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 degree 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, ventilator and airway management.

During this year, it is also 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. First year fellows can select to gain additional expertise in education, research, or quality improvement. They can 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.

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.

Electives

To facilitate individualized career planning, a multitude of non-core rotations are available for 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, peri-operative 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

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
• 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, 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