ANESTHESIOLOGY CRITICAL CARE MEDICINE
Our ACGME accredited fellowship is a robust, multidisciplinary training program that provides diverse experiences in education, clinical exposure, and leadership at Loma Linda University Medical Center, a 734-bed tertiary referral, Level I Trauma, Certified Stroke and STEMI center located 60 miles east of Los Angeles, CA. We serve the Inland Empire, which encompasses the two largest counties in the US, San Bernardino and Riverside, home to a large under-served population with complex medical co-morbidities. There is exposure to a wide variety of disease processes, including trauma, complications of transplantation, vascular, general, cardiothoracic, and neurological surgery. The training program is comprised of faculty from the Departments of Anesthesiology, Pulmonary/Critical Care Medicine, Emergency Medicine, Neurology and Surgery, thus demonstrating its true interdisciplinary nature. Dedicated faculty provide a comprehensive, state of the art approach to patient care in a complex environment. The variety of clinical experiences in this multidisciplinary program provide unequaled learning opportunities for the critical care fellow. As our fellows progress through clinical rotations, they experience increasing levels of responsibility with the goal of becoming expert clinicians, educators and leaders. Fellows become proficient with procedures such as thoracentesis/chest tube placement, paracentesis, lumbar puncture, bronchoscopy, and percutaneous tracheostomy.
We offer a one-year Anesthesiology Critical Care Medicine Fellowship for those individuals who have successfully completed an Anesthesiology residency and are board eligible or certified. Also, a two-year Critical Care Fellowship is now available for those individuals who have successfully completed an Emergency Medicine residency and are board eligible or certified. Completion of this Anesthesiology Critical Care Medicine Fellowship allows graduates to sit for the ABA subspecialty certification examination in Critical Care. Core rotations are listed and described below. Additional elective rotations are also available.
There are four fellows each year, with varying available positions annually because some fellows are on a two-year track.
Surgical ICU (SICU)
A minimum of three months will be spent in the Surgical ICU at Loma Linda University Medical Center (LLUMC). This 24 bed ICU is staffed by faculty from Anesthesiology and Surgery/Critical Care Medicine. The service co-manages critically ill patients recovering from vascular, general, urologic, orthopedic, obstetric, transplant, and otolaryngologic surgery. It also co-manages critically ill trauma patients with internal organ, orthopedic, spinal cord, and traumatic brain injuries. Our transplant program is growing and includes liver, kidney and pancreatic transplants.
Cardiothoracic ICU (CTICU)
A minimum of two months will be spent in the CTICU at LLUMC. This rotation allows our fellows a unique opportunity to work closely with Cardiothoracic Surgery faculty and intensivists. This service assumes primary responsibility of all adult patients recovering from cardiac transplantation, open heart surgery, thoracic, and complex vascular surgeries. Experience with mechanical circulatory assist devices are gained during this rotation.
Neuro-Multidisciplinary Critical Care Service (NMCCS)
A minimum of two months will be spent on the Neuro-Multidisciplinary Critical Care Service (NMCCS). This service is staffed by faculty from Anesthesiology, Emergency/Critical Care Medicine, and Neurology/Critical Care Medicine and manages patients with neuro-medical diseases including hyperacute ischemic strokes, status epilepticus, nonsurgical hemorrhagic strokes, acute meningitis, encephalitis, myasthenic crisis, and other neurologic disorders. Additionally, NMCCS manages neurosurgical patients with intracranial hemorrhages, AV malformations, subdural hematomas, those requiring craniotomies for brain tumors and seizure mapping.
Medical ICU (MICU)
A minimum of one month will be spent in the MICU at LLUMC. This rotation allows our fellows a unique opportunity to work closely with Pulmonary/Critical Care Medicine faculty. The MICU service assumes primary responsibility for the management of patients with a variety of acute and chronic medical illnesses not often seen on other core rotations.
Surgical Burn Unit
A minimum of one month will be spent in the Burn Unit at Arrowhead Regional Medical Center. ARMC is a level II trauma center specializing in the care of burn injuries. This 18 bed burn unit is staffed by faculty from Surgery/Critical Care Medicine, fellows from Anesthesiology and Surgery/Critical Care Medicine, and residents from surgery. The service assumes primary responsibility for management of critically ill patients recovering from burn and traumatic injuries.
East Campus Code Blue Coverage
One week per month, our fellows work directly with the supervising intensivist to provide overnight emergency coverage for the 8-bed Medical/Surgical ICU at Loma Linda University Medical Center East Campus. In addition to duties in the ICU, our fellows gain an invaluable experience being the leader of the rapid response/code blue team for the 120-bed acute care hospital. Physical Medicine and Rrehabilitation, Orthopedics, Neurosurgery, and Family Medicine are among the primary services offered at this facility. In 2018, Loma Linda University Medical Center – East Campus received recognition as a Top Teaching Hospital by The Leapfrog Group, an independent hospital watchdog organization.
