Internal Medicine Subspecialty Critical Care Fellowship

Yale University School of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine offers fellowship 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 2 or 3-year Internal Medicine sub-specialty (e.g., Nephrology, Infectious Disease, Cardiology, Rheumatology, Oncology, Gastroenterology, etc.). When combined with another internal medicine subspecialty fellowship program, this twelve-month clinical experience confers eligibility to sit for the Critical Care Medicine board examination.

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 Chapel Street (St. Raphael’s) campuses, which are both located in New Haven. They also rotate to Bridgeport Hospital which has the only specialized burn ICU in the state of Connecticut. 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. Fellows have the opportunity to work within several distinct ICU services:

• The York Street Campus Medical ICU (MICU) Service is under the directorship of Dr. Shyoko Honiden. This ICU is regarded as one of the region's elite units. The York Street Campus (-YSC) MICU is housed in the state-of-the-art facility on the 9th and 10th floors in the Smilow Cancer Hospital. There are 40 ICU beds alongside 15 step-down beds. The MICU team cares for an average daily census of 36 critically ill patients with a wide range of life threatening disorders, such as septic shock, acute respiratory distress syndrome, and acute liver failure. There are over 5000 admissions per year in this busy unit with approximately 30% requiring mechanical ventilation and a median length of stay of 3 days. We receive 500 transfers annually from hospitals in the region for second opinions and specialized care that cannot be offered locally.
  There are four teams in the York Street MICU, each led by a PCCSM faculty member who work with fellows, residents, and advanced practice providers who are team members. In addition to PCCSM and CCM fellows and Internal Medicine residents, the MICU is a major training site for medical students, as well as residents and fellows from several departments, including Surgery, Emergency Medicine, and Obstetrics-Gynecology. The MICU is a haven for clinical research, with multiple faculty conducting studies in acute lung injury, sepsis, cognitive impairment, sleep, diabetes, liver failure, and end-of-life care.
  The MICU at YSC is staffed by in-house intensivists overnight ensuring supervision, quality care and education 24 hours a day. Critical Care Fellows will have both daytime (~ 12 weeks) and night rotations (~8 weeks total, in 2 week blocks, Mon-Thurs only with Fr-Sun off) in the YSC MICU. On day rotations fellows serve as visible leaders and are 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. As the year progresses, there will be increasing responsibilities such as assisting with ICU triage.
• The Chapel Street Campus Medical ICU Service (St. Raphael’s) is housed within the 500-bed St. Raphael’s campus. There are 16-beds in the MICU on this campus. In busy winter months, the census peaks with ~ 20 patients as we overflow into the adjacent stepdown unit care area. Dr. Aydin Pinar is the site MICU director. There are 2 teams, each led by a Pulmonary and Critical Care Attending, alongside fellows and primary care residents. As with the York Street campus, there is an on-site intensivist every night with backup support from our tele-ICU team to ensure supervision, quality care and education 24 hours a day. While there are residents overnight, there are no in-house overnight responsibilities for Critical Care fellows at this campus.
• 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, use of mechanical circulatory assist devices, echocardiography and participate in right heart catheterizations.
• The Surgical ICU (SICU) Service is a 21 bed unit. The overall goal of the SICU rotation is for CCM fellows to gain experience and competence in managing critically ill patients in the unique environment of the surgical intensive care unit. The SICU at Yale New Haven Hospital is a multidisciplinary unit that includes patients from multiple surgical services including obstetrics and gynecology, general surgery, gynecologic oncology, trauma, orthopedics, ear, nose and throat surgery, thoracic surgery, transplant surgery including liver and renal transplant. In addition, the SICU team manages trauma cases and is run by the surgical trauma service. Therefore, CCM fellows have a unique opportunity to experience the full range of surgical intensive care from trauma, pre-operative and post-operative management. While the CCM fellows are rotating on service, they function as a surgical intensive care unit fellow providing direct patient care to all of the critically ill patients. The service is led by critical care trained faculty from trauma/general surgery, anesthesiology as well as emergency medicine. Fellows will rotate on this service for 1 month typically during their fellowship. There is no overnight call during this rotation.
• The Cardiothoracic ICU (CT ICU) Service at YNHH is an 18-bed multidisciplinary unit. The patient population consists of a robust general cardiac and thoracic surgery experience, a cardiac transplantation program, and a rapidly growing extracorporeal life support (ECLS) and mechanical circulatory support program. Fellows will be participate in multidisciplinary work rounds (which includes surgery housestaff, advanced practice providers, pharmacists and dieticians), and will help manage patients with complex physiology alongside critical care faculty on this service who are dual-trained in Anesthesiology and Critical Care, or in Cardiothoracic Surgery and Critical Care. There is no overnight call on this service.
• The Neurocritical Care Service (NICU) is a 14 bed unit with overflow into the surgical ICU. CCM fellows rotate through the Neurological Intensive Care Unit (NICU) at Yale-New Haven Hospital, typically for 4 weeks, during their fellowship. The goals of this rotation are broad and include learning all of the skills required to evaluate and manage critically ill patients with neurologic and neurosurgical diseases, including but not limited to subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, traumatic brain injury, status epilepticus, Guillain-Barre Syndrome, brain tumors, diseases of the spinal cord and CNS infections. Fellows are expected to attend neurology and neurosurgical conferences and are afforded the opportunity to join Neurosurgeons in the operating room. NICU work rounds are conducted with highly skilled neurointensivists. Dr. Emily Gilmore is the medical director, and Dr. Guido Falcone, Dr. Kevin Sheth, Dr. David Hwang, Dr. Nils Peterson, Dr. Rachel Beekman, Dr. Kevin Gobeske, Dr. Jennifer Kim, Dr. Jessica Magid-Bernstein, and Dr. Morgan Prust are the other faculty. There is no overnight call on this service.
• Interventional Pulmonary Rotation (IP) The Interventional Program (IP) offers the most advanced diagnostic and therapeutic approaches to various diseases in the chest, including lung nodules and masses, enlarged lymph nodes (mediastinal adenopathy), complex airways and pleural effusions. Our trained interventional pulmonologists are leaders in the field and have more experience than anybody in the state and surrounding area. The IP service at Yale-New Haven Hospital is under the directorship of Dr. Kyle Bramley. CCM fellows spend one month on the IP service during their fellowship where they develop basic bronchoscopy skills, and learn about chest tube management. They get exposure to advanced bronchscopic procedures, pleural procedures and percutaneous tracheostomies. Dr. Erin Debiasi serves as the Procedural Education Director the IP service.
• 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.

