Critical Care Medicine has a long and proud history at The Johns Hopkins Hospital. Walter Dandy, M.D. developed the first Intensive Care Unit (ICU) in the world, a postoperative neurosurgical unit, at The Johns Hopkins Hospital in 1928. In 1958, our affiliate, Johns Hopkins Bayview Medical Center (then named the Baltimore City Hospital) opened the first integrated fully staffed ICU in the country. Today, the Johns Hopkins Hospital operates seven Adult ICUs, a Pediatric ICU, and a Neonatal ICU. Johns Hopkins Bayview Medical Center has five Adult ICUs and one Pediatric ICU. Many of these units have received both regional and international acclaim for their excellence. Although each unit is structured somewhat differently, all provide a formal educational experience for the individual interested in pursuing a career in critical care.

In the main building of the hospital center, a single floor has a dedicated critical care center having a combined capacity of nearly 100 beds for medical, neurological, pediatric, and surgical patients offers an opportunity for clinical experience unparalleled in the nation. The Weinberg Comprehensive Cancer Center , which is attached to the main building, houses an additional 20 bed ICU, 16 additional operating rooms, and the Oncology ICU. These are coupled with a dedicated research effort in basic cardiac, pulmonary, neurologic and metabolic aspects of intensive care in both the laboratory and patient areas. Equipment reflecting our commitment to these projects includes not only mass spectrometry, echocardiography, nuclear medicine equipment, bronchoscopy, high frequency ventilators and the like, but Departmental laboratories provide for the clinical measurements of everything from serum catecholamines to ionized calcium. A Center for Quality and Safety, which is directed by one our intensivists leads the nation in innovations that are significantly improving how critical care services are provided and the outcomes from critical illness and injury.

Many individuals come to the department with extensive previous training ranging from boards in other specialties to M.D./Ph.D. graduates who leave faculty positions to obtain training in Critical Care Medicine. This Department prides itself both in having the resources and the flexibility to design programs on an individual basis to meet the clinical and research expectations of these unusual and highly qualified men and women.

The Division of Adult Critical Care Medicine offers critical care medicine fellowship programs which meet all certification requirements of the American Board of Anesthesiology and which are accredited by the Accreditation Council for Graduate Medical Education (ACGME). An overriding principle behind these programs is that one does not specialize but "generalizes" in Critical Care Medicine. This multidisciplinary tenet resounds through all levels of these fellowship programs. These programs reflect our cross-disciplinary perspective on and highlight a significant commitment to critical care medicine as an independent subspecialty.

Our Mission [ Top ]

To provide an educational environment optimized for the development of clinician/basic science leaders in multidisciplinary critical care medicine
To build mastery in diagnosis and management of complex problems in critically ill patients
To acquire an appreciation for the depth and breadth of the specialty of critical care medicine including;

• Scientific principles
• Medico-legal issues
• Ethical dilemmas
• Administrative duties
• Educator responsibilities and benefits
• Performance Improvement;

To learn principles of study design and statistical analysis;
To appreciate the role of information management in the critical care setting;
To provide clinical and basic science research opportunities.

Integrated Fellowship [ Top ]

This program is an integrated fellowship with the Department of Surgery's Fellowship in CCM and utilizes all resources which presently reside at Johns Hopkins Hospital and its affiliate JHBMC. The core program is centered in a surgical intensive care environment including the Surgical Intensive Care Unit (SICU, 16-beds), the Weinberg Intensive Care Unit (Weinberg ICU, 20-beds), and the cardiac Surgical Intensive care Unit (15 beds). Patients, representing more than 9,000 patient-days, are admitted from the adult trauma, transplant, vascular, cardiac, thoracic, orthopedic, plastic, obstetric, gynecologic-oncology, endocrine and general surgical services. Additional rotations in the Medical ICU, Neurosciences Critical Care Unit, Neurovascular ICU and Pediatric ICU are routinely provided. Rotations through the Oncology ICU and the Burn ICU (JHBMC) are available for appropriate candidates. Electives are available in all medical subspecialties as well as Pulmonary Physiology, Echocardiography and Infection Control.

