Senior Medical Student

How Should I Plan my M3/M4 Years to Set Me Up for the Critical Care Path?

• The most important part of preparing for residency is performing well on your core clerkship rotations, sub-internship rotations, and electives, especially if in the intensive care unit (ICU). Extracurricular activities including research should not distract you from academic performance, but can be helpful as an adjunct when feasible.
• Rotate in any of the available ICUs at your institution. Some medical schools will not allow ICU rotations until fourth year. If available, rotating in a community ICU can be very beneficial. There may not be any residents in that ICU, which can give you more one-on-one contact with an attending and increased procedural exposure. Other rotations that can help prepare you for residency are your emergency medicine (EM) clerkship, trauma, interventional radiology, and anesthesia. These rotations have high patient acuity and are all integral parts of the acute care continuum.
• Find mentors in EM and critical care. These may be residents, fellows, or attendings with whom you worked on your clerkships or elective rotations. They can provide insight into the field and guidance for the future.
• Get involved with research in EM or critical care. Reaching out to mentors can be a great way to find projects.

Getting Involved with Emergency Medicine Locally and Nationally

• Emergency Medicine Interest Group (EMIG): local institution
• Residency fair and conference attendance
• SAEM interest groups, academies, committees, and annual meetings
• Emergency Medicine Residency Association (EMRA)
• American College of Emergency Physicians (ACEP)

Are There Research Mandates?

Research requirements will vary by program. Some centers focus on clinical experience. If you are looking for a purely academic center, then early research is encouraged. Critical care is an evidence-based, research-oriented field, so getting involved in research specific to critical care tends to be beneficial in demonstrating interest in advancing the field.

Differences Between Three- and Four-Year Programs

Both three- and four-year programs can provide an excellent foundation for a career in EM. Learning will continue far beyond residency; you will not learn all you need to know about the field in residency regardless of training duration. Three- and four-year programs all meet training requirements and will train you to be a good physician. A four-year program can give you extra time and electives to spend on your area of interest.

If you choose a four-year institution, ensure that the fourth year will add to your education. This would be a good year to focus on EM administration, advising younger physicians, and developing your leadership skills as well as an area of academic interest. A fourth year may allow for more dedicated time pursuing critical care-related projects. An extra year of residency may not be worthwhile to those already planning to pursue further training in fellowship, however, as it extends training time without being necessary for success.

ICU Experience to Pursue Critical Care

The primary focus in residency should be on EM education. To be a successful critical care fellow, you should first build a strong foundation with EM residency. Time spent in the ICU during residency varies across programs, and can vary from 16-34 weeks depending on the residency. If your program has less dedicated ICU time, consider spending additional elective time or shadowing in the ICU.