Critical Care Service
Education
Research
Fellowship Structure

GENERAL DESCRIPTION

The Internal Medicine Fellowship in Critical Care at St. Vincent's Hospital and Medical Center of New York is a 24-month training program.  Its primary goal and objective is to provide trainees with the cognitive and procedural skills required to care for the critically ill.  Five fellows are accommodated for 2-year periods.  Accommodation is made for trainees who have already completed two years of training in another subspecialty of internal medicine, and who require only one year of CCM training.  Prerequisites for entry into the program include completion of an approved Internal Medicine residency and eligibility or certification by the American Board of Internal Medicine.

ST. VINCENT'S HOSPITAL AND ITS INTENSIVE CARE UNITS

Saint Vincent's Hospital is a 480-bed tertiary care acute care general hospital.  It is one of the three university hospitals of New York Medical College, and a voluntary hospital serving the Greenwich Village area and portions of Chelsea, the Bowery and other parts of southern Manhattan. 

St. Vincent's has a long tradition of involvement in Critical Care.  The hospital had one of the earliest horse-drawn ambulances in New York, and was one of the first to motorize soon after the turn of the century.  The first coronary care unit in New York and the first mobile coronary care unit in the United States were conceived in the 1960's by the late Doctor William J. Grace.  Two of the earliest critical care texts were authored by Saint Vincents physicians.  Moreover, five of the past presidents of the society of Critical Care Medicine spent major portions of their training and careers at Saint Vincents.

In keeping with this tradition, St. Vincent's critical care system has developed into eight full-time high-level units, and two major "step-down" units.  St. Vincent's special care areas have evolved to meet the particular needs of its specific patient populations and include over 50 beds.

THE CRITICAL CARE SERVICE

The Critical Care Service (CCS) is dedicated to the practice of multidisciplinary Critical Care Medicine.  The service has a long tradition at St. Vincent's Hospital and is an active participant in the management of patients in each of the adult intensive care units. A Critical Care fellowship has been in place since 1974.

Dr. Mark Astiz, Professor of Medicine, directs the four full time Critical Care trained faculty.  A primary care approach is espoused with fellows bearing primary responsibility for patient care in the assigned areas.  Fellowship rotations include:

1) Medical Intensive Care Unit - The MICU is an 8-bed unit directed by the CCS with approximately 650 admissions a year.  The average daily census varies between 10-15 patients. The severity of illness is high with an average APACHE-II score of 28.  A broad range of patients is admitted.  Care is directed by the fellow and housestaff team in concert with the Critical Care and primary medical attending.

2) Neurosurgical Intensive Care Unit - The NSICU is a 4-bed unit with approximately 200 admissions per year.  The case mix includes head trauma, subarachnoid hemorrhage and elective neurosurgical procedures for intracranial and spinal disorders.  The Critical Care Services co-manages these patients with the Neurosurgical team; specifically, the CS is responsible for all management of cardiopulmonary, metabolic and infectious complications.

3) Cardiothoracic Surgical Unit - The CTU consists of a 10-bed acute care unit. Approximately 400 cardiac procedures are performed a year.  The fellow rotates in the Cardiothoracic Service and is responsible for management under the auspices of the Cardiothoracic Surgery Attending.

4) Surgical Intensive Care Unit - The SICU is a 12-bed unit, including four dedicated trauma beds.  The CCS directs the unit.  An active surgical case load includes a variety of high-risk surgical procedures and a vigorous trauma service.  Care is directed by a surgical housestaff team and fellow in concert with the critical care attendings and primary surgical attending.

5) Coronary Care Unit - The CCU is a busy 12-bed unit with a 24-bed step down area.  Directorship is under the Section of Cardiology.  Saint Vincents is a major cardiac center with an active angioplasty program and an active electrophysiology program.  Fellows rotate into the CCU service and direct housestaff care in concert with the CCU and primary attendings.

6) Respiratory Care Unit - The RCU is a 10-bed unit directed by the CCS.  Patients requiring prolonged mechanical ventilation who are potential candidates for weaning are admitted from each of the adult special care units.  A high rate of success is enjoyed in this unit with nearly 70% of patients ultimately being weaned.  All cases are managed by the fellow directed housestaff and Critical Care attendings.

EDUCATION

The service is committed to fellowship training.  A multidisciplinary background in Critical Care Medicine is provided that will enable fellows to pursue positions of leadership in academic or clinical careers.  All rotations are supervised by an assigned Critical Care attending who rounds daily with the fellows.  Conferencing is held three times per week.  A core lecture series is presented over the first three months of the fellowship.  Subsequent conferences include a fellow-directed journal club, case conferences, MICU-SICU Committee meetings, question and answer secessions.

RESEARCH

Research participation is required of fellows participating in the two-year program.  Clinical and experimental opportunities are available.  A research program is designed with the program director. The goal is completion of a study that results in a presentation at a national meeting and a publication.  A fully equipped laboratory is dedicated to septic shock research.  Areas of interest include microvascular and metabolic aspects of septic shock.  In addition to the institutionally based trials, the Critical Services is an active participant in large multicentral trials involving novel therapies for septic shock.

FELLOWSHIP STRUCTURE

The initial year is unit-based, with core rotations through the MICU, CTU, SICU/NSICU and RCU.  Elective rotations also include the Anesthesiology, Non-Invasive Cardiology and the CCU.  The second year contains 4 months of clinical experience, with the remaining portion of the year dedicated to a research program selected by the fellow and program director.  Call is inhouse every sixth to seventh night for each of the two years.  A month for vacation is included in each year.

HOW TO GET INFORMATION

To obtain more information regarding our program, please write or email to:

Mark E. Astiz, M.D., Program Director
Section of Critical Care Medicine
Coleman 1050 East
Saint Vincent Catholic Medical Centers
St. Vincent's Manhattan
170 West 12th Street
New York, NY   10011
mastiz@svcmcny.org

or call Ms. Diane Mizrach, Secretary to the Section of Critical Care Medicine, at (212) 604-8336