Clinical Curriculum

Overview

The Critical Care Fellowship at Cleveland Clinic is intended for graduates of Emergency Medicine and Internal Medicine training programs, as well as for trainees with prior subspecialty training in Cardiology, Infectious Diseases, Hepatology and Nephrology. The Critical Care Fellowship requires a two-year commitment for most trainees. We offer dedicated three-year tracks for trainees interested in pursuing a master’s degree or additional research in medical education, basic/translational science or clinical trials.

First and Second Year Critical Care Curriculum

Year 1: Building the Foundation for Excellence in Critical Care

The first year of fellowship is designed to build the clinical foundation required to become an excellent critical care physician. Fellows develop core expertise through immersive rotations that emphasize the essential knowledge, judgment and technical skills of critical care medicine, including bronchoscopy, bedside ultrasound and echocardiography, airway management, intubation, central venous and arterial access, ventilator management and ECMO.

Just as importantly, the first year marks the beginning of a deliberate process of professional identity formation. We believe that becoming a critical care physician involves more than mastering procedures or medical knowledge. It requires fellows to grow into clinicians who lead teams, communicate with clarity, serve patients and families with compassion, and make sound decisions in high-stakes environments.

Throughout the first year, fellows are supported in identifying an academic mentor, clarifying their emerging career interests and selecting a scholarly pathway in education, research or quality improvement. Mentorship and scholarship are intentionally coordinated so that each fellow develops a meaningful academic focus early in training.

As part of our commitment to leadership development, first-year fellows also participate in Quality in Leadership, our structured leadership and quality improvement curriculum. This program provides practical leadership training, team-based problem solving, quality and process improvement methods and project-based scholarship. Through this experience, fellows begin to see themselves not only as skilled intensivists but as leaders capable of improving the systems in which patients receive care.

Year 2: Refining Expertise, Leadership, and Career Direction

The second year of fellowship is designed to help fellows move from foundational competence toward greater clinical sophistication, professional clarity and leadership maturity. Fellows develop a deeper understanding of the physiology of critical illness, with a greater emphasis on mechanical ventilation, hemodynamics, heart-lung interactions and the thoughtful application of organ support systems to the needs of individual patients.

During this year, fellows are challenged to refine not only what they know but also how they think, lead and make decisions in complex ICU environments. Clinical experiences and elective opportunities are intentionally aligned with each fellow’s evolving career goals, allowing fellows to deepen expertise in areas such as education, research, quality improvement, simulation, subspecialty critical care or health systems leadership.

Scholarship remains an important part of the second-year experience, but it is framed as part of each fellow’s broader goals. Fellows work with mentors to translate their interests into meaningful presentations, quality improvement initiatives, educational work or research projects that reflect their developing voice and future direction as critical care physicians.

By the end of the second year, fellows should demonstrate growing independence as clinicians, increased confidence as leaders of interprofessional teams and a clearer sense of the contribution they hope to make to the field of critical care medicine.

Electives

To facilitate individualized career planning, a multitude of non-core rotations are available to fellows. These opportunities include, but are not limited to:

• Cardiovascular Intensive Care Unit (post-operative cardiovascular patients, ECMO and ventricular assist devices)
• Coronary Intensive Care Unit
• Heart Failure Intensive Care Unit
• Trauma Intensive Care Unit and Burn Center (Metro Health Medical Center)
• Surgical Intensive Care Unit
• Community Hospital Intensive Care Units
• Infectious Disease
• Thoracic Surgery
• Radiology and Interventional Radiology
• Formal education courses (statistics, clinical trial design, epidemiology, teaching pedagogy, curriculum development, etc.)
• Leadership Education (Mandel Global Leadership and Learning Institute and Education Institute Courses)
• Pulmonary Hypertension ICU Management and Right Heart Catheterization

Critical Care Cardiology Track

The increasing complexity of patient care in Cardiovascular Intensive Care Units often requires an understanding and mastery of Critical Care Medicine. The Critical Care Cardiology (CCC) track at Cleveland Clinic offers additional training opportunities to applicants after completion of a General Cardiology Fellowship. We have a well-established history of training Cardiologists to pursue excellence in Critical Care Medicine and offer unique opportunities to gain experience in mechanical ventilation, advanced heart failure, imaging, Cardiac Intensive Care Unit, post Cardiovascular Surgery ICU and ECMO teams. Applicants can apply for either a one or two year training program in Critical Care Cardiology.

One advantage of our program is that cardiologists work in lockstep with both the Cardiology and Critical Care Medicine fellowships. Single-year fellows will encounter a curriculum heavily focused on mastering the essentials of critical care and mechanical ventilation. There is wide latitude for those who do a second year to gain additional expertise in mechanical circulatory support, perioperative cardiac support, heart failure medicine or to pursue mentored research with leaders in both Cardiology and Critical Care Medicine.

