Critical Care Medicine Fellowship

Welcome to the Orlando Health’s Critical Care Medicine (CCM) Fellowship Program at Orlando Regional Medical Center (ORMC). We are pleased that you are considering this program. Our fellowship received initial accreditation from the Accreditation Council for Graduate Medical Education (ACGME) in 2010.
Our fellowship’s mission is to produce the finest Intensivists who are able to excel in a wide range of post fellowship careers including clinical, academic, and/or research positions. We provide comprehensive clinical training including specialized rotations in Trauma/Surgical, Neurosurgical, and Obstetrical Critical Care. We have focused rotations in Point-of-Care Ultrasound, Advanced Bronchoscopy, Pharmacodynamics & Therapeutics, Critical Care Nutrition, Anesthesia and many others. We offer up to 10 months of dedicated research and elective time. We work closely with the other Internal Medicine Subspecialty Fellowships at ORMC including Pulmonary, Infectious Diseases, Hematology/Oncology, and our new Cardiology Fellowship (starting Academic Year 2017).
Orlando Regional Medical Center is an 808-bed academic community hospital. Orlando Health has 7 residency programs and 17 fellowship programs. ORMC is a Level One Trauma Center and a JCAHO-certified Comprehensive Stroke Center with advanced neurointerventional capabilities. Our campus has a large academic cancer center and large women’s hospital with dedicated ICU for high-risk obstetrical care and advanced gynecologic cancer care.
Orlando is much more than beautiful weather, tourists, and theme parks. We have a growing arts scene and a new state-of-the-art performing arts center. We have professional sports teams with multiple sporting venues. The natural beauty of Florida cannot be compared. We are surrounded by numerous lakes, fresh-water springs, and biking/hiking trails. Orlando is 90 minutes from our closest beach.
We accept Internal Medicine and Emergency Medicine Physicians who are board-eligible or board certified. Consistent with ACGME requirements, our program requires you to complete 1 or 2 years of training based any previous Fellowship training. We are looking for dynamic people who are excited about working in a multidisciplinary team environment.
Throughout this site, you’ll find descriptions of the program, participating hospitals, application materials, and program requirements.
If you have questions, please contact Daisy Gomez, Fellowship Coordinator, at Daisy.Gomez@orlandohealth.com or call 321.843.5172.

We look forward to receiving your application through Electronic Residency Application Service (ERAS).

Sincerely,
Timothy W. Jones, MD
CCM Program Director

Core Curriculum

The mission of the Critical Care Medicine Fellowship Program is to provide a balanced program of clinical, academic and investigative experience. Our goal is to train and develop physicians in the management of acute care conditions. Graduating intensivists will be able to excel in either private practice, public and/or academic teaching hospitals. Our full-time attending physicians are dedicated to directly supervising each fellow’s training experience. The program is structured so fellows have extensive one-on-one contact with faculty. Significant emphasis is placed on ongoing educational opportunities where faculty and fellows work together to explore and resolve clinical problems.

The Clinical Training Program

Orlando Health’s Critical Care Medicine Fellowship Program is accredited by the ACGME for subspecialty training in the management of acute care illnesses. This program will lead to eligibility for board certification in Critical Care Medicine by the American Board of Internal Medicine (ABIM) or American Board of Emergency Medicine (ABEM). The duration of this training program is 1 or 2 years depending on previous ACGME-accredited Fellowship Training.
Clinical training for Critical Care Medicine Fellows focuses on an in-depth clinical experience that utilizes a multidisciplinary approach to the care of critically-ill patients. Faculty members share in caring and managing each patient and provide direct supervision to fellows.
This is a sample schedule for the 2-year fellowship. (If you qualify for a 1-year fellowship, then this example would not apply.)
PGY 4
Medical ICU/Coronary Care Unit – 6 months
Neuro ICU/Women’s ICU – 1 month
Surgery/Trauma Critical Care – 1 month
Research/Elective -- 4 months
PGY 5
Medical ICU/Coronary Care Unit – 4 months
Neuro ICU/Women’s ICU – 1 month
Surgery/Trauma Critical Care – 1 month
Research/Elective – 6 months

Electives (others electives are possible if requested):
• • Research
• Independent Study
• ICU Administration and Quality Improvement
• Critical Care Pharmacodynamics
• Critical Care Nutrition
• Point-of-Care Ultrasound
• Pulmonary
• ECMO (at Florida Hospital Orlando)
• Infectious Diseases
• Nephrology
• Advanced Bronchoscopy
• ICU Telemedicine
• Transition to Clinical Practice
• VAMC ICU (Veterans Affairs Medical Center Orlando)
Clinical Responsibilities

During a 2-year training program, fellows spend a total 14 months in the ICU setting (Medical, Cardiac, Surgical/Burn/Trauma, Neuro, and Women’s ICUs). Fellows take responsibility of assigned patients, participate in daily multidisciplinary teaching rounds, perform procedures, participate in daily family rounds, admit patients to the ICU, and provide critical care consultative services. Through graduated levels of responsibility, fellows begin to lead the multi-disciplinary team, which includes residents, nurses, respiratory therapists, clinical pharmacists, nutritionists, rehabilitation services, and students.

