EM-SCC Prelim Year
EM-SCC: The Prelim Year
The surgical prelim year is designed to introduce EM-SCC fellows to surgical services and create a foundation of knowledge for the second year of critical care fellowship training. The prelim year is structured to provide 9 to 10 months of experience in various surgical services, in addition to 2 to 3 months of critical care.
The expectation while rotating on a surgical service is that the EM fellow will be functioning as an intermediate-level surgical resident and will be managing complex surgical disease. During the fellow’s time on a surgical service, the fellow will perform typical responsibilities of a surgical resident, including seeing consults in the emergency department or ICU, rounding with the team, performing bedside procedures, and participating in operative cases.
On the trauma teams, the fellow will be acting as a true fellow and will be leading a team of 5-10 residents in conjunction with the advanced practice providers. Fellows will be expected to manage trauma admissions/resuscitations, lead daily rounds, and ensure the trauma service is running smoothly.
| Rotation | Duration |
|---|---|
| Multi-Trauma Critical Care (MTCC) | 2 months |
| Neuro-Trauma Critical Care (NTCC) | 1 month |
| Critical Care Resuscitation Unit (CCRU) | 1 month |
| Trauma Teams | 2 months |
| Acute Care Emergency General Surgery (ACES) | 1 month |
| Soft Tissue Surgery | 1 month |
| Thoracic Surgery | 0.5 month |
| Cardiac Surgery | 1 month |
| Vascular Surgery | 1 month |
| Trauma Endovascular | 1 month |
| Palliative Care | 0.5 month |
Second Year Training Pathways
Second Year Training Pathways
EM-SCC fellows are asked to designate a specific pathway, based on their future career interests in either surgical critical care or cardiac surgery critical care. The pathways are designed to help the fellow best prepare for their future roles in the critical care environment. The preliminary year is the same, regardless of pathway, and fellows are not asked to designate a pathway until their semi-annual review in the early calendar year.
Surgical Critical Care (SCC) Pathway
The Surgical Critical Care Pathway emphasizes more traditional surgical critical care environments.
The first year includes at least eight months of critical care training with time on the Trauma Teams, vascular services, and the Acute Care Emergency Surgery (ACES) service, as well as many others. The remaining four months are composed of critical care months within the Shock Trauma Center.
The second year is predominantly focused on critical care, with nearly 10 months of critical care rotations ranging from trauma to cardiac to surgical critical care. By the end of the second year, the fellow will be well prepared to sit for the SCC board examination, as well as begin their career as a surgical critical care intensivist.
EM-SCC Surgical Critical Care Training Pathway: Second-Year Rotations
| Rotation | Duration |
|---|---|
| Multi-Trauma Critical Care (MTCC) | 2 months |
| Neuro-Trauma Critical Care (NTCC) | 2 months |
| Surgical ICU (SICU) | 2 months |
| Cardiac Surgery ICU (CSICU) | 1 month |
| Trauma Teams | 2 months |
| Critical Care Echocardiography | 0.5 month |
| Anesthesia | 0.5 month |
| ICU Elective | |
| Elective |
Cardiac Surgery Critical Care (CSCC) Pathway
The Cardiac Surgery Critical Care Pathway allows the fellow to focus their experience on advanced cardiac disease and mechanical support while also integrating the traditional surgical critical care rotations.
EM-SCC Cardiac Surgical Critical Care Training Pathway: Second-Year Rotations
| Rotation | Duration |
|---|---|
| Multi-Trauma Critical Care (MTCC) | 2 months |
| Neuro-Trauma Critical Care (NTCC) | 1 month |
| Surgical ICU (SICU) | 1 month |
| Cardiac Surgery ICU (CSICU) | 3 months |
| Trauma Teams | 2 months |
| Critical Care Echocardiography | 0.5 month |
| Anesthesia | 0.5 month |
| ICU Elective | |
| Elective |
Clinical Rotation Schedule
Trauma Teams
STC is the busiest trauma center in the state of Maryland, allowing fellows to evaluate and treat the sickest population of trauma patients in our state-of-the-art trauma resuscitation unit (TRU) during their two months on the trauma service. The TRU is made up of 13 dedicated trauma beds managed by trauma nurses, trauma anesthesiologists, the trauma team, and our trauma radiologists. The fellow on the Trauma service is responsible for leading the team of residents (surgical and EM). During a busy and exciting month, you are responsible for admitting all trauma patients when on call, running trauma resuscitations, managing the trauma bays, and overseeing your team in the care of all trauma patients on your service.
