Fellow

Fellowships have become more standardized since the Emergency Medicine Critical Care Medicine (EM-CCM) pathway achieved ACGME accreditation. There is still wide variation in the training process depending on the type of critical care fellowship chosen. Below is some general information on what can largely be expected during fellowship.

• Teaching and Leadership Responsibilities: Most fellowships have expectations that you will teach residents and medical students and participate in departmental or hospital committees.
• Moonlighting: Moonlighting opportunities are program-dependent. All moonlighting activities are factored into your duty hours and cannot exceed the 80 hours per week restriction mandated by the ACGME. Many programs allow for moonlighting in both the intensive care unit (ICU) and emergency department (ED). Keep in mind that the American Board of Emergency Medicine (ABEM) states you must be actively practicing emergency medicine (EM) in order to sit for boards, so availability of moonlighting during fellowship should be an important discussion point while interviewing.
• Salary: The vast majority of programs offer PGY-based salaries, which can be found on each institution's Graduate Medical Education (GME) website.
• Work Hours: These are highly variable. Generally speaking, you should expect to work 14-24 shifts per month depending on which ICU you are rotating through, and up to the ACGME limit of 80 hours per week. Some programs have a night float system to decrease call time for their fellows.
• Research Requirements: ACGME requires a scholarly project for fellowship completion. This can take the form of a peer-reviewed journal article, case report, book chapter, etc. Individual fellowship programs may have requirements that exceed this.
• ICU Rotations During Fellowship: Most programs will allow you to rotate at different ICUs within their institution, which include but are not limited to medical, surgical, cardiothoracic, cardiac, neuro/stroke, and trauma/burn. Many programs additionally over tele-ICU or ICU triage rotations. Certain pathways (such as neurocritical care) have less broad exposure, however. Information on ICU rotations can be found on each program's website.
• Possible Electives: Most fellowships offer a generous amount of elective time. Electives available vary among different institutions. It is important to ask fellowships what types of electives they offer, especially if you are interested in a particular area of critical care. Some examples of common electives include ultrasound, pediatric ICU, anesthesiology, interventional pulmonology/bronchoscopy, extracorporeal membrane oxygenation (ECMO), nephrology, infectious disease, palliative care, nutrition, radiology, acute pain service, and research.