SurgicalCriticalCare.net / AcuteCareSurgery.net
Official website of the OrlandoHealth Surgical Critical Care and Acute Care Surgery Fellowships
Today, an increasing proportion of patient care and hospital resources revolves around the Intensive Care Unit (ICU). Intensivist-led models of ICU care have been shown to improve patient outcome while simultaneously reducing costs. Hospitals and universities nationwide are now recruiting well-trained surgical intensivists to direct such care. As a result, the Surgical Critical Care and Acute Care / Trauma Surgery Fellowships at Orlando Regional Medical Center (ORMC) focus not only on the clinical practice of intensive care, but also on ICU administration, quality improvement, and resource utilization. Our didactic program emphasizes multidisciplinary, state-of-the-art patient care, clinical research, evidence-based medicine guideline development, cost-containment, and database-driven process improvement. This comprehensive approach to patient care, academic productivity, and ICU administration ensures that our graduates are well prepared to effectively lead an ICU program.
The Surgical Critical Care Fellowship program at Orlando Regional Medical Center is an American Council for Graduate Medical Education (ACGME) accredited 12-month residency program that is intended to prepare graduates for a career in either academic or private practice surgical critical care. The educational philopsophy of the program is to provide a comprehensive matrix upon which to:
Each fellow is trained according to the recommended guidelines set forth by the Society of Critical Care Medicine to ensure a comprehensive exposure to all aspects of critical care practice (Guidelines for Advanced Training for Physicians in Critical Care, Crit Care Med 1997; 25:1601-1607). Our ultimate goal is to fully prepare our graduates to be not only superb clinicians, but also excellent academic teachers and thought leaders in their future institutions.
The Surgical Critical Care Residency is based at Orlando Regional Medical Center (ORMC), the 800+ bed flagship hospital of a seven-hospital not-for-profit comprehensive healthcare system ("OrlandoHealth") that serves the needs of patients throughout Central Florida as well as millions of tourists each year. Orlando Regional Medical Center has served as the regional Level I Trauma Center and Burn Center for almost 20 years and currently provides trauma care for 22 different counties. With the Arnold Palmer Women and Children's Hospital and Charles Lewis / MD Anderson Cancer Center, ORMC serves as a state-of-the-art tertiary referral center providing Central Florida with a full range of medical services.
The program accepts two (2) residents per academic year with the option to complete an additional year in acute care / trauma surgery if desired. The prerequisites for acceptance to the program include: completion of an accredited graduate educational program in the disciplines of general surgery, neurosurgery, urology or obstetrics/gynecology OR completion of at least 3 clinical years in such a program with a categorical residency position to return to upon completion of the surgical critical care program. Please note that residents in preliminary positions do not meet these requirements.
Our comprehensive educational program in surgical critical care begins with an initial twelve-week lecture series by the critical care faculty addressing the "basics" of critical care management. The concepts introduced are reinforced at the patient bedside during daily patient teaching rounds. Following the initial lecture series, we begin to focus on developing the resident's advanced clinical skills as well as administrative skills and scholarly pursuits. Bimonthly evidence-based medicine guideline development working conferences are alternated with monthly research conferences and monthly "Professional Development" lectures. These advanced skills conferences are in addition to a weekly critical care lecture series, which addresses a variety of critical care topics throughout the year.
Each resident upon completing the residency is expected to be able to demonstrate the folowing skills:
Post-graduate training, including that in surgical critical care, is frequently referred to as a "fellowship". As this training program is accredited by the Residency Review Committee (RRC) of the ACGME, it is officially termed a "residency". For all intents and purposes, the two terms are synonymous in this setting and are used interchangeably.
No. The ACGME requires that each applicant has either completed an ACGME-accredited residency program in general surgery, neurosurgery, urology, or obstetrics/gynecology OR completed at least three (3) years of clinical training with a categorical position to return to in their respective specialty upon completing the surgical critical care residency program.
Yes. In fact, a number of board-certified general surgeons have completed the residency program in recent years to either gain further knowledge and experience to improve their patient care or as a means to redirect their surgical career.
The ACGME requires that no more than 25% of the residency time be devoted to direct operative care. We consider this residency to be "non-operative" in that the surgical critical care residents do not have operative responsibilities outside of the critical care unit. The residency is oriented to promote the development of advanced skills in the diagnosis and management of the critically ill, using the latest technology, instrumentation, and medications. This advanced knowledge and expertise in clinical patient care, unit administration, and research activity comes at the price of not operating for at least eleven months of the residency. The residents do perform bedside tracheostomies and endoscopic procedures on a regular basis as part of their routine patient care. Occasionally, they may assist the general surgery faculty or residents with emergent bedside abdominal decompression in the critical care unit. The residents may elect to spend one of their two elective months rotating on either the Trauma Team or Burn Service where they would participate in scheduled operative procedures.
The call is generally five nights per month and shared with general surgery and emergency medicine residents. Each resident has at least one day off each week and one to two weekends off each month without clinical responsibilities. There is no "at-home call" at any time. The ACGME 80-hour per week resident duty hours requirement is strictly followed. While on call, a designated call room is available as are a resident's lounge and physician's dining room.
The ancillary support services at ORMC are excellent. The surgical critical care residents are not required to start peripheral intravenous lines, draw blood, transport patients, or perform other roles or procedures that could be construed as being "non-educational". · These support services include: In-house surgical / trauma attending faculty 24/7; dedicated Doctor of Pharmacy specializing in surgical critical care; full-time surgical critical care research coordinator; In-house attending radiologists and radiology technicians (including ultrasound, computerized tomography and magnetic resonance imaging) 24/7; experienced respiratory therapy department; bedside echocardiography 24/7; intravenous line team 24/7; Wound Management team; Nutritional Support team.
The medical center library is available 24 hours a day. It is equipped with the OVID Medline literature search engine as well as a wide variety of bound journals and textbooks. OVID is also available from any computer in the hospital. Residents may also arrange to have OVID access from their home computer for free. Any articles that are not available either on-site or via computer download are generally obtainable through inter-library loan within 24 hours without fee to the resident. There is a dedicated conference room in the Burn / Trauma ICU where all of the teaching conferences take place. The residents have their own office for individual study.
Each trainee receives a formal one-on-one evaluation quarterly from the program director in addition to informal discussions as indicated. The evaluation of the resident's performance consists of comprehensive rotation specific evaluations by the faculty and 360 degree evaluations performed by the ICU nursing and respiratory therapy staff. The resident and program director discuss the resident's progress, clinical and diagnostic skills, technical skills, didactic knowledge, problem-solving ability, judgment, and intra-personal skills as necessary. All patient care and procedures performed by the surgical critical care residents are documented online. As a result, patient and procedure lists can be viewed and printed by the program director and resident at any time to review and monitor the resident's experience and training. The results of the annual Multidisciplinary Critical Care Knowledge Assesssment Program (MCCKAP) exam are discussed with each resident as they become available from the Society of Critical Care Medicine. Each surgical critical care resident completes an evaluation of each critical care faculty member on a quarterly basis or following each elective rotation, which is reviewed by the program director. Issues raised are discussed with the faculty members, as necessary, on an anonymous basis.