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Program Overview

Our Mission

The Critical Care Residency program serves Kansas City and the Midwest Region and strives to provide our graduates with the necessary tools to work in a wide range of practice models. This is done by giving fellows experience across a range of intensive care unit settings in both a tertiary/quaternary referral center and a community hospital that cares for underserved populations. Our graduates will have the skill sets needed to enjoy a very fulfilling career in critical care, whether they decide to become clinician educators, enter a private practice or pursue an academic pathway.

Program Details

The UMKC School of Medicine Critical Care Medicine Fellowship is a two-year program; alternatively, internists with ABIM certification in a qualified internal medicine subspecialty (e.g., pulmonary, nephrology, cardiology, hematology, infectious disease) are eligible for one-year of critical care medicine training. Our program offers both one- and two-year positions based on availability.

Our Critical Care Medicine Fellowship program is designed to train clinically competent and scholarly intensivists. Fellows spend time at Saint Luke’s Hospital and University Health Truman Medical Center, both are primary teaching hospitals for the UMKC School of Medicine. While the program emphasizes clinical experience, clinical and/or basic science research activity is required. Fellows are expected to vigorously pursue teaching medical students and residents with the aim of becoming excellent clinician educators. Regularly scheduled conference presentations by the fellows are included in this teaching responsibility.

Hospital Affiliates

Saint Lukes’s Hospital (SLH)

SLH is a designated Level I Trauma, Stroke, and STEMI Center by the Missouri Department of Health and Senior Services. SLH and the Saint Luke's Mid America Heart Institute have the region’s longest continuously operating adult heart transplant program and one of the nation’s top 25 cardiology and heart surgery programs. SLH also provides treatment for complex brain and spinal cord diseases. The nationally ranked Saint Luke's Marion Bloch Neuroscience Institute is home to the nation’s leading stroke reversal program, which is dedicated to preventing and treating stroke. SLH also has very successful liver and kidney transplantation programs, which continue to grow.

The critical care services at SLH are provided in four different closed ICUs with 24/7 intensivist coverage — the Medical Surgery Trauma ICU (MSTICU), the Cardiac Care Unit (CCU), the Neurosurgical ICU (NSICU) and the Cardiovascular ICU (CVICU). The CVICU and CCU provide services for cardiac and cardiothoracic surgery patients and other critically ill patients. These services include temporary hemodynamic support devices like VV and VA ECMO, IMPELLA system, Tandem Heart and IABP. Another unique opportunity for fellows is the availability of tele-critical care services at SLH. Tele-critical care is an innovative electronic intensive care patient care and monitoring program that spans multiple hospitals throughout the region and enhances outstanding bedside care.

More about SLH

University Health Truman Medical Center (UHTMC)

UHTMC is where fellows spend 25% of their training and do their in-house calls. UHTMC has two closed ICUs, the Medical ICU and surgery trauma ICU. UHTMC is one of the busiest adult emergency rooms in the Kansas City metropolitan area, with more than 60,000 visits per year. It is the main campus for the UMKC and homebase for some of the School of Medicine's residency programs, such as emergency medicine. UHTMC provides care in many specialty areas and serves a diverse patent population.

More about UHTMC

Rotations

ICU rotations: MSTICU, CCU, CVICU, NSICU

First- or second-year fellows work under the direct supervision of a critical care medicine faculty member at ICUs in Saint Luke’s Hospital or University Health Truman Medical Center. Fellows supervise 2-4 residents from internal medicine, emergency medicine, anesthesiology or family medicine. Fellows take an active role in patient management on these very busy services. They provide initial and ongoing consultative service and work closely with residents, critical care Advanced Practice Providers (APP) and faculty members. Fellows manage approximately 15 new consults or admissions per week and follow up to 25 inpatients at any given time. Fellows are expected to take pager calls from home and are responsible for inpatient care no more than two weekends a month.

Critical care fellows are not expected to write routine daily notes on MSTICU or CCU patients, as these are usually done by the rounding residents. This should give time for fellows to focus on high-level decisions and help team members when needed. The MSTICUs are busy and provide fellows with opportunities to manage a complex variety of critically ill patients with medical, surgical and trauma emergencies. In the CVICU and CCU, this will include managing patients on ECMO, IABP LVAD and IMPELLA devices. Fellows will also get the opportunity to place and monitor pulmonary artery catheters. In the neuro ICU, fellows will be able to manage neurocritical care emergencies and get training on ICP monitoring.

Electives

Fellows will have several flexible options for their electives. These include nephrology, infectious disease, CNS diagnostic radiology, abdominal diagnostic radiology, PICC line service and CVOR with TEE training. Fellows are also given the opportunity to visit our tele-critical care site to get familiar with this unique and expanding innovation.