Faculty [ Top ]

The SICU, Weinberg ICUand Cardiac SICU are covered by 16 faculty members, all BC/BE in Critical Care Medicine. Primary appointments reside in the Departments of Anesthesiology and Critical Care Medicine (ACCM) and Surgery. These include:

Todd Dorman, M.D., FCCM Associate Professor Departments of Anesthesiology/CCM, Medicine, Surgery & School of Nursing Acting Associate Dean and Director, Office of CME Vice-Chair, Critical Care Services Medical Director, Johns Hopkins Critical Care Information Systems Chair, Critical Care Committee, Johns Hopkins Hospital Chair, CME Advisory Board, Johns Hopkins School of Medicine
Peter J. Pronovost, M.D., Ph.D., FCCM Director, Adult Critical Care Medicine Division Director, Cardiac Surgical Intensive Care Unit Associate Professor Department of Anesthesiology/CCM, Surgery, and Health Policy and Management Co-Chair Johns Hopkins Hospital Safety Committee Director, Johns Hopkins Center for Quality, Safety & Innovation	Bradford J. Winters, M.D., Ph.D. Director, Medical Emergency Response Teams Project Assistant Professor Department of Anesthesiology/CCM & Surgery
Sean M. Berenholtz, M.D., MHS, FCCM Director, Surgical Intensive Care Performance Improvement Council Assistant Professor Department of Anesthesiology/CCM & Surgery	Adam Sapirstein, MD Co-Director Surgical Intensive Care Unit Assistant Professor Department of Anesthesiology/CCM
Nauder Faraday, MD Associate Professor Department of Anesthesiology/CCM Director, Perioperative Genormics Research	Julius Pham, M.D., MD Assistant Professor Department of Anesthesiology/CCM
David Efron, M.D. Assistant Professor Department of Surgery	Ralph J Fuchs, M.D. Assistant Professor Department of Anesthesiology/CCM
Elliott Haut, M.D. Assistant Professor Department of Surgery	Pamela A. Lipsett, M.D., FCCM, FACS Professor Departments of Surgery and Anesthesiology/CCM Co-Director, SICU & Weinberg ICU Director, Surgical Critical Care Fellowship
Eddie E. Cornwell, III, M.D. Assistant Professor Department of Surgery & Anesthesiology/CCM Director, Adult Trauma Service	Pedro Mendez-Tellez, MD Medical Director, Respiratory Care Services Assistant Professor Department of Anesthesiology/CCM
Jeff Dodd-o, MD, PhD Associate Professor Department of Anesthesiology/CCM Associate Director, Residency and Education	Theresa Hartsell, MD, PhD (COS Expertise profile) Director, Critical Care Fellowship Co-Director, Weinberg Intensive Care Unit Assistant Professor Department of Anesthesiology/CCM
Elizabeth Martinez, MD Medical Director Adult Postanesthesiology Care Units Assistant Professor Department of Anesthesiology/CCM

Nine fellows are accepted each year from the primary specialties of Anesthesiology and Surgery into a variety of 1 and 2 year fellowship tracks in Critical Care Medicine. Emergency Medicine candidates are also considered. Integrated two-year fellowships in Cardiac Anesthesiology and Critical Care Medicine or CCM and other Anesthesiology subspecialties are offered. Typically individuals participating in the two-year tracks have a strong interest in clinical or basic science research. Research integrating staff and support across all of the adult, pediatric, and neonatal ICUs and related Primary Departments demonstrates further our commitment to multidisciplinary CCM and its acceptance hospital and university-wide.