Hospital for Special Care

Hospital for Special Care has 200 beds and is licensed as a Long-Term Acute Care Hospital (LTAC). The Hospital services patients with chronic respiratory diseases from spinal cord/neuromuscular disorders, COPD, chronic ventilator dependency and long term weaning from mechanical ventilation. Acute rehabilitation is also provided. Our fellows have the option to spend time at HSC as an elective during their training.

Chest and Critical Care Radiology

As radiographic studies are a critical part of our pulmonary and critical care medicine, learning how to interpret radiographic studies of the thorax is critical. Fellows meet on a daily basis in the thoracic radiology suite and read films with the thoracic radiology service.

Anesthesiology

Fellows can rotate through the operating room with anesthesiology at Yale-New Haven Hospital and learn the technical skills of intubation, vascular access and difficult airway management.

Tele-ICU

From 7PM to 7AM, experienced intensivists and nurses support ICU patients in area affiliated hospitals from the secure InSight Clinical Center. The tele-ICU team collaborates with the bedside care team, reviews the EMR, monitors vital signs and laboratory data to identify concerning trends. Specialized audio and video equipment allows for a seamless interface. Given that tele-ICU has become a reality in many parts of the country, CCM fellows with interest are given the opportunity to spend some nights at the ‘bunker’ to learn about how care is delivered and participate in QI projects.

A number of didactic opportunities are available to fellows. There is a PCCM Summer Lecture Series which covers core CCM topics at the start of fellowship. During the academic year, PCCSM hosts a weekly Grands Rounds lecture. In addition, fellows have 1 to 2 conference hours per week to accommodate a rotation of critical care conference, journal club, research in progress, ultrasound cases and additional didactic sessions. 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.

The Critical Care Medicine fellowship accepts applications via the Electronic Residency Application Service (ERAS). The CCM Fellowship participates in the NRMP match (program number 1420814001). Yale CCM fellowship has 3 slots for the 1-year program each year.

Interviews will be held virtually in accordance with our institutional policy.

Applicants considered for the 1-year Critical Care training program must have:

1. Completed a 3-year IM residency AND a 2 or 3-year IM subspecialty fellowship in the United States.
2. US Citizen, Permanent Resident or Sponsored on an H1 or J1 visa.
3. At least three letters of recommendation, one from their current Program Director
4. USMLE scores
5. Personal Statement
6. Registered with NRMP

If you have any questions regarding the application process, please contact Ms. Porto, our fellowship program coordinator.

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

Fellowship Program Coordinator