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 under the directorship of Dr. Jonathan Siner and Dr. Peter Marshall is the associate director. This ICU is regarded as one of the region's elite units. The 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 16 step-down beds. The MICU team cares for an average daily census of 30-36 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 4000 admissions per year in this busy unit with approximately 50% requiring mechanical ventilation and a median length of stay of 3 days. We receive 400 transfers annually from hospitals in the region for second opinions and specialized care that cannot be offered locally. Four teams cover the MICU, each led by a PCCSM faculty member supported by fellows, residents, and advanced practice providers. 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. 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. As the year progresses, there will be increasing responsibilities as they help with ICU triage.
  • 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. 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 the 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 overnight call one night a week 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. Kevin Sheth is the medical director, and Dr. Guido Falcone, Dr. Emily Gilmore, Dr. David Hwang and Dr. Nils Peterson are the other faculty. Fellows work with housestaff from Anesthesiology, Emergency Medicine, Neurology, and Neurosurgery, and faculty from Emergency Medicine and Neuro-critical care. There is no overnight call on this service.
  • Thoracic Interventional Pulmonary Rotation (TIP) Thoracic Interventional Program (TIP) 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 TIP service at Yale-New Haven Hospital is under the directorship of Dr. Jonathan Puchalski. CCM fellows spend one month on the TIP service during their fellowship where they develop basic bronchoscopy skills, 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 TIP service.

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 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. Dr. Aydin Pinar is the site ICU director. There are no in-house overnight responsibilities. As with the YSC MICU, there are in-house night intensivists for this unit overnight to ensure supervision, quality care and education 24 hours a day. During the SRC rotation fellows round with attending and housestaff in the ICU are also responsible for performing bronchoscopies and thoracentesis.

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.

Critical Care Electives (samples)

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 either at Yale-New Haven Hospital or the West Haven VA 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.


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. We will consider video interviews to facilitate scheduling for outstanding candidates. Please note that the one-year critical care medicine fellowship is listed under ONE umbrella ‘Pulmonary and Critical Care’ for Yale in the ERAs system. Once there, the one-year program will be listed individually as a separate track. If you have any questions regarding the application process, please contact Ms. Porto, our fellowship program coordinator.


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

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

Kathleen Akgün, MD, MS
Assistant Professor of Medicine
Associate Program Director Director of Medical ICU, VA Connecticut Healthcare System West Haven, VA