Internal Medicine Subspecialty Critical Care Fellowship

Yale University School of Medicine, Division of Pulmonary and Critical Care Medicine offers select positions for dedicated clinical training in Critical Care Medicine.

A one-year Critical Care Medicine fellowship is aimed at physicians who have completed or plan to complete a full ABIM fellowship in another Internal Medicine sub-specialty (e.g., Nephrology, Infectious Disease, Cardiology, Rheumatology, Oncology, Gastroenterology, etc.). When combined with another internal medicine fellowship program, this twelve-month clinical experience confers eligibility to sit for the Critical Care Medicine board examination.

Clinical Curriculum:

Fellows rotate through a broad mix of ICUs in a schedule that it is integrated with the three-year Pulmonary Critical Care fellowship.

Critical Care Fellows split their time between Yale-New Haven Hospital’s York Street and St. Raphael’s Campuses both located in New Haven, with the majority of time spent at the York Street Campus. They also rotate to Bridgeport Hospital which has the only specialized burn ICU in the State. In addition, there is elective time that is customized to the fellows career goals and prior training.

Yale New Haven Hospital-York Street Campus (YNHH-YSC) is a quaternary referral center with a dedicated cancer hospital (Smilow Cancer Center) with over 1000 beds. YNHH-YSC provides advanced services such as solid organ and bone marrow transplantation, trauma care and complex cardiovascular surgery. It offers fellows an opportunity to work within several distinct ICU services:

  • The Medical ICU (MICU) Service is a 36 bed unit that cares for a variety of general medically ill patients. There are over 4000 admissions per year with approximately 50% requiring mechanical ventilation and a median length of stay of 3 days. This unit annually receives over 400 transfers from hospitals in the region for second opinions and specialized care that cannot be offered at local institutions. The fellow guides a team of housestaff composed of interns and Internal Medicine residents with oversight by faculty from the Division of Pulmonary and Critical Care Medicine. In-house intensivists cover the MICU overnight. Critical Care Fellows will have both daytime and overnight rotations in the YSC MICU. During the day rotation they will be part of one of the teams responsible for running work rounds, teaching the housestaff and performing procedures under the guidance of the attending. During the overnight rotation they are responsible for supervising the housestaff and reviewing admissions with them and performing procedures under the guidance of the nocturnal intensivist.
  • The Coronary Care Unit (CCU) is a 14 bed unit that cares for patients with myocardial infarction, post-cardiac catheterization, congestive heart failure, LVADS and heart transplant. The unit is staffed by attending cardiologist, cardiology fellows and medical housestaff. During this rotation the critical care fellow will round with the team, learn about the advanced management of heart failure, echocardiography and participate in right heart catheterizations.
  • The Surgical ICU (SICU) Service is a 21 bed unit that cares for Trauma patients and post-operative surgical patients from General Surgery, Thoracic, Otolaryngology, Urology, Plastic Surgery, Orthopedics, and Obstetrics and Gynecology. The fellow oversees a group of housestaff from Anesthesiology, General Surgery and Emergency Medicine. The service is led by Critical Care-trained faculty from Trauma/General Surgery, Anesthesiology and Emergency Medicine. Fellows take in-house call one day per week, during which they are able to participate in major trauma resuscitations and emergent procedures.
  • The Cardiothoracic ICU (CT ICU) Service is a 18 bed unit that serves all Cardiac and Thoracic Surgical patients at YNHH. The fellow is integral in management of the complex pathophysiology associated with these cases. The fellow leads a multidisciplinary team of Surgery housestaff, Advanced Practice Providers, Pharmacists, and Dietitians. The patient population consists of a robust general cardiac and thoracic experience, a cardiac transplantation program, and a rapidly growing extracorporeal life support (ECLS) and mechanical circulatory support program. The Critical Care faculty on this service are dual-trained in Anesthesiology and Critical Care, or in Cardiothoracic Surgery and Critical Care. There is overnight call one night a week on this service.
  • The Neurocritical Care Service (NICU) is a 14 bed unit that provides care for neurosurgical trauma patients with isolated spine and head injuries, patients with a variety of neurovascular problems such as subarachnoid hemorrhage and general neurology patients requiring ICU care such as those with status epilepticus. Fellows work with housestaff from Anesthesiology, Emergency Medicine, Neurology, and Neurosurgery, and faculty from Emergency Medicine and Neuro-critical care. There is overnight call one night a week on this service.
  • Interventional Pulmonary Rotation (IP) provides the critical care fellows a dedicated time to learn bronchoscopy, thoracentesis and chest tube placement from our IP faculty.

Yale-New Haven Hospital-St. Raphael Campus (YNHH-SRC) is the community hospital for New Haven and has approximately 500 beds.

  • The YNHH-SRC (MICU) Service is a 16-bed unit cares for critically ill patients from the New Haven Community with a wide variety of medical problems. Residents on this service are from Yale Internal Medicine Primary Care program, and faculty are Pulmonary and Critical Care attendings. Call on this service is from home and there are no in-house overnight responsibilities.

Bridgeport Hospital is a community hospital affiliated with Yale-New Haven Heath Systems. It houses the only burn center in the state of CT. The fellows will rotate through in the Burn ICU where they will learn about critical care of patients with severe burns including fluid management, inhalational injuries, and nutrition in these complex patients.


Didactic Curriculum:

A number of didactic opportunities are available to fellows. Fellows present cases (in rotation with fellows from Pulmonary Critical Care) to faculty discussants at the weekly State Chest Conference. Weekly core content lectures on a variety of topics relevant to critical care medicine follow. Conference time is protected for fellows, unless extreme clinical circumstances mandate otherwise. Each of the individual ICUs have educational lectures for the fellows.

A variety of other educational opportunities occur at the various teaching sites. These include daily teaching rounds in all ICUs (which are regularly led by either the fellow or attending physician), YNHH-YSC Multidisciplinary monthly journal club, Medical Grand Rounds.


Application:

The Critical Care Medicine fellowship accepts applications via the Electronic Residency Application Service (ERAS), but does not participate in the National Residency Matching Program.


Vacation, Stipends, and Benefits:

All fellows receive four weeks of vacation. Fellows are paid by Yale-New Haven Hospital commensurate with their PGY level.


Contact Information:
Fellowship Program Coordinator
Susan Porto
susan.porto@yale.edu
203-785-3207

Margaret A. Pisani, MD, MPH
Associate Professor
Fellowship Program Director
Department of Medicine
Division of Pulmonary and Critical Care Medicine
margaret.pisani@yale.edu

Shyoko Honiden, MD, MS
Associate Professor
Associate Program Director
Director of Simulation
Department of Medicine
Division of Pulmonary and Critical Care Medicine
shyoko.honidon@yale.edu