Rotations

ECU Health is a large referral center for hospitals in Eastern North Carolina.

Intensive Care Unit Rotations

There are 5 ICUs that fellows will rotate through during their fellowship training.

MICU

The Medical Intensive Care Unit is a closed, 24 bed intensive care unit. It is managed by two attending PCCM physicians, two fellows, two senior residents and 4-5 junior residents or interns. The fellows and the MICU attendings lead daily teaching rounds and provide education on relevant aspects of critical care medicine for the residents.

The fellow interacts closely with the residents providing supervision and guidance for patient care as well as teaching and supervising procedures for the residents.  Fellows will actively participate in patient assessment and decision making.  Patients in this unit are critically ill and often medically complex.  CRRT, Mechanical Ventilation, Bedside ultrasonography/echocardiography are common elements in this unit. The MICU fellow takes a primary role in many procedures including airway management, bronchoscopy, Central Line and Arterial Line placement, chest tube placement, amongst many other procedures.

CICU

Critically ill patients admitted to the Cardiology Intensive Care Unit are managed by the PCCM faculty who are the primary attending providers in this 24 bed closed unit. The CICU admits and cares for critically ill cardiac patients as well as medical patients when the MICU is filled to capacity.  It is a high acuity unit where VV-ECMO, CRRT, cardiac mechanical support, and other high risk procedures are managed by the intensivists. Fellows rotating on this service will gain hands on experience managing patients and performing procedures. Fellows assigned to this service will primarily take care of patients along with a team of advanced practitioners.

NSICU

Critically ill patients with neurologic and neurosurgical disease will be cared for in the NeuroScience Intensive Care Unit which is a 24 bed closed unit.  Fellows will work in this unit with attending neurocritical care physicians.  They will be exposed to subspecialty patients with neurologic disorders, postop neurosurgical patients, and patients undergoing endovascular cerebral procedures.  Fellows will primarily take care of patients along with a team of advanced practitioners.

SICU/TICU

The Surgical and Trauma Intensive Care Unit encompasses critically ill patients with surgical and traumatic injuries in this 24 bed closed unit.  ECU Health is a level 1 trauma center and the SICU/TICU is run by Surgical and Trauma Critical Care Surgeons.  Fellows will rotate on this service and acquire the knowledge and skills necessary to manage patients with problems unique to the surgical intensive care setting. The fellow will act as a member of the Surgical Critical Care/Trauma Team. Bedside teaching and procedure training will occur as part of the daily work rounds.

CVICU

The Cardiovascular Intensive Care Unit cares for critically ill patients undergoing advanced cardiac surgery (CABG, valvular repair/replacement, etc) as well as patients on VA-ECMO.  Fellows will rotate with attending physicians who are Cardiac Surgeons.  Fellows will round and help manage patients with a team of advanced practitioners.

Inpatient Pulmonary Consultation Rotation

The fellows will rotate through the pulmonary consultation service are responsible for all inpatient pulmonary consults. Patient care on the pulmonary consultation service is provided by one attending, three fellows, and a variable number of internal medicine residents.

The service receives between 100 and 150 new consultation requests per 4 week rotation. The fellows are responsible for seeing and evaluating all new patients and presenting the cases to the attending during teaching rounds after formulating an assessment and plan. The fellows also teach and supervise the residents who rotate on the service.

The fellow is responsible for interpreting all pulmonary function tests under the guidance of the consult attending. The fellow also performs all inpatient bronchoscopies with the direct supervision of a faculty member. Procedures such as Thoracentesis and tube thoracostomy are performed by the fellow or the fellow supervises and teaches the resident performing the procedure. The fellow will learn ultrasound-guidance in the use of thoracentesis as well as other pleural treatments including chest tubes, Pleur-x catheters, and pigtail catheters.

Inpatient Critical Care Consultation Rotation

The fellows will rotate through the critical care consultation service and will be responsible for critically ill patients outside of the ICUs.  Fellows will triage admissions from the Emergency Department as well as assess and stabilize critically ill patients on the general and intermediate floors.  Fellows will also follow and consult on patients who have tracheostomies on long term ventilators or who are weaning from the ventilator (outside of the ICU).  Fellows will be primarily managing the ventilators and tracheostomies (including exchange, upsize/downsize, and decannulation).  Fellows will also be the primary point for all code blue/cardiac arrest in the hospital outside of the ICU

Electives and other Rotations

Required Rotations:

Research: 3-4 blocks of research

VV-ECMO: will encompass ECMO education as well as taking call with the ECMO team for consultations and cannulations.  Daily management of patients on VV-ECMO

Thoracic Surgery: consult service working with Thoracic surgery team

Advanced Heart Failure: consult service working with Advanced Heart Failure team

ECHO: Advanced Echocardiography with educational didactics and hands on practice

Transplant Elective: External elective in lung transplant

Simulation Lab: simulation lab education and teaching sessions, procedural practice