Critical Care Track

From the Oregon Scholars Critical Care Chief...

Tully - OSP Chief

Dear Prospective Residents and Fellows,

Thank you for your interest in the OHSU Anesthesiology Critical Care Medicine (CCM) program. We provide an outstanding educational experience in critical care medicine under highly respected and accomplished faculty. 

Critical care fellowship at OHSU can be pursued in two ways. For trainees who are currently enrolled in or have completed their anesthesiology residency, we offer a traditional one-year CCM fellowship. For trainees entering anesthesiology residency from medical school, we offer the Oregon Scholars Program (OSP) critical care track, a 48-month program that integrates a one-year CCM fellowship into the final two years of anesthesiology residency. Each year, two OSP critical care positions are offered through the Match with one categorical and one advanced position. We are proud to be the first combined anesthesiology-critical care medicine program in the country. 

Critical Care Curriculum at OHSU

OSP Combined Residency &Fellowship Track: Upon completion of the OSP critical care program, trainees meet ACGME requirements for board eligibility in both anesthesiology and anesthesiology critical care. In addition to the core anesthesiology curriculum, OSP trainees complete nine core critical care rotations, one elective critical care rotation, and three elective rotations.

Traditional Fellowship Track:  During their first month, traditional fellows complete an orientation rotation where they spend a week on each of our three core adult ICUs. Subsequently, they complete nine core critical care rotations and three elective rotations.

Critical care experiences are obtained primarily in our three core adult intensive care units, all of which have anesthesia intensivists as medical directors: OHSU's Cardiovascular ICU and Neurosciences ICU, and the Portland Veteran's Administration Surgical ICU. Elective opportunities are available in the medical ICU, trauma and surgical ICU, pediatric ICU, and neonatal ICU. 

OHSU is a Level 1 Trauma Center and a quaternary referral center for Oregon, southwest Washington, northern California, and Alaska, resulting in a diverse and often critically ill patient population.

Our trainees become proficient in the post-operative care of patients undergoing cardiac, thoracic, vascular, neurologic, major spine, and major abdominal operations, in addition to heart, liver, kidney, and pancreas transplantation. Trainees also gain experience caring for patients with critical neurologic illnesses including hemorrhagic and embolic strokes, seizures, and neuromuscular disorders in our Neurosciences ICU. Additionally, we care for non-surgical cardiac critical care patients and critically ill obstetric and gynecologic patients in our cardiovascular ICU.  We also have a growing adult ECMO program at OHSU. 

Our intensive care units are staffed by a multidisciplinary group of intensivists, including anesthesiologists, surgeons, neurologists, pulmonologists, and cardiologists, fostering a comprehensive critical care education. 

A variety of non-critical care electives including heart failure, transthoracic echocardiography, radiology, pulmonology, infectious disease, nephrology, and palliative care enhance our training. Research opportunities are readily available, and we work to identify potential research mentors early in the trainee's fellowship. 

OSP Sample Schedule

PGY-1 Year:       2 ICU rotations as an intern

PGY-2 Year:       2 ICU rotations as a CA-1 resident

PGY-3 Year:       2 ICU rotations as a CA-2 resident

PGY-4 Year:       3 ICU rotations as a CCM fellow

                           3 elective rotations as a CCM fellow

                           7 anesthesiology rotations as a CA-3 resident

PGY-5 Year:       6 ICU rotations as a CCM fellow

                           1 elective ICU rotation as a CCM fellow

                           6 anesthesiology rotations as a CA-4 resident

Traditional Fellow Sample Schedule

PGY-5 Year:       1 orientation rotation

                           9 ICU rotations as a CCM fellow

                           3 elective ICU rotations as a CCM fellow

Didactic Experience

The academic year starts with three weeks of daily didactics in critical care topics, which then transitions into a weekly multidisciplinary lecture series to provide fellows with a solid foundation of critical care knowledge. Additionally, multidisciplinary critical care M&M occurs once per month, which brings together critical care providers from all disciplines. During monthly afternoon conferences, fellows present critical care topics and relevant journal articles to the anesthesiology critical care faculty and their fellow trainees. There is an annual transthoracic echocardiography "boot camp" at the beginning of the academic year with both didactic and practical learning on models. Our faculty are proficient in bedside transthoracic echocardiography and ultrasound in the ICU and this hands-on learning is an integral part of the ICU rotations as well.  Trainees also participate in multiple half-day critical care simulation sessions in our state-of-the-art simulation center.

Benefits of the OSP

The Oregon Scholars Program is an innovative and exciting way for an anesthesiology resident to become simultaneously confident and proficient in providing both intraoperative and post-operative care to critically ill patients. As anesthesiologists, we have a unique knowledge of the physiologic and pathophysiologic changes that occur in surgical patients, which makes us well-equipped to provide post-operative critical care. Also, familiarity with the challenges of ICU management of a broad range of surgical patients allows us to plan for the post-operative course while taking care of patients in the operating room. Each complements and enhances the other, so that senior fellows are able to maintain their intraoperative skills while also enriching their critical care practice. 

Another benefit of the OSP CCM program is the consistent exposure to critical care didactics over the 48-month course, which builds and reinforces a knowledge base in critical care, ensuring that trainees are prepared and knowledgeable prior to starting advanced critical care rotations. 

OSP trainees are paired with faculty advisors from within the critical care division. This consistent mentorship throughout the program helps to integrate the junior trainees into the critical care division and gives scholars an invaluable source of career advice and planning.

This thorough, integrated training has made our graduates highly competitive when applying for jobs or additional fellowships. Previous graduates have been very successful in obtaining positions in anesthesiology and critical care medicine at academic and private hospitals across the country. Others have gone on to pursue further fellowship training at prestigious programs prior to entering the work force.

Living and Training in Portland

Portland is the principle metropolitan area in Oregon and boasts the excitement and variety of a major city with the friendly feel of a smaller town, ideal for both singles and families with children. The restaurant, microbrewery, winery, and coffee scenes are all highly acclaimed and constantly evolving. Food carts, farmer's markets, and community gardens are scattered across the city. Cycling, rain or shine, is a major mode of transportation. Additionally, ocean beaches, ski slopes, wine country, and the Columbia River Gorge are only a short drive away from the city. 

Trainees often refer to our Anesthesiology and Perioperative Medicine (APOM) department as our "APOM family." Our faculty, staff, and residents genuinely enjoy working together, support each other, and create a very welcoming environment in which to train. 

Thank you for your interest in our critical care program. I look forward to hearing from you with any questions.

Sincerely,

Michelle Tully, MD
Critical Care Chief Resident 2017-2018
Oregon Scholars Program