Critical Care Fellowship Program

Clinical training comprises the entire one-year fellowship and parts of the first and second years of the two-year fellowship. Training occurs in structured one-month blocks, under the supervision of designated attending physicians. All fellows are required to complete 6 months of Medicine-based ICU and 3 months Non-medicine-based ICU time. This will comprise the majority of the one-year clinical fellowship while the two-year fellowship will complete between 12-15 months of ICU time with the remaining time used for elective experiences and research education and productivity.

MUSC Main Hospital Core Rotations

Medical Intensive Care Unit: The fellow supervises a team of medicine residents and interns in the care of critically ill medical patients in this large, closed ICU setting. The MUSC MICU is a major referral center for the state and region.

Neurosciences Intensive Care Unit: The fellow integrates with a team of dedicated neuro-intensivists in the care of patients who are critically ill due to an underlying neurological diagnosis. The rotating fellow will gain experience in post-stroke care as well as the management of cerebral edema, status epilepticus, encephalitis among other conditions.

Surgical Trauma Intensive Care Unit: The fellow integrates with a team of trauma-certified surgical intensivists in the care of critically ill surgical/trauma patients. MUSC is a designated level one trauma center and transplant center. The rotating fellow will gain experience in post-trauma and post-operative care as well as the management of traumatic brain injury and hemorrhagic shock among other conditions.

Procedures: During the rotation in our bronchoscopy lab, fellows will gain experience with core bronchoscopy and thoracic procedures with the opportunity to be involved in a wide range of cutting-edge interventional technologies, including rigid bronchoscopy, Endobronchial ultrasound (EBUS), Navigational bronchoscopy, Endobronchial brachytherapy, airway stents, Bronchial Thermoplasty and ultrasound guided pleural procedures such as placement of PleurRx® and pigtail catheters.

Pulmonary Consultation: The fellow integrates with a team of pulmonary and critical care fellows, residents and/or students in providing inpatient consultation. The critical care fellow will receive exposure to pulmonary physiology training to complement the training they will received during their ICU rotations.

Throughout the rotations, fellows will gain extensive experience with fiber optic bronchoscopy, thoracic ultrasound, pleural manometry, chest tube insertion (surgical and modified Seldinger), tunneled pleural catheters, airway management/endotracheal intubation, ultrasound guided central line placement, bronchial thermoplasty, pulmonary artery catheters, and critical care echocardiography.

ART Core Rotations

Medical/Surgical Intensive Care Unit: The fellow supervises anesthesia and emergency medicine residents in providing intensive care to medical patients in the MSICU (closed unit) including general oncology and bone marrow transplant patients, GI and hepatology patients, and transplant recipients. The fellow will also join rounds on the surgical patients in the MSICU under the direction of an anesthesia-intensivist allowing for broad exposure to peri- and post-operative critical illness.

Cardiovascular Intensive Care Unit: The fellow integrates with a multidisciplinary team of anesthesia-intensivists, cardiologists and cardiothoracic surgeons in the care of critically ill cardiac patients. The rotating fellow will gain experience in post-MI and post-cardiac surgery patients as well as the management of advanced heart failure, arrhythmias among other conditions.

Lung Transplant: MUSC is the only lung transplant center in South Carolina. The fellow manages both recent and distant lung transplant recipients in the in-patient setting under the direction of dedicated lung transplant attending physicians. The rotation provides experience in the unique aspects of post-transplant critical illness and immunosuppression regimens and complications.

Pulmonary Consultation: The fellow integrates with a team of pulmonary and critical care fellows, residents and/or students in providing inpatient consultation. The critical care fellow will receive exposure to pulmonary physiology training to complement the training they will received during their ICU rotations. 

Ralph H. Johnson VA Medical Center Core Rotations

VA Medical Intensive Care Unit: The critical care fellow leads a team of internal medicine residents in the care of medical ICU patients. The fellow also joins the anesthesia team in the operating room for early cases in order to gain experience with airway management.

Additional Training

Interpersonal Skills: All trainees are taught and counseled regarding personal interaction with other members of the health care team, patients, and their families. The attending physicians in the division serve as role models for the trainee.

