Critical Care Medicine Fellowship

Welcome to the Critical Care Medicine Fellowship Program of the Department of Anesthesiology of The University of Texas Medical School at Houston.

Introduction

The sections below contain an overview of our program, faculty, and facilities as well as the fellow’s responsibilities and evaluation criteria. The resources at the disposal of our fellows are considerable. There is computer access to the University of Texas MD Anderson Cancer Center (UTMDACC) library, on-line journals, PubMed, medical texts, and pharmaceutical databases as well as all laboratory data and a variety of scan images available on our new electronic medical records system. Our ICUs are staffed by a multidisciplinary team of physicians, ethicists, pharmacists, dieticians, physiotherapists, respiratory technicians, advanced nurse practitioners, physician assistants, and medical students. It is our hope that you will consider becoming a part of our dynamic critical care team.

The faculty help guide and instruct our fellows to develop the clinical judgment and advanced skills necessary to perform as an attending intensivist upon completion of this program. We also encourage our fellows to take advantage of the many opportunities for research and publications during their fellowship year. It is our objective to train the future leaders in the field of Critical Care Anesthesiology, and we openly invite you to be a part of that exciting future.

Application: Critial Care Medicine Fellowship Program Online Form

The Texas Medical Center

The Texas Medical Center (TMC) is the largest medical center in the world. The TMC is formed of 49 institutions that include 14 renowned hospitals, three medical schools, six nursing schools, and schools of dentistry, public health, and pharmacy among others. The TMC encompasses more than 1,000 acres and consists of more than 162 buildings, 33.8 million gross square feet of patient care, education, and research space (approximately the size of Chicago inside the “Loop”). There are 6,800 patient beds and more than 6 million total patient visits per year with 18,000 patients coming from outside the country; there are 153,000 surgeries performed annually. More than 93,500 people work in the TMC, which has an annual regional economic impact of $14 billion. The TMC is also a worldwide leader in research with more than $1.8 billion in annual research expenditures. There is not a better place in the country to be challenged every day and start your career.

Clinical and Educational Facilities at UTHealth/UTMDACC

The Critical Care Medicine Program has seven intensive care facilities disseminated in the Texas Medical Center. At Memorial Hermann-Texas Medical Center our fellows can rotate through the Shock-Trauma Intensive Care Unit (STICU), the Neurotrauma Intensive Care Unit (NTICU), the Burns ICU, the Transplant ICU, and the Pediatric ICU. At MD Anderson Center our fellows rotate through the Surgical and Medical ICUs (52 beds). Among them the trainees have a total of more than 100 beds and more than 25 ICU attendings. The ratio of attendings to fellows (>10:1) is greater than the minimum required by the ACGME (1:1), and our attending physicians are available 24 hours a day.

All of our ICUs have a ratio of 1:1 and 1:2 nurses per patient depending on the severity of the illness. A number of technicians and respiratory therapists at all levels are available to assist our fellows in the management of these critically ill patients. State of the art equipment (Transcranial Doppler, Lithium dilution cardiac output, and Esophageal Doppler for continuous cardiac output monitoring, Xe-CT scan, Thromboelastogram, etc.) is available in all the units, and technical support is readily available to support any equipment malfunction. All the laboratory facilities supporting the management of critically ill patients are available 24 hours a day, including toxicology, blood gases, and chemistries, as well as radiological facilities including CT, Angiography, and MRI. Multiple consult services are available around the clock (e.g., nephrology, cardiology, infectious diseases, etc.) to ensure that every possible resource is in place to maximize our patient outcomes.

There are numerous library facilities in the Medical School and at the Texas Medical Center Jesse Jones Library; Pub Med service and access to on-line textbooks are available via remote access with an active library account (provided to all fellows). Additionally, study materials for board preparation are provided to our fellows at the beginning to the fellowship along with a curriculum dedicated to ensuring passage of the critical care boards on the first attempt. The didactic program for our fellows include lectures given by our staff as well as multidisciplinary lectures given in conjunction with other critical care fellowships in the medical school.

Memorial Hermann-Texas Medical Center

Memorial Hermann-Texas Medical Center (MH-TMC) was established in 1925 and was the first hospital to open in the Texas Medical Center. MH-TMC is one of only two adult Level 1 trauma centers and the only pediatric trauma center in the City of Houston. MH-TMC is part of the Memorial Healthcare System, the largest not-for-profit hospital system in Texas, which provides health care through its more than 11 hospitals across the Houston area. It is also the primary teaching hospital of The University of Texas Health Science Center at Houston (UTHealth). MH-TMC has a capacity of more than 600 beds (818 licensed beds), more than 30% of which are ICU beds. Medical care is provided for 15,000 patients per month and more than 40,000 trauma cases per year. Memorial Hermann Life Flight air ambulance services operate a fleet of six helicopters providing emergency rescue and air transport services to a 150 mile radius around Houston. As the primary teaching hospital for The University of Texas Medical School at Houston, MH-TMC provides comprehensive services in surgery, internal medicine, anesthesiology, obstetrics, and cardiology as well as cutting-edge research in a variety of medical specialties. There are multiple ICUs at Memorial Hermann-Texas Medical Center, including the Neuro-trauma, Burn, Cardiovascular, Transplant, Pediatric, and Shock-Trauma Intensive Care Units.