Acute Care Emergency Surgery
As a first-year fellow, you will be an active member of the surgical team on the Acute Care Emergency Surgery Service. You will be rounding with the surgical team and consulting on medically complex and critically ill patients, as well as operatively assisting in cases including appendectomy, cholecystectomy, bowel ischemia and abdominal compartment syndrome.
Cardiac Surgery
Rotation on the Cardiac Surgery Service will involve collaborative care of post-operative patients in the CSICU as well as a substantial amount of time in the operating room participating in a wide variety of cases. Aortic dissections, coronary bypass grafting, and valve replacements are among the basics of what you’ll see this month. During this month, you will also have the opportunity to observe and learn from cardiac anesthesia and perfusionists, and observe intraoperative TEE.
Soft Tissue Service
Shock Trauma has a team dedicated to the care of soft tissue infections. While rotating on this service, you will have the opportunity to learn about extensive necrotizing wound infections, participate in operative debridement, and provide wound care for complex and often large wounds, as well as participate in reconstructive efforts for these wounds.
Vascular Surgery (Trauma Vascular/Endovascular)
The aim of this rotation is to provide a month of exposure to basic endovascular and vascular surgical treatment of injury as well as hemorrhage control in the injured or critically ill patient. Fellows will participate in all activities of the service, which include the evaluation of patients, operative planning, intraoperative decision-making, and postoperative care, as well as outpatient surveillance and follow-up visits.
Critical Care Resuscitation Unit & Surgical Resuscitation
A novel unit dedicated to the rapid assessment and care of critically ill patients transferred from other institutions, the CCRU is a six-bed unit designed to admit the highest acuity patients for stabilizing and facilitating the definitive care they require. The unit has broad expertise to care for a wide variety of diagnoses including vascular disasters, shock, conditions requiring ECMO support, intracranial hemorrhage, ischemic strokes, acute fulminant hepatic failure, and obstetrical emergencies.
Anesthesia
During this rotation, the fellow will be partnered with a group of University of Maryland School of Medicine anesthesiologists to become more familiar with perioperative sedation, analgesia and paralytic medications as deemed appropriate for the clinical situation. Fellows will learn and apply various airway assessment scoring systems, how to maintain an open airway and provide adequate bag-mask ventilation, learn proper airway manipulation and intubation with and without a laryngoscope, and perform alternatives to conventional endotracheal ventilation, such as Bougie-assisted placement.
Echo
Working directly with a skilled ultrasonographer, fellows will learn how to complete a full echocardiographic examination, interpret the data collected, and make recommendations on fluid status and fluid responsiveness. By the end of the rotation, fellows will have a strong foundation of TTE.
Elective Rotation Options
Fellowship Elective Rotation Options
- Neurocare ICU
- Johns Hopkins University - Bayview Burn ICU
- Medical or Pediatric ICU
- Trauma Anesthesiology
- Trauma Radiology
- Trauma Infectious Disease
- Interventional Pulmonology
- Emergency Medical Services
- Hyperbaric Medicine
EM-SCC Didactic Curriculum
Monday: Trauma Case Conference with Dr. Scalea
A highlight of the STC/SCC fellowship includes this weekly case conference with Dr. Scalea and our trauma surgeons. Each week, the fellows currently rotating on the trauma service informally present an interesting case from their week to discuss with the trauma attendings. The conversation covers all aspects of the patient's presentation, surgical intervention and post-operative care. This is an excellent opportunity to learn from trauma surgery’s greatest physicians.
Tuesday: Critical Care Lecture Series - DC-5
A one-hour multidisciplinary critical care conference with critical care medicine fellows at the University of Maryland Medical Center, George Washington University, National Institutes of Health, Washington Hospital Center, and Walter Reed National Military Medical Center. Each week, a national expert lectures on topics relevant to critical care medicine fundamentals, system-based lectures, radiology, pharmacology, and procedural topics.
Wednesday: Surgical Critical Care Core Lectures
Thursday: General Surgery Department & STC Grand Rounds
- General Surgery Department & Shock Trauma Center Grand Rounds and M&M
- A fellow-led, one-hour weekly lecture (Journal Club, Grand Rounds, or Research Conference)
Friday: Multidisciplinary Critical Care Conference
A Friday afternoon lecture that is hosted by the CC Medicine Fellowship and is open to all members of the Critical Care discipline at UMSOM. A wide variety of topics are covered including various lectures on mechanical support, massive transfusion, EKG interpretation, DEI, nutrition, and many more.