Ongoing Research [ Top ]

Health Sciences

Outcomes

• Long and short term ICU outcomes
• Impact of intensivists on clinical and financial outcomes
• Impact of nurse staffing on patient outcomes
• Reduced CRBSI
• Evidence-based approach to extubation decision making
• Remote intensivists impact on clinical and economic outcomes
• Long-term outcome in patients with ARDS
• Long-term outcomes in patients that develop Critical Illness Neuropathy during Acute lung injury (ALI)

Risk Factor Assessments

• Risk factors for outcomes related to transfusion practice
• Risk factors for perioperative pulmonary outcomes
  

Process Assessment

• ICU structure and process relationships to clinical and economic outcomes
• Development and implementation of quality measures in the ICU
• Safe systems design
• Team building
• Family satisfaction assessments
• Utilization of the PDSA approach in the ICU
  

Clinical Sciences

Sepsis

• Antibiotics and antifungals
• Novel therapies such as cytokine antagonists and natural anticoagulants
• Pharmacokinetic drug dosing

ARDS

• Low lung volume ventilation
• Prone positioning
• Nitric oxide
• HFOV
• Liquid ventilation

Cardiovascular

• General vs regional anesthesia
• Hypothermia
• Supraventricular tachyarythmias
• Perioperative hypertension
• Perioperative stress response
• Perioperative QT prolonagtion

Informatics

• Web-based error reporting (ICUSRS project)
• Computer-based point of care patient records (Eclipsys)
• Computerized database management strategies
• Web-based educational tools
• Severity of illness scoring (APACHE III)
• Videoconferencing applications

Basic Sciences

Sympathetic nervous system

• Vasoactive drug effects
  
• Control of splanchnic capacitance blood vessel tone

Hemostatic function

• Platelet activation and aggregation
• Interactions between coagulation and inflammatory cascades

Cytokine responses

• TNF, IL2, IL4, IL6

Vasomotor reactivity

Pharmacogenomics

• Perioperative molecular genetic center
• Renal failure
• Cardiovascular outcomes in perioperative period

Phospholipase enzyme systems

Educational Schedule [ Top ]

Formal educational programs include a daily lecture series that covers an extensive list of critical care topics related to physiology, pharmacology, patient management, critical care billing, and unit administration. A multidisciplinary weekly journal club meets with participation from fellows and attendings from the SICU, MICU, CSICU, NCCU and PICU. Monthly performance improvement meetings, clinical research forums and multi-unit case conferences further enhance the educational environment.

ICU Teaching Conference:

Every Tuesday, Wednesday, Thursday & Friday 0930 to 1030
Location: SICU & WICU Conference Rooms, Blalock 7 & Weinberg 3A

Daily X-Ray Conference:

Every day from 0915 to 0930
Location: Radiology reading rooms

ICU M&M Conference:

First Monday every month 0930-1030
Location: SICU Conference Room, Blalock 7

ICU Performance Improvement Meeting:

Third Monday every month 0930-1030
Location: SICU Conference Room, Blalock 7

ICU Fellows Seminar:

Second through last Monday every month
Location: SICU Conference Room, Blalock 7

Critical Care Journal Club:

Second through last Monday every month
Location: Finney Conference Room, Tower 8

Critical Care research Conference:

First Monday every month
Location: Finney Conference room, Tower 8

Critical Care Case Conference:

Third Thursday every month
Location: Pulmonary & CCM Conference Room, Blalock 910

Future [ Top ]

Construction on a new Critical Care Tower and a new Childrens & Womens’ Center and additional research facilities are now being planned and are scheduled to open 2008.

Admission [ Top ]

Nine fellows are accepted each year from the primary specialties of Anesthesiology and Surgery into a variety of one- and two-year fellowship tracks in Critical Care Medicine. Integrated two-year fellowships are also offered.Occasionally fellows from other primary training specialties like Emergency Medicine are considered

Typically, individuals participating in the two-year tracks have a strong interest in clinical or basic science research. Research which integrates support staff across all the adult, pediatric, and neonatal ICUs and related primary departments demonstrates further our commitment to multidisciplinary CCM and its acceptance both within the hospital and university. The end result is a physician whose training is well-rounded and who is better equipped for critical care medicine in this new century.

The Application Process [ Top ]

The following are minimum requirements for consideration for the fellowship interview:
1. Transcript of medical school record, certified by the medical school
2. Medical School Dean's letter of recommendation (original)
3. Three letters of recommendations (originals)
4. Completed application (either electronