||Surgical Critical Care/Trauma
||Baylor University Medical Center (BUMC) is a 1,008-bed tertiary care hospital in the heart of Dallas with a high level of acuity and approximately 39,000 admissions a year. Since 1997, the American College of Surgeons has recognized BUMC as a Level 1 Trauma Center with approximately 2,400 admissions yearly. There are 123 total ICU beds, 57 of which are surgical ICU beds. Currently, our surgical critical care faculty provides care for trauma, acute care surgery, general surgery, solid organ transplant, heart and lung transplant, cardiothoracic, neurosurgery, orthopedic and orthopedic spinal surgery, ENT, oral surgery, OB-GYN, and plastic surgery. The surgeons in the Division of Trauma, Critical Care and Acute Care Surgery have always been closely involved in general surgery resident education (9 residents a year), as well as research and quality initiatives. Our surgeons also serve as Texas A & M Health Science Center College of Medicine faculty and are heavily involved in medical student education. There are 48 medical students in each class that rotate on our campus starting in their 2nd year. The Division of Trauma, Critical Care and Acute Care Surgery faculty is a diverse group including surgical critical emergency medicine and pulmonary critical care intensivists, and 14 of the 15 faculty are Surgical Critical Care Board Certified.
The ACGME approved our Surgical Critical Care Fellowship in March 2016 for four (4) fellowship positions, although we currently have funding for three (3). The goal of our Surgical Critical Care Fellowship program is to prepare the fellows to function as qualified practitioners at the advanced level of performance expected of Board-certified sub-specialists. The fellowship will allow fellows to develop proficiency in the management of critically-ill and injured patients, develop necessary qualifications to supervise surgical critical care units, and to conduct scholarly activities in trauma/surgical critical care.
The 12-month fellowship is designed to provide surgical critical care fellows with an education in the principles and practice of state-of-the art trauma and surgical critical care according to medical knowledge and patient care, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal and communication skills. This is accomplished by exposing the surgical critical care fellows to a broad array of surgical illnesses through didactic instruction in the basic and clinical sciences, as well as education during teaching rounds, primary patient care, educational conferences, and specialized rotations. Upon completion of training, the surgical critical care fellows are expected to integrate the acquired knowledge into the clinical situation to demonstrate proficiency in surgical critical care decision-making, specific organ system support, evaluation of new technology and treatment techniques, ICU administration, outcomes assessment, research design, and interaction with patients, families, and health care personnel. The Surgical Critical Care Fellowship will be individualized to each applicant and is focused on developing their future practices whether in academics or a private setting. The fellowship year is also customized to address specific deficits that the candidate feels that he/she might have with respect to operative, non-operative, and interventional management.
Surgical and Trauma ICU (STICU) —3 months
• 23 ICU beds
Cardiothoracic and Transplant Surgery ICU (CTICU) — 4 months
• 34 ICU beds, Including patients with heart and lung transplants, total artificial hearts, durable and percutaneous LVAD and RVADs (including Impella) ECMO, and solid organ transplants including liver, kidney and pancreas
Advanced Cardiac Anesthesiology/ Intensive Care Nephrology —1 Month
• Cardiac Anesthesia with a CTICU focus - ½ month
o Patients will be seen pre-operatively, in the operating room and post-operatively in the CTICU. Involves a lot of procedures such as intubation, swan-ganz catheter placement, transesophageal echocardiogram, use of vasopressors and ionotropes, various ventilator strategies, use of massive transfusion and all of this in very critically ill patients.
• ICU Nephrology - ½ month
o Patients in both STICU and CTICU with a focus on management of CRRT, Hemodialysis and electrolytes
Medical Intensive Care Unit (MICU) — 1 month
Acute Care and Trauma Surgery — 1 month acting as Junior Faculty
Two elective months (only one can be non-surgical)
• Possible electives:
o Vascular Surgery
o Colorectal Surgery
o Infectious Diseases
o Interventional Radiology
o Cardiothoracic Surgery
o Thoracic Surgery
o GI/ Endoscopy
o Or the PD will work with the fellow to tailor an elective that meets the fellow’s needs
Home Call (Sunday through Wednesday)
In-house night call fellow available only Thursday through Saturday from 6 PM – 6 AM.
ECMO Call only for the fellows on CTICU. The general surgery residents, attendings and nurse practitioners in-house can care for most issues and the fellows only get called or called in for valid reasons. An 80 –hour workweek per ACGME rules will apply at all times.
Night Call (6:00 PM to 6:00 AM Thursday through Saturday)
The fellow covers both the STICU and the CTICU, makes nightly rounds with the general surgery residents and Advanced Practice Practitioners as a team with a focus on education. The fellow will also respond to trauma activations as long as the ICU patients have been stabilized and will have opportunities to operate as a Junior Faculty.
Conferences for surgical critical care include journal club, process improvement and quality assurance meetings, research and didactic lectures. Also, collegial interaction with the pulmonary critical care service and their fellows (2 per year) includes a weekly combined didactic lecture series that alternates between specialties. The fellows will participate in the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) along with an ASSET course, ATLS certification or re-certification and if available, an ATLS Instructor course.
Critical review of research is an integral requirement for the fellows. The fellows are expected to create two Practice Management Guidelines for Trauma topics and keep the current Guidelines up to date. Also, there are dedicated monthly research meetings with research support staff. The fellows are expected to develop at least one research project and to be submitted as an abstract for presentation at a national-level conference and complete a manuscript for publication in a peer-reviewed journal. There are ample opportunities to accomplish this during the one-year fellowship. If the fellows are meeting their research and fellowship expectations, they will also attend a national meeting, usually the Eastern Association for the Surgery of Trauma as a group and participate in the Dodgeball Tournament with our Baylor University Medical Center Dallas team.