Professional Attitudes: Professionalism is expected of all trainees at all times. This includes proper appearance, treating all patients and their families with respect, dignity and empathy, treating all other physicians and medical personnel as colleagues, and performing medical duties at the highest level.

MUSC Simulation Center: Fellows receive central line training at the MUSC Simulation center, in addition to Code Simulation training each month fellows rotate to the MICU. The MUSC Simulation Center is an excellent training resource for fellows. For more information, visit the Health Care Simulation Center website.

Educational Conferences

Core Pulmonary and Critical Care Conferences

Our critical care conference series unites critical care fellows from pulmonary, surgery, anesthesia and neurology fellowship programs to learn from a wide range of critical care faculty with different critical care training and expertise. This conference provides comprehensive critical care education and content is based on the ABIM core curriculum for Critical Care Medicine. Additionally, critical care fellows are able to attend a pulmonology-focused clinically-oriented didactic series by the faculty with content based on the ABIM core curriculum for Pulmonary Medicine. This series complements the pulmonary pathophysiology training of critical care fellows.

Pulmonary and Critical Care Case Conferences and Grand Rounds

This is an hour-long conference in the style of a morning report where recent, interesting cases in ambulatory and inpatient pulmonary and critical care are presented to discuss evaluation, diagnosis and management. Faculty are heavily involved in case discussions. Once monthly, conference is converted to a divisional grand rounds presented by in the fellows on topics in pulmonary and critical care. Fellows perform a literature review of interesting clinical questions on patient diagnosis and management from cases seen on the floor.

Research Conferences and Career Development Series

This conference is a showcase for education and career development in the areas of clinical, translational and educational research. The conference features presentations on anything from completed research by faculty and fellows, to research work in progress, to speakers from other divisions and departments within the University and guest speakers from outside MUSC. The conference brings together colleagues and career scientists in order to convene in an environment that is supportive and with feedback that is constructive. The one-hour meeting typically includes presentation of research results, discussions of experimental design and methods, and suggestions from the audience for future studies. Critical care fellows in the two-year program will have the opportunity to present their work and receive constructive feedback on methodology, data analysis and presentation skills. Additionally, the embedded career development series focuses on developing careers in academic and community medicine. Topics focus on a range of important career skills from manuscript and grant writing to billing and contract negotiations. This focus is on career readiness and development as young professionals.

Journal Club

This is a once monthly conference to discuss influential articles both new and historical in both pulmonary and critical care medicine. Fellows will work with a mentor to select important papers and discuss design, analysis and impact of paper on practice. Statisticians are available to further discuss statistical analysis. This series is designed to teach trainees methods for evaluating scientific literature.

Multidisciplinary Educational Conferences:

Critical Care Grand Rounds

This is a monthly conference attended by a variety of critical care disciplines including surgical, medical, anesthesia, neuro-critical care, and different members of the ICU care team, including nurses, respiratory therapists, physical therapists, and pharmacists. Topics surrounds evidence-based medicine and advanced therapies in critical care.

Interstitial Lung Disease Case Conference

This is a monthly conference attended by ILD pulmonologists, medical transplant, thoracic radiology, pathology and thoracic surgery to discuss work-up and management of ongoing clinical cases of various interstitial lung diseases.

Morbidity and Mortality

This conference addresses cases from the medical and critical care services in which there may be potentially avoidable adverse outcomes. The goals of this conference are to identify medical error, modify future behaviors, and prevent repetition of errors in the future.

Thoracic Tumor Board

This is a weekly conference with medical oncology, radiation therapy, radiology and thoracic surgery held at the Hollings Cancer Center, where case management decisions are discussed regarding potential and confirmed lung and mediastinal malignancies.

Sleep Case Conference and Journal Club

This is a monthly conference with sleep medical, otolaryngology, dental medicine, psychiatry where interesting sleep medicine cases are presented to discuss patient evaluation and management decisions. Recent journal articles are often presented by pulmonary fellows rotating on the sleep medicine service.