Shock Trauma Intensive Care Unit, Memorial Hermann-Texas Medical Center

The Shock Trauma ICU (STICU) at Memorial Hermann-Texas Medical Center is a 25-bed ICU that admits patients 14 year and older. The STICU supports our level one trauma center and life flight service that cares for over 40,000 trauma victims per year. The patients admitted to the STICU have suffered some form of trauma or are general surgery, orthopedics, otolaryngology, obstetrics/gynecology, or oral-maxillofacial surgery patients.

The STICU team acts as a consultant service. It consists of a board certified critical care attending (surgery), a critical care fellow (either surgery or anesthesiology), a PGY-2, 3, or 4 anesthesiology resident, a PGY-2 surgery resident, a PGY-1 anesthesiology resident, and PGY-1 surgery resident. The team may also include fourth-year medical students. The critical care fellow is expected to perform as a junior attending on this service.

MDACC ICU ROTATIONS

MD Anderson Cancer Center is a world-renowned cancer research and treatment hospital and referral center. MD Anderson received US News & World Report’s #1 ranking among cancer hospitals in 2010. Patients come to MD Anderson from around the world seeking the most current and aggressive treatment possible for their malignancies. Many patients are enrolled in investigational/research protocols. The cancers and many of their treatments are associated with significant end-organ side effects that require intensive care management. Adverse sequelae related to treatment, combined with the morbidity associated with the tumors alone, provide for very complex patient management opportunities and a very exciting place to learn and work.

Both surgically and medically critically ill patients are admitted to the ICU in MD Anderson. Surgical patients admitted to the ICU are usually recovering from surgical interventions for their cancer. Given the complex nature and often-advanced state of many of the cancers our surgeons treat, these patients frequently suffer significant postoperative organ dysfunction and need aggressive interventions to manage and prevent organ failure. As a fellow you will have the opportunity to work with world-renowned surgeons from all surgical disciplines and are expected to coordinate the care of their patients with the primary team and other consultants.

Medical patients admitted to the ICU have cancers that are not amenable to operative intervention. This may be due to the advanced state of their cancer or because their cancer is better managed with chemotherapy and/or radiation therapy. These patients often suffer significant morbidity due to the advanced nature of their cancer or because of the side effects of chemotherapy and radiation therapy and need aggressive interventions. You will have the opportunity to work with world-renowned medical oncologists and coordinate the care of these critically ill patients.

The intensive care units are staffed by board certified/eligible critical care anesthesiologists, pulmonologist, and surgeons who are readily available and eager to instruct you in the science and art of critical care. As the fellow you will be part of a multidisciplinary team that includes anesthesiology residents, medical students, ethicists, pharmacists, dieticians, physiotherapists, respiratory technicians, advanced nurse practitioners, and physician assistants.

In 1999 The University of Texas MD Anderson Cancer Center opened its newest building, the Alkek Hospital. The entire seventh floor of this new structure houses the 54-bed, state-of-the art intensive care unit. Generous financial support from MD Anderson Cancer Center and an administration that believes in practicing on the cutting edge of critical care ensures that we have the latest technology available in our ICUs.

PDF: Fellowship Objectives

Research Facilities

The intensive care units have an excellent patient base and support personnel for research. Many clinical studies are in progress. The large number of patients with very interesting pathologies not only allows for experience, but the ability to complete studies in short periods of time. Our attending physicians are research oriented with projects under way in the ICU and laboratories of the Department of Anesthesiology. Numerous papers based on models of tissue ischemia, coagulation, sepsis, circulation, new modes of ventilation, etc., have been published by our faculty.

We strive to provide an outstanding clinical and educational experience for our fellows. Please do not hesitate to contact us with any questions that you may have about our program or the application process!

Application: Critial Care Medicine Fellowship Program Online Form

Gregory H. Botz, MD, FCCM
Program Director, Critical Care Medicine Fellowship
Professor of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center
The University of Texas Medical School at Houston

George Williams, MD
Assistant Program Director, Critical Care Medicine Fellowship
Assistant Professor of Anesthesiology
Assistant Professor of Neurosurgery, Division of Neurocritical Care
The University of Texas Medical School at Houston