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Tips For Critical Care Anesthesiology (CCA) Fellowship

Critical Care Anesthesiology (CCA) is a one year fellowship following the completion of an anesthesiology residency. The application process is run by San Francisco Match (SFMatch) and begins in November of the applicant’s CA-2 year.

I’ve previously written about CCA from a fellow’s perspective, one point being that each year there are many unfilled positions. One can speculate why this is the case, but in the end, I think it boils down to the fact that many choose to pursue anesthesiology because they don’t enjoy continuity-of-care, multidisciplinary bedside rounds, note-writing, etc. There’s more liability and often times less compensation compared to working exclusively in the operating room. Consequently, the saying is that anesthesiologists have one reason to specialize in critical care – they really like critical care medicine. 🙂

With all that said, I have absolutely no regrets choosing to do a CCA fellowship. It reinforces the fundamental pathophysiology which I’ve always loved, and quite frankly, it also makes me a more versatile cardiothoracic anesthesiologist knowing how intraoperative decisions can affect postoperative care.

Here are some tips I’ve compiled for those embarking on a CCA fellowship.

PICK A TEXTBOOK

Have a goal to read a complete textbook of critical care during your fellowship. I read Vincent’s Textbook of Critical Care (affiliate link). In particular, I liked how the textbook broke down topics into short, digestible chapters. I read a few each week, and in addition to reading the literature (see below), I felt like I built a great foundation for my career as an intensivist. Check out my Amazon Store for other Anesthesia and ICU Book recommendations.

READ THE LITERATURE

The practice of critical care is extremely challenging. You’ll be taking care of the sickest patients. You’ll often see unusual presentations of common pathologies, ailments with conflicting treatments, and treatments with variable efficacy. Staying up to date with the literature is not only important to reinforce your general fund of knowledge, but also helps with research, journal clubs, and other presentations you may be asked to give.

Journals I regularly peruse: NEJM, Cochrane Library, JAMA Critical Care, The Lancet, Critical Care Medicine, CHEST Journal, Anesthesiology

I can’t stress the importance of reference management software to stay organized with the evidence. For Apple users, I strongly recommend Bookends, but there are plenty of other options out there (Endnote, Mendeley, Zotero, etc.) Download the PDF of the journal article, create categories within the reference manager, and build your library! This habit will serve you well for the rest of your career. 🙂

CRITICAL CARE ULTRASOUND (CCEeXAM)

The National Board of Echocardiography (NBE) Examination of Special Competence in Critical Care Echocardiography (CCEeXAM) is another facet of your critical care training to focus on. Log all of your ultrasound exams during fellowship (cardiac, lung, abdominal, vascular, etc.) as these will be necessary in addition to passing the written CCEeXAM. I’ve written about my impression of the exam and also shared some notes I created. Also, if you have an iPhone, be sure to check out my EchoTools app!

BOARD EXAM PREPARATION

The critical care anesthesiology written board exam was probably the most difficult exam I had taken. Compared to other exams, there really is no “consensus” on how to study for it like using First Aid for the USMLE Step 1 or PTE Masters for the advanced perioperative TEE boards. Much of the material I used was from SCCM and SEEK questions in addition to reading the ABA’s content outline. These days, there are some resources specifically catered for CCA such as Anesthesiology Critical Care Board Review (affiliate link).

LEARN FROM EVERYONE

You might be working alongside fellows with backgrounds in internal medicine, surgery, emergency medicine, as well as anesthesiology. You’ll certainly be within multidisciplinary teams consisting of nurses, respiratory therapists, pharmacists, case managers, social workers, dietitians, physical and occupational therapists, etc. Never miss a chance to pick an RT’s brain about ventilator settings… or have a dietitian walk you through TPN orders… or help a bedside ICU nurse turn a patient. Not only do you learn and foster teamwork, but you’ll also gain significant perspective and consideration for the efforts of your colleagues.

If you’ve completed or are enrolled in a CCA fellowship, drop me a comment below with your tips as well! 🙂

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