scholarly journals Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel J. Minter ◽  
Sean D. Levy ◽  
Sowmya R. Rao ◽  
Paul F. Currier
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Career Choice ◽  
The United States ◽  
Fellowship Training ◽  
Critical Care Medicine ◽  
Residency Programs ◽  
Medical Icus ◽  
Sponsored Programs ◽  
Residency Program Directors

Background. The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM). Methods. We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM. Results. Of the 249 PDs contacted, 107 (43%) completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05), primary medical ICUs (63.9% versus 41.3%, p=0.03), and closed staffing models (88.5% versus 41.3%, p<0.001). Residents from university-sponsored programs were more likely to pursue specialty fellowship training (p<0.001) overall but equally likely to pursue careers in PCCM as those from community-sponsored programs. Factors predictive of residencies with a higher percentage of graduates pursuing training in PCCM included larger ICUs (>20 beds), residents serving as code leaders, and greater proportion of graduates pursuing specialization. Conclusions. While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.

FELLOWSHIP TRAINING IN ADULT CRITICAL CARE MEDICINE IN THE UNITED STATES AND CANADA

1979 ◽  
Vol 7 (3) ◽  
pp. 140
Author(s):  
Dennis M. Greenbaum ◽  
Robert S. Dobrin ◽  
Eric Rackow ◽  
Henning Pontoppidan ◽  
Robert F. Wilson
Keyword(s):  
United States ◽  
Critical Care ◽  
The United States ◽  
Fellowship Training ◽  
Critical Care Medicine

scholarly journals Critical Care Education During Internal Medicine Residency: A National Survey

2010 ◽  
Vol 2 (4) ◽  
pp. 555-561 ◽  
Author(s):  
Khalid F. Almoosa ◽  
Linda M. Goldenhar ◽  
Jonathan Puchalski ◽  
Jun Ying ◽  
Ralph J. Panos
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Critical Care ◽  
Intensive Care ◽  
Teaching Methods ◽  
The United States ◽  
Internal Medicine Residency ◽  
Critical Care Medicine ◽  
Internal Medicine Residents ◽  
Medicine Education

Abstract Background Current training practices and teaching methods for critical care medicine education during internal medicine residency have not been well described. This study explored critical care medicine education practices and environments for internal medicine residents in the United States. Methods A web-based survey recruited Pulmonary and Critical Care Medicine fellowship program directors involved with internal medicine residency programs at academic institutions in the United States. Results Of 127 accredited Pulmonary and Critical Care Medicine programs in 2007, 63 (50%) responded. Demographics of the intensive care units varied widely in size (7–52 beds), monthly admissions (25–300 patients), and presence of a “night float” (22%) or an admissions “cap” (34%). All programs used bedside teaching, and the majority used informal sessions (91%) or didactic lectures (75%). More time was spent on resident teaching in larger (≥20 bed) medical intensive care units, on weekdays, in programs with a night-float system, and in programs that suspended residents' primary care clinic duties during their intensive care unit rotation. Conclusions Although similar teaching methods were used within a wide range of training environments, there is no standardized approach to critical care medicine education for internal medicine residents. Some survey responses indicated a correlation with additional teaching time.

Entrustable Professional Activities and Curricular Milestones for Fellowship Training in Pulmonary and Critical Care Medicine

2014 ◽  
Vol 42 (10) ◽  
pp. 2290-2291 ◽  
Author(s):  
Henry E. Fessler ◽  
Doreen Addrizzo-Harris ◽  
James M. Beck ◽  
John D. Buckley ◽  
Stephen M. Pastores ◽  
...  
Keyword(s):  
Critical Care ◽  
Fellowship Training ◽  
Critical Care Medicine ◽  
Entrustable Professional Activities ◽  
Professional Activities

Guidelines for the Management of Intravascular Catheter-Related Infections

2001 ◽  
Vol 22 (4) ◽  
pp. 222-242 ◽  
Author(s):  
Leonard A. Mermel ◽  
Barry M. Farr ◽  
Robert J. Sherertz ◽  
Issam I. Raad ◽  
Naomi O'Grady ◽  
...  
Keyword(s):  
Critical Care ◽  
The United States ◽  
Underlying Disease ◽  
Critical Care Medicine ◽  
Intravascular Catheter ◽  
Coagulase Negative Staphylococci ◽  
Pulmonary Artery Catheters ◽  
Potential Pathogen ◽  
Adults And Children ◽  
Healthcare Epidemiology

