The Washington University Anesthesiology Critical Care Medicine Fellowship offers multidisciplinary training at one of the nation’s consistently ranking top-10 leading academic medical centers. The 12-month program is dedicated to preparing outstanding intensivists for rewarding careers in critical care medicine and provides comprehensive training in a supportive and stimulating environment.

Fellows spend at least nine months receiving clinical training in our various high acuity ICUs. The remaining three months are spent gaining focused expertise in a wide selection of areas (view 2019-2020 Didactics and Elective Options) and pursuing mentored projects in basic or clinical research. Critical care fellowship applicants must be board-eligible in anesthesiology, surgery, obstetrics, or emergency medicine. The Accreditation Council for Graduate Medical Education (ACGME) has approved the program since its inception (over 25 years ago).

Washington University School of Medicine in St. Louis also offers critical care fellowship programs in surgery, pulmonary medicine, pediatrics and neurology/neurosurgery. The institution’s breadth of expertise in critical care medicine provides a rich learning environment for all of its critical care fellows.

Home base – the critical care units

Barnes-Jewish Hospital is a quaternary referral center, level 1 trauma center, and stroke center of excellence that is consistently ranked among the top hospitals in Missouri and the U.S. BJH has a broad catchment area and an enormous scope of influence over medical care in the Midwest. Our patient base is largely made up of patients from Missouri and parts of every bordering state: Iowa, Illinois, Kentucky, Tennessee, Arkansas, Oklahoma, Kansas, and Nebraska.

The trauma, burn, and surgical intensive care unit (SICU) is a closed ICU that comprises 36 beds allocated to an array of critically ill or injured surgical patients requiring pre-operative stabilization, post-operative intensive care after elective or emergency surgery, or critical care following complications of surgical illnesses. Patients admitted to the SICU arrive from all of the surgical subspecialties, thus providing a broad base of experiences to trainees. We also boast a robust trauma and transplant experience. We provide a high-intensity staffing model with in-house attending physicians available 24-7. Our multi-professional model encompasses critical care nursing, pharmacy, respiratory therapists, therapy services, and patient care providers as valued ICU team members. Our multidisciplinary intensivist faculty have a national presence in research, advocacy, and education.    

Our CCM fellows also spend a significant portion of their time in our state-of-the-art cardiothoracic intensive care unit (CTICU), a 30-bed unit devoted to the perioperative care of a diverse mix of routine and complex cardiac and thoracic surgical patients. Among other strengths, we have world-class lung transplantation, cardiac transplantation, ventricular assist device, extracorporeal support (ECMO), complicated valvular repair and replacement, and aortic repair programs.

Fellows also spend time rotating in our academic medical ICU, dedicated surgical oncology ICU, and one of our large high acuity community mixed ICUs. This broad exposure ensures trainees will see the spectrum of critical care medicine pathology during their fellowship. Our goal is to create board-certified, well-rounded intensivists.

Other intensive care units that play a significant role in our fellowship training include neurology and neurosurgical ICUs, oncology ICUs, coronary care unit, progressive care ventilator rehabilitation unit, emergency department trauma and critical care unit, and the pediatric ICU at Saint Louis Children’s Hospital.

The educational curriculum – foundation and innovation

Our goal is to train fellows that are future leaders in the specialty of critical care medicine, and a multi-faceted didactic program underlies that goal. Our weekly multidisciplinary critical care lecture series (MDCCLS) provides the foundation for a strong base of knowledge. Attending faculty speakers from various disciplines participate, delivering a distillation of the most current thinking in all facets of critical care medicine. We also have a weekly Fellows Critical Care Lecture Series (FCCLS) with speakers from our own Division of Critical Care (view the 2019-2020 Master Lecture Schedule). As part of the FCCLS, each fellow gives two lectures per year on the topics of their choice.

In order to ensure successful board certification post graduation, we provide a robust CCM written board review lecture series. This also includes an in-service practice training exam during your fellowship year. Our goal is to provide trainees with all of the tools needed to become board-certified intensivists. 

We have also developed a formal CCM ultrasound course aimed at preparing fellows for board certification in Advanced Critical Care Echocardiography now offered by the National Board of Echocardiography.  Our CCM point of care ultrasound curriculum includes hands on scanning, didactics, and case-based lecture review.  We also have opportunities with transesophogeal echocardiography (TEE) through a dedicated rotation, case-based lectures series, and simulation with our state of the art TEE simulator.

At our monthly journal club and research-focused lectures, both faculty members and fellows participate in lively discussions inspired by the most current literature.

Our monthly clinical outcomes and unit-based quality Improvement meetings flush out the administrative component of training. These settings provide a forum to discuss patient safety and opportunities to improve our delivery of critical care medicine.  Each fellow will be responsible for the completion of a quality improvement project which will often lead to publication opportunities.

Innovations in the education of our fellows are constantly being explored and expanded. Currently we are collaborating with the nationally recognized Clinical Simulation Center at the Washington University School of Medicine to develop novel approaches to fellow, resident, and medical student education. We host hands-on procedural labs to round out exposure to all aspects of critical care (ventilator rounds, surgical airway lab, REBOA lab, etc). Additionally, we have a web-based critical care library (journal resources and taped lectures) that provide our fellows with a consistently up-to-date, accessible learning resource.

Research and national opportunities – mentorship on the cutting edge

The Department of Anesthesiology is a national leader in research. We ranked second among departments of anesthesiology nationwide with over $12.7 million in National Institutes of Health funding in 2017. The School of Medicine ranked fourth in NIH funding with over $410 million awarded in 2017.

Clinical and basic science investigations occur in all of the subspecialty areas, and many include partnership with experts in other disciplines such as cardiology, hematology or endocrinology. Fellows are offered mentorship in developing their own research projects, as well as encouraged to participate in ongoing research projects. All research seminars and research conferences are open to our fellows, and our monthly clinical research group is a valuable source of project development ideas.

We value national involvement and all CCM fellows receive membership in the Society of Critical Care Medicine (SCCM) and the Society of Critical Care Anesthesiologists (SOCCA).  Fellows have access to discretionary funds to facilitate attendance at national meetings.

Putting it all together

Critical care medicine is a rapidly advancing subspecialty, and the Multidisciplinary Critical Care Fellowship Program at Washington University and Barnes-Jewish Hospital provides innumerable opportunities to help shape the future of the field.  Our fellowship program has trained almost 200 intensivists over the past 25 years. We hope that you will contact us to further explore our exciting program and the incredible city of St. Louis.