1-year curriculum

Sample 2-year curriculum (modifiable based on prior cardiology experience and career focus)

Critical Care Clinician Scientist Curriculum

Beyond excellent clinical training, the Critical Care Fellowship offers a wide array of options for fellows interested in becoming clinician scientists. Supported by an NIH T32 grant as well as philanthropic and other funding, we offer dedicated training to fellows interested in basic science, translational or clinical trials research. These pathways offer additional master's or PhD training for those interested. Critical Care areas of potential interest include:

• ARDS
• ECMO
• Sepsis
• Mechanical ventilation
• Heart-lung physiology
• Point of care ultrasound
• Medical education
• Simulation
• Informatics/big data
• Hemodynamics

Fellows interested in the Clinician Scientist Track have their clinical training front-loaded, thus freeing additional time during the second year to begin research. T32 trainees are afforded significant protected time to pursue research with the goal of further NIH funding thereafter. For additional information about this program, please contact our program.

Emergency Medicine Critical Care

Physicians with training in Emergency Medicine bring essential skills in acute care, resuscitation and high-stakes decision-making that complement and enrich the multidisciplinary ICU environment. Our Critical Care Medicine Fellowship at Cleveland Clinic is proud to offer a tailored experience that builds on this strong foundation, providing EM-trained fellows with the additional depth, mentorship and curricular focus necessary to thrive in the ICU and beyond.

Customized Curriculum

We recognize that EM-trained fellows may benefit from additional longitudinal exposure to core internal medicine domains that are essential to the practice of multidisciplinary critical care. To that end, our curriculum includes focused experiences in:

• Chronic Disease Management
  Immersive rotations that deepen fellows’ expertise in the longitudinal aspects of diseases commonly seen in the ICU—such as advanced heart failure, COPD, cirrhosis and diabetes—integrated with outpatient follow-up opportunities where possible.
• Infectious Diseases in the ICU
  Dedicated consult experience focuses on complex ICU infections, antimicrobial stewardship and management of immunocompromised hosts.
• Nephrology for the Intensivist
  Enhanced training in acid-base disturbances, fluid management, renal replacement therapies (including CRRT and SLED) and consultative nephrology in critically ill patients.
• Hematology & Oncology Critical Care
  Opportunities to participate in specialized units that care for patients with malignancy, stem cell transplant, and complex hematologic conditions, common areas of exposure in tertiary ICU care.

EM/CCM Mentorship & Professional Development

We take pride in our strong cadre of Emergency Medicine–trained intensivists—many of whom trained in our program—who are actively engaged in the mentorship and growth of current fellows. Opportunities include:

• One-on-One Mentorship with EM/CCM faculty to guide clinical development, board preparation and career trajectory.
• EM/CCM Alumni now practicing across the country who can offer career and networking advice to current EM/CCM fellows.
• Career Development Sessions focused on navigating dual-board certification pathways, hybrid EM/ICU practice models, and academic vs. community-based opportunities.

Simulation

Simulation in medical education enables learners to practice necessary skills in an environment that allows for errors and professional growth without risking patients' safety. With a 10,000-square-foot expansion of the Simulation Center Dry Lab, two wet labs, two Difficult Airway Centers and a task-based simulation lab, Cleveland Clinic is at the cutting-edge of simulation training. Simulation-based teaching is built into the educational curriculum of our fellowship program. During fellow orientation, we train incoming fellows in invasive procedures, basic airway skills, critical care ultrasound and bronchoscopy using the array of resources and faculty committed to simulation education.

Additionally, our fellows participate in online and immersive simulation curricula that are offered annually on advanced airway management, mechanical ventilation, hemodynamic assessment, neurologic emergencies, ECMO and advanced ICU procedures (e.g., PA catheter, transvenous pacing, pericardiocentesis, cricothyroidotomy). These form a core part of our educational profile.

Simulation Fellowship

Cleveland Clinic's Education Institute offers a one-year fellowship designed to develop leaders with vision, knowledge and a commitment towards developing simulation-based training to improve healthcare for patients at Cleveland Clinic and beyond. The fellowship is a one-year project-based, longitudinal experience that enables a fellow to conduct research regarding simulation. Participants are selected based on an application and may complete this fellowship in parallel with their second year of critical care training. Ancillary benefits include exposure to developing, operating and managing a simulation program. The program will utilize experts in the Cleveland Clinic’s Education Institute to provide a core learning experience. In addition, fellows identify a content mentor who will help provide clinical guidance throughout the project as well as a mentor in the Simulation and Advanced Skills Center. Involvement in this program would require extension of fellowship training.

• Learn more about this program