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.

scholarly journals 53. A Descriptive Analysis of Air Medical Directors in the United States

1996 ◽  
Vol 11 (S2) ◽  
pp. S44-S44
Author(s):  
Kathy J. Rinnert ◽  
Ira J. Blumen ◽  
Michael Zanker ◽  
Sheryl G. A. Gabram
Keyword(s):  
Internal Medicine ◽  
United States ◽  
Emergency Medicine ◽  
Critical Care ◽  
Descriptive Analysis ◽  
The United States ◽  
Air Transport ◽  
Medical Services ◽  
Medical Directors ◽  
Mission Profile

Purpose: The practice of helicopter emergency medical services is variable in its mission profile, crew configuration, and transport capabilities. We sought to describe the characteristics of physician air medical directors in the United States.Methods: We surveyed medical directors concerning their education, training, transport experience, and roles/responsibilities in critical care air transport programs.Results: Two page surveys were mailed to 281 air medical services. Three programs merged or were dissolved. Data from 122/278 (43.9%) air medical directors were analyzed. One-hundred eleven respondents reported residency training in: Emergency Medicine (EM) 44 (39.6%), Internal Medicine (IM) 18 (16.2%), General Surgery (GS) 18 (16.2%), Family Practice (FP) 12 (10.8%), dual-trained (EM/IM, EM/FP, IM/FP) 11 (9.9%) and others 8 (7.2%). Medical directors’ roles/responsibilities consist, most frequently of: drafting protocols 108 (88.5%), QA/CQI activities 104 (85.3%), crew training 98 (80.3%), and administrative negotiations 95 (77.7%).

Variability in Critical Care–Related Charge Markups in Medicare Patients

2018 ◽  
Vol 84 (10) ◽  
pp. 1622-1625 ◽  
Author(s):  
Joshua Tseng ◽  
Harry C. Sax ◽  
Rodrigo F. Alban
Keyword(s):  
Internal Medicine ◽  
Critical Care ◽  
Endotracheal Intubation ◽  
Chest Tube ◽  
Critical Care Medicine ◽  
Tube Placement ◽  
Arterial Line ◽  
Fee For Service ◽  
Related Services ◽  
Line Placement

Charge markups for health care are variable and inflated several times beyond cost. Using the 2015 Medicare Provider Fee-For-Service Utilization and Payment Data file, we identified providers who billed for critical care hours and related procedures, including CPR, EKG interpretation, central line placement, arterial line placement, chest tube/thoracentesis, and emergent endotracheal intubation. Markup ratios (MRs), defined as the amount charged divided by the amount allowable, were calculated and compared; 42.1 per cent of physicians billing for critical care–related services were specialized in emergency medicine (EM). EM had the highest overall MR (median 4.99, IQR 3.60–6.88) and provided most of the services. MRs differed between genders in select cases (critical care hours: anesthesiology, EM, internal medicine, pulmonary and critical care medicine; CPR, pulmonary and critical care medicine; chest tube placement/thoracentesis, internal medicine). These differences in MR did not correspond to higher rates of Medicare allowable amounts ( P = NS). In conclusion, charge markups significantly varied by physician specialty. EM physicians had the highest MRs for most critical care–related services, including critical care hours, EKG interpretation, CPR, central venous line placement, and emergent endotracheal intubation. EM physicians also provided most of these services. Charge markups are associated with adverse consequences and represent potential targets for cost containment and consumer protection.

Anesthesiology Critical Care Medicine Fellowship Training

1995 ◽  
Vol 81 (3) ◽  
pp. 441-445 ◽  
Author(s):  
Daniel P. Stoltzfus ◽  
Charles B. Watson ◽  
Marianne C. Ries
Keyword(s):  
Critical Care ◽  
Fellowship Training ◽  
Critical Care Medicine
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