One month will be spent rotating on the Infectious Disease service where our fellows develop skills in the investigative diagnosis and treatment of a wide variety of infectious disease in the hospital setting, particularly in the ICU. The goal is to become more adept at infectious disease medical management and antibiotic stewardship.
One month is spent on the Interventional Pulmonology Service, which performs 30-40 bronchoscopies and 20-30 pleural procedures monthly, including advanced bronchoscopic procedures in the OR such as airway stent placement, endobronchial ultrasound, and thermoplasty.
Point of Care Ultrasound (POCUS)
To complement the daily bedside ultrasound teaching from our intensivists in the ICU, our fellows spend a dedicated month rotating with Dr. Davinder Ramsingh, a national leader in the research of perioperative point of care ultrasound. The curriculum highlights the key aspects of cardiac, pulmonary, abdominal, vascular, neuro, and hemodynamic ultrasound for the perioperative and acute care setting.
Loma Linda University has a busy cardiac echocardiography laboratory under the direction of Dr. Bansal, a world-renowned echocardiographer. In addition, fellows will have the opportunity to gain expertise in perioperative transesophageal echocardiography (TEE) under the guidance of our cardiac anesthesiologists. Fellows will be allowed to spend up to 2 months on this service acquiring this skill. Fellows will be expected to review, as well as perform, multiple echocardiographic examinations under the supervision of an attending echocardiographer while on this rotation. Lastly, this rotation allows the opportunity to obtain TEE minimums to obtain TEE certification.
To augment the education gained from clinical experience, we offer a comprehensive didactic program that includes the following:
Surgical ICU Journal Club: These faculty-mentored, resident-led, weekly group discussions, involving fellows, faculty, and residents, cover a variety of classic and recently published articles in critical care medicine.
Surgical ICU Lecture Series: These faculty-led, weekly lectures cover a variety of critical care topics.
Critical Care M&M Conference: The weekly NMCCS, CTICU and SICU team M&M conferences cover case presentations and discussions to promote quality improvement, patient safety, and excellence in patient care.
Critical Care Grand Rounds: A distinguished speaker is invited monthly to discuss a variety of critical care topics
Critical Care Fellow Chapter Review: Every Friday, a fellow is assigned to prepare and present a chapter review from a critical care textbook and current medical literature to medical students, residents, co-fellows and our critical care faculty. This is an invaluable educational opportunity that provides fellows with additional teaching experience.
Critical Care Fellow Journal Club: Faculty-mentored, fellow-led, monthly group discussions, involving fellows, faculty, and residents, cover a variety of classic and recently published articles in critical care medicine.
“ECHO Rounds”: These monthly lectures by cardiac anesthesiology faculty provide a Basic TEE lecture prior to reading 5 perioperative TEE's. Immediately after echo rounds, The ECHO Pathology Workshop allows hands on interactive experience in the simulator lab.
POCUS Lectures: Fellows may attend Wednesday morning weekly POCUS lectures by Dr Ramsingh as well as the POCUS conference held in September in Huntington Beach.
Research is an integral component of the mission of Loma Linda. We have a very active Research Division under the Department of Anesthesiology, directed by Dr. Davinder Ramsingh. The Department currently has multiple grants from the National Institutes of Health (NIH), and from other medical societies. Clinical research is geared with a single purpose in mind: to improve patient outcomes. This is accomplished through many avenues involving innovation with cutting edge medical technologies, novel education tools, a high acuity patient population, and diverse department of nationally renowned clinicians and basic scientists. The Department collaborates with researchers on campus who study coagulation disorders, patient care protocols/pathways, hemodynamic monitoring, and point of care ultrasound. The Department is a national leader in the research of hemodynamic monitoring and perioperative point of care ultrasound. Our fellows are supported and encouraged to engage in research as well as a quality improvement projects related to critical care. The Fellow will be given an opportunity to spend dedicated time on a research project if so desired.
Critical Care is hard work, and we remember to take time to unwind, commiserate, and celebrate! Dr Darwish, our Wellness Director, helps fellows balance work and life.
Daniel Lyman, DO (EM)
Sean Thrush, DO (EM/IM)
Nicolas Montano, MD (EM)
Andrew Huang, DO (EM)
HOW TO APPLY
Candidates interested in the Anesthesiology Critical Care Fellowship should apply via the San Francisco Match. We offer four fellowship positions per year.
For more information:
Tel: (909) 558-4475 x47438