On-call ICU Coverage

Fellows cover the ICU in 12-hour shifts. Fellows perform in-house overnight call using a night float system. There is in-house board-certified critical care attending physicians available to the fellow at any time. In the ICU, fellows do not take home call. When fellows are not on-call in the ICU at night or over the weekend, then they have no responsibilities for patient coverage. We strictly monitor work-hours and duty-free hours to abide by ACGME requirements.

Conferences/Educational Activities

Critical Care Medicine Grand Rounds
CCM Grand Rounds is a weekly didactic lectures series led by CCM Faculty, other specialists, and Fellows. Lectures cover various topics across all of Critical Care Medicine. There is a focus to understand sentinel research articles in the topic, how they should be applied to current care, current evidence-based guidelines, and any literature updates since the guidelines were published.

CCM Journal Club
CCM Journal Club is a monthly meeting to discuss recent advances in the peer-reviewed medical literature, apply critical analysis of the study, and discuss the clinical significance. This is presented by a Fellow with Faculty mentorship. Often the discussion leads to academic debate among CCM Faculty and Fellows.

CCM / Infectious Diseases Clinical Case Conference
CCM / ID CCC is a case-based conference presented by the CCM Fellows and the ID Fellows. Each month a Fellow from each service presents a clinical case with following didactic lecture discussing evaluation and management of various topics.   

CCM / Surgical Critical Care Clinical Case Conference
CCM / SCC CCC is a case-based conference presented by the CCM Fellows and the SCC Fellows. Each month a Fellow from each service presents a clinical case with following didactic lecture discussing evaluation and management of various topics.   

CCM Morbidity and Mortality Conference
CCM M & M is a monthly conference led by Fellows in which we reflect and discuss individual cases or series of cases. The purpose is to learn from complications and errors, to modify our practice based on previous experiences, and prevent future errors leading to complications. CCM M&M occurs in a non-judgmental, non-punitive academic environment.

CCM Research and Quality Improvement Conference
CCM Research & QI Conference is a monthly conference in which the Fellows discuss the current state of their projects and what they intend to do over the next month to advance their project. Faculty members are present to provide mentorship and guidance. Discussion often involves understanding the practicalities of performing clinical research, understanding the IRB, and statistics.

Radiology Conference
Radiology Conference is a monthly didactic lecture given by Radiology Faculty discussing imaging modalities used in Critical Care Medicine, common and pathognomonic findings, and their clinical significance. Current images from ICU patients may be used to exemplify teaching points.
Simulation Sessions
Orlando Health Medical Education Center for Simulation Based Training is a multi-million dollar facility that is open 24-hours per day and available to all Fellows for open learning. Faculty lead simulation sessions to train fellows in various clinical scenarios and procedures. Fellows learn how to recognize and manage critical situations in a low risk environment to later apply in high-risk situations. We have numerous simulators from procedures, including intubation, critical airway management, bronchoscopy, central lines, chest tubes, and others. Faculty members also provide simulation in other settings such as “Breaking Bad News” to patients or families.

Other Fellowship Didactic Lecture Series: Pulmonary, Cardiology, Hematology/Oncology
CCM Fellows regularly attend didactic lectures given in other ORMC Fellowship Programs. For example, CCM Fellows may attend a Hematology/Oncology Fellowship lecture about “Acute Hemolytic Anemias,” a Cardiology Fellowship lecture on “Acute Management of Congestive Heart Failure,” or a Pulmonary Fellowship lecture on “Hospital Management of COPD Exacerbations.”

Courses and Meetings

CCM Fellows will become members of the Society of Critical Care Medicine (SCCM) and American College of Chest Physicians (ACCP). A small stipend is given to join other professional societies or to travel to one national meeting per year to present a poster or abstract. CCM Fellows take Critical Care Medicine In-Service Training Examinations from both the Association of Pulmonary Critical Care Program Directors (APCCMPD) and SCCM.

Facilities

Orlando Health is one of Florida's most comprehensive private, not-for-profit healthcare networks. Orlando Health is a distinguished healthcare leader for nearly 2 million Central Florida residents and 4,500 international visitors annually. We care for over 100,000 inpatient admissions and nearly 900,000 outpatient visits each year. Orlando Health is a $2.8 billion not-for-profit health care organization and a community-based network of physician practices, hospitals, and outpatient care centers throughout Central Florida. Additionally, Orlando Health provides more than $204 million in support of community health needs.