Rotation Schedule

Two-Year Fellowship Curriculum

Year 1

  • 4 Months MSTICU/CCU — Saint Luke’s Hospital
  • 1 Month CVICU — Saint Luke’s Hospital
  • 1 Month NSICU — Saint Luke’s Hospital
  • 1 Month Anesthesia — Saint Luke’s Hospital
  • 2 Months ICU — University Health Truman Medical Center
  • 1 Month Trauma Critical Care — University Health Truman Medical Center
  • 6 weeks of Research — Saint Luke’s Hospital
  • 2 Weeks of Echocardiography — Saint Luke’s Hospital

Year 2

  • 4 Months MSTICU/CCU — Saint Luke’s Hospital
  • 1 Month CVICU — Saint Luke’s Hospital
  • 1 Month NSICU — Saint- Luke’s Hospital
  • 2 Months Elective (ID, Nephrology, Research or potentially others) — Saint Luke’s Hospital
  • 2 Months ICU — University Health Truman Medical Center
  • 6 weeks of Research — Saint Luke’s Hospital
  • 2 weeks of Echocardiography — Saint Luke’s Hospital

1-Year Fellowship Curriculum

  • 4 Months MSTICU/CCU — Saint Luke’s Hospital
  • 2 Months ICU — University Health Truman Medical Center
  • 1 Month CVICU — Saint Luke’s Hospital
  • 1 Month NSICU — Saint Luke’s Hospital
  • 1 Month Anesthesia — Saint Luke’s Hospital
  • 1 Month Trauma Critical Care — University Health Truman Medical Center
  • 6 weeks if Research — Saint Luke’s Hospital
  • 2 Weeks of Echocardiography — Saint Luke’s Hospital

Procedures

Critical care fellows conduct patient procedures in our closed ICUs, including all intubations, central lines, arterial lines, pulmonary artery catheters, bronchoscopies, lumbar punctures, chest tubes and thoracenteses. We also utilize ultrasound (POCUS, POCECHO, etc..) daily in our program for volume responsiveness, to evaluate shock, assess pleural disease and guide procedures.

Calls

Two critical care fellows share night calls at the UHTMC ICU with the nine pulmonary critical care fellows. Critical care fellows do about 30 calls per year, or every tenth on average. These calls are either in person or pager calls from home, depending on the training and comfort level of the in-house ICU resident.

Didactics and Conferences

We have monthly didactics in two main blocks. The first is a three-hour block on the first Wednesday of every month. The second is an hour-long block on the last Wednesday. In addition, fellows are encouraged to attend a monthly MSTICU meeting when Case Conferences (M&Ms) are presented by fellows or another team member. Fellows are also encouraged to attend monthly internal medicine grand rounds, and quarterly critical care Evidence Practice (EPT) Team meetings.

In addition, critical care faculty will provide fellow-level teaching at the bedside, which includes volume assessment, POC ECHO, POC US, ventilator settings and asynchrony, pulmonary artery catheter monitoring and evidence-based practice.

Research

Fellows work with a faculty member of their choice. It is the fellows’ responsibility to identify a faculty member to collaborate with. Research project(s) must be approved by the program director. The minimum expectation for fellows is to publish a research abstract at one of the critical care conferences during their training and to submit a research manuscript by the end of their two-year program.

Evaluation

Formative evaluation

Fellows are evaluated each month of the 24-month fellowship. Evaluations are in line with currently accepted ACGME milestones. The following areas are evaluated:

  • Clinical judgment
  • Clinical skills
  • Medical knowledge
  • Humanistic qualities
  • Commitment to scholarship
  • Medical care
  • Professional attitudes
  • Behavior
  • Clinical competence

Fellows are evaluated in these areas each month, and performance is reviewed and discussed by the attending that month. Semi-annually, fellows receive structured feedback from the program director. Performance is reviewed with appropriate counseling and any necessary remedial actions

Summative evaluation

Semi-annually, the program director completes a written evaluation of each fellow based upon review of monthly evaluations. These evaluations stipulate the degree to which fellows have mastered each component of clinical competence and have acquired proficiency in each of the required procedural skills. Fellows may appeal judgments of academic deficiencies or misconduct. See the Disciplinary Action Policy located for more information.

Evaluation of faculty and program

Fellows evaluate each rotation monthly and provide confidential feedback to the program director on the performance of the faculty and merits and deficiencies in the training program. The teaching staff meets with fellows semi-annually to evaluate the utilization of resources available to the program, the contribution of SLH and TMC to the program, financial and administrative support, the volume and variety of patients available to the program for educational purposes, the performance of members of the teaching staff, the quality of supervision of fellows, and the effectiveness of the program in achieving the stated goals and objectives.