CRITICAL CARE ANESTHESIOLOGY FELLOWSHIP
Ihab Dorotta, MD
Critical Care Anesthesiology
Associate Program Director
Darcy Mainville, MD
Critical Care Anesthesiology
Melody Chang, MD
Critical Care Anesthesiology
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.
1 YEAR TRACK
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.
2 YEAR TRACK
A two-year Critical Care Fellowship is 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. 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, as as management of VA and VV-ECMO.
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 and inpatient rehabilitation center. Physical Medicine and Rehabilitation, 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.
Point of Care Ultrasound (POCUS)
To complement the daily bedside ultrasound teaching from our intensivists in the ICU, our fellows spend a dedicated month learning about the Foresight Curriculum, developed by 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. Along with TTEs performed while on their ICU rotations, the POCUS rotation allows fellows to collect exams toward their optional Critical Care Echo certification (CCEeXAM).
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 if the fellow decides to invest the time required.
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.
To augment the education gained from clinical experience and bedside didactics by critical care faculty, 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.
Surgical ICU Quality Improvement Committee Meetings: Fellows have the opportunity to participate in multidisciplinary quality and process improvement with the physician, nursing and other ancillary service groups once a month. This is followed by SICU attending and fellow discussion about SICU practice patterns and their alignment with evidence based medicine.
Critical Care M&M Conferences: 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.
“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.
Critical Care Fellow Fridays:
Every Friday is for the fellows. On this day, fellows, attendings, residents, and medical students may learn from expert attendings, attend advanced skills labs, lead journal clubs, and lead board review sessions. This is an invaluable part of our education that arms fellows with additional teaching experience, advanced procedural skills, as well as board preparation.