Orlando Health has multiple inpatient facilities, including: Orlando Regional Medical Center; Dr. P. Phillips Hospital; South Seminole Hospital; Health Central Hospital, the Arnold Palmer Medical Center, which consists of Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies; South Lake Hospital (50 percent affiliation); and St. Cloud Medical Center (20 percent affiliation). More than 2,000 physicians have privileges at Orlando Health, which is also one of the area’s largest employers with more than 18,000 employees.

Orlando Health has 7 residency programs and 17 fellowship programs with 119 Faculty and 257 Residents/Fellows.

Residencies

• Emergency Medicine
• Internal Medicine
• OB-GYN
• Orthopedic Surgery
• Pathology
• Pediatrics
• Surgery

Fellowships

• Critical Care Medicine
• Pulmonary Diseases
• Infectious Diseases
• Cardiology (starting 2017)
• Hematology/Oncology
• EM Administrative/Research
• Emergency Medical Services
• EM Ultrasound
• Pediatric Orthopedics
• Orthopedic Trauma
• Pediatric Emergency Medicine
• Pediatric Gastroenterology, Hepatology, and Nutrition
• Primary Care Sports Medicine
• Sports Medicine
• Colon & Rectal Surgery
• Surgical Critical Care
• Acute Care Surgery

Medical students from universities across the country, including Florida State University, University of Florida and University of South Florida, come to ORMC to complete their medical education and training.

Orlando Regional Medical Center (ORMC) is our main academic teaching hospital where the vast majority of Critical Care Medicine training will occur. In 2017, ORMC opened a brand new patient tower with state of the art ICUs.

Orlando Health UF Health Cancer Center is a fully integrated statewide cancer treatment and research program with University of Florida Health. Our residents have the opportunity to participate in the medical care of patients with hematological and oncological diseases.

Winnie Palmer Hospital for Women & Babies is an Orlando Health hospital which is dedicated to the unique needs of women and babies. WPH has the 4th largest Neonatal ICU in the country and 12,000-15,000 deliveries per year. Our program covers the 5 bed Women’s ICU providing Obstetrical Critical Care in the peripartum period and Adult Critical Care for patients with advanced gynecologic cancer.

Research

Sepsis and Hemodynamics 

• Fluid Resuscitation and Rapid Response Teams in collaboration with Edwards Life Sciences using EV1000 and ClearSight System
• Predictive Analytics in the management of Hypotension

Delirium

• Early Mobility in ICU and Delirium
• “Feet on the Floor” mobility and Mechanical Ventilation Days
• Typical and Atypical Antipsychotics at QTc prolongation in Critically-ill Patients.

Interventional Pulmonary

• Endoscopic Lung Volume Reduction in COPD using endobronchial valves.

Previous Projects: The Oscillation for ARDS Treated Early Trial (Canadian Institute of Health Research – CIHR); H1N1 Double-blind randomized Phase III Drug Trial; Rapid Response Prediction Modelling in Collaboration with Rothman Healthcare; SAPS 3 validation

Vacation and Sick Leave

Each CCM Fellow is entitled to 3 weeks of paid vacation each year. All vacations must be scheduled in advance with the Program Director to provide appropriate coverage. No two fellows in the same year may take vacations at the same time unless approved by the Program Director.
In the event of illness, the CCM Fellow informs the Program Director of the problem. Coverage arrangements are made for unexpected absences.

Multi-disciplinary Team

Orlando Health is a comprehensive multidisciplinary medical center which has extensive ancillary services available. ICU patients are divided and distributed into several medical teams. Each team is lead and guided by an attending physician who is primarily responsible for the overall management decisions. The CCM Fellow assumes increasing responsibility for many of the day-to-day care issues as they advance in their training and education. Other team members include:
• Residents in Internal Medicine and Emergency Medicine
• Critical Care Nurses
• Registered Respiratory Therapists
• Clinical Pharmacist
• Nutritionist
• Medical Students

We do not want learners to be too overwhelmed by clinical responsibility such that learning suffers. We have several mid-level providers (ARNPs and PA-Cs) who have advanced training in the management of critically ill patients. These mid-level providers offer protected time during teaching rounds by covering morning admissions and consultations. They also round on a separate “non-teaching” service to provide an appropriate case-load for learners.

Application Information

What you need to know to apply
If you are interested in a fellowship in Critical Care Medicine, we invite you to apply through ERAS (Electronic Residency Application Service). ERAS is an internet based application process developed by the Association of American Medical Colleges to transmit fellowship applications, letters of recommendation, program director letters, medical transcripts and other supporting credentials from applicants, residency programs and medical schools to fellowship program directors using the internet. For information about the process or to register for ERAS online, visit www.aamc.org/eras.
Note: All qualified applicants are considered for interviews. However, the volume of applicants precludes us from offering interviews to all qualified candidates.