emergency medicine and the resuscitative care unit

“…Critical emergency medicine physicians should be proficient in invasive monitoring techniques, including invasive blood pressure monitoring, central venous pressure measurement, and pulmonary artery catheterization [ 44 ]. These skills can be acquired during specialization or through subspecialization [ 45 ].…”