Good patient care in the modern cardiac intensive care unit (CICU) requires more than an organ-specific approach. Noncardiovascular problems such as sepsis, renal replacement therapy and multi-organ failure are increasingly common. Over half of patients in CICUs now have noncardiac primary diagnoses.¹

Critical care cardiology aims to address this increased patient complexity. Recent studies found that intensivists reduce mortality and improve outcomes in the CICU.^2,3 A physician can pursue a critical care medicine (CCM) fellowship before or after general cardiology training. Cardiology fellows may also dedicate elective time to additional ICU training during their cardiovascular fellowship. Currently, only the former allows for CCM board eligibility.

The University of Minnesota Critical care cardiology fellowship is a one-year Accreditation Council for Graduate Medical Education-accredited CCM fellowship designed for cardiologists interested in pursuing a career in critical care cardiology. The following is a Q&A with the program director, Andrea M. Elliott, MD, FACC.

What makes the University of Minnesota program unique?

Many programs are designed around a preexisting two-to-three-year CCM fellowship. One strength of our program is that it was fundamentally designed for cardiologists. Thus, our curriculum hits the required CCM topics, landmark trials and simulation experiences yearly as opposed to curricula designed for a longer program.

Fellows in Training (FITs) can also maintain the skills they earned during their general cardiology fellowship, with elective opportunities in transesophageal echocardiograms, right heart catheterizations, intra-aortic balloon pump insertion and temporary pacemaker placements. Many CCM programs have difficulty guaranteeing these procedures during CCM fellowship, which can result in difficulty retaining skills and credentialing as trainees seek their future jobs.

Critical care medicine is a demanding field. What does your program do to promote wellness?

The ACGME requires that CCM fellows in a one-year pathway have 12 months of clinical experience in that year. Further, a huge part of critical care training is experiential; the more you are there, the more you will see. We try to have dedicated lighter rotations between ICU blocks. There are also only two weeks of in-house nights. We also think wellness is facilitated by community; we collaborate with the various CCM programs to bring fellows together academic and social settings, and partner with the psychology and palliative care groups to offer a program to focus on fellow well-being.

One of the difficulties of a one-year fellowship is applying for jobs as soon fellowship starts. How do you support fellows in their job search?

The preparation for your job starts on day one. Orientation includes meeting with leadership in cardiology and critical care to begin to establish rapport. All fellows also take a professional course, which focuses on preparing for job interviews, contract negotiation, and common pearls and pitfalls during the interview process. We have a formal mentorship and sponsorship program wherein our faculty offers career support and national connections, promotes scholarly collaborations on research efforts and facilitates participation in professional organizations. Finally, the fellowship funds two conferences each year and has protected time for both interviews and conferences.

What else would you like to share with potential applicants regarding your fellowship?

We have fun! This is true at our program and so many others across the nation. Critical care cardiology is full of great people, passionate about the care of critically ill people plagued by cardiac pathology. We are privileged to interact with these patients and their families at some of the most important moments of their lives. It is an incredibly rewarding journey, and we are excited to share it with interested fellows!

Please reach out to elliotta@umn.edu for any questions regarding the University of Minnesota Critical Care Cardiology Fellowship program.

References:

1. Shashank SS et al. Changes in Primary Noncardiac Diagnoses Over Time Among Elderly Cardiac Intensive Care Unit Patients in the United States. Circulation: Cardiovascular Quality and Outcomes. 2017;10(8). Doi: 10.1161/CIRCOUTCOMES.117.003616
2. Kapoor K et al. A Collaborative Cardiologist-Intensivist Management Model Improves Cardiac Intensive Care Unit Outcomes. JACC. 2017;70(21):2737-2738. Doi: 10.1016/j.jacc.2017.07.739
3. Na SJ et al. Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit. JACC. 2016:68;24(2637-2648). Doi: 10.1016/j.jacc.2016.09.947
4. Bartos JA et al. Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation. Circulation. 2020;141:877-886. Doi: 10.1161/CIRCULATIONAHA.119.042173