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 trainees with prior subspecialty training in Cardiology, Infectious Diseases, Hepatology, and Nephrology. The Critical Care Fellowship requires a 2-year commitment for most trainees.  We offer dedicated 3-year tracks for those trainees interested in pursuing a Master’s or additional research in medical education, basic/translational science or clinical trials.

Year 1 and Year 2

Year 1

The first year of fellowship focuses on developing clinical expertise in critical care medicine. During this period, our fellows complete a series of core rotations focused on building knowledge and mastering skills specific to critical care including bronchoscopy, bedside ultrasound/echo, intubation, line placement, and ventilator management.

During this year, it is pivotal for fellows to identify an academic mentor (a key aspect of our program) and choose an area of interest from the multiple academic opportunities available. Mentorship and scholarship occur in a coordinated fashion.  For example, first year fellows participate in a structured training program in leadership and quality improvement.  This program, called Quality in Leadership (QuIL) provides trainees with leadership training, specific skills in quality and process improvement, and meaningful scholarship through team based projects.

Electives during the first year emphasize opportunities to begin research and participate in non-core rotations. 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
• Pulmonary Hypertension ICU Management and Right Heart Catheterization

Year 2

The second year of fellowship focuses on developing a deeper understanding of the physiology of the critically ill patient and how organ support systems affect this. The goal is to master the nuances of mechanical ventilation and hemodynamic physiology and to tailor these to the critically ill patient. Further elective time is aimed at continued research, clinical electives and leadership development to support career goals. All fellows also participate in a mentored writing curriculum. By the end of the year, fellows should expect to submit at least one manuscript for publication and present their research project at an International Critical Care Conference.

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.  The first year of training focuses heavily on mastering the essentials of critical care and mechanical ventilation. There is wide latitude for those who do a second year to gain expertise in mechanical circulatory support, peri-operative support, and to pursue mentored research with leaders in both Cardiology and Critical Care Medicine.

Critical Care Education Track

Overview

The Clinical Education Track is designed to provide in-depth training to fellows who aspire to a career in academic medical education.

This is done through:

• Training in the science of medical education, theoretical frameworks, and principles.
• Development of effective didactic and clinical teaching skills.
• Development of skills needed to create and implement curricula and methods of assessment.
• Research and scholarship in medical education.
• Networking with leaders in the field of medical education.

The fellows accepted for this track will:

Complete their clinical rotations in the first two years similar to traditional fellows and continue for a third year as a clinical instructor. Fellows will earn a Master of Education in Health Professions Education (MEHPE) during their second year of training and third year as clinical instructor.

The MEHPE program is a collaboration between the Cleveland Clinic Center for Educational Resources and Cleveland State University. It offers a two-year cohort-based curriculum focusing on the skills needed to be a medical educator. The cohort model includes a group of students who progress through the MEHPE program together (i.e., starting/ending at the same time; following a pre-determined schedule of courses).  The benefits to the cohort model are that it provides opportunities for cohort members to learn with and from each other while building professional networks and connections.

Specifically, courses address adult learning theory, curriculum design and instruction, learner assessment, evaluation of educational programs, healthcare education research and technology in health professions education. The pedagogy is blended between live and online courses, with live courses delivered at Cleveland Clinic main campus during the evening to accommodate working health professionals. The program occupies six semesters of instruction and 30 credit hours for degree attainment.

Curriculum

The fellows accepted for this track will be committed to staying at CCF for an additional year as clinical instructors.  The general clinical training rotations are below.

Clinical Training Rotations

The Education Scholarship Training curriculum includes enrollment in Medical Biostatistics Courses in the fall and spring of the fellow’s first year training. During this year, fellows also participate in medical student education as clinical instructors at the Cleveland Clinic Learner College of Medicine.

Master’s degree courses start in August of the fellow’s second year of training. The Master’s courses continue for 24 months with a thesis project required for successful graduation.

Critical Care Clinician Scientist

Overview

Beyond excellent clinical training, the Critical Care Fellowship offers a wide array of options for fellows with interest 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 masters or PhD training for those interested. Critical Care areas of interest include

• ARDS
• ECMO
• sepsis
• mechanical ventilation
• point of care ultrasound
• medical education
• simulation
• informatics/big data

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.

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, several on-line and immersive simulation curricula are offered annually on advanced airway management, hemodynamic assessment, neurologic emergencies, ECMO, and mechanical ventilation. These form a core part of our educational profile.

Simulation Fellowship

The Cleveland Clinic Education Institute offers a 1-year fellowship is designed to develop leaders with vision, knowledge and a commitment towards developing simulation-based training to improve healthcare for patients at the Cleveland Clinic and beyond. The fellowship is a one-year project-based, longitudinal experience that enables a fellow to conduct research regarding simulation. Ancillary benefits include exposure to developing, operating and managing a simulation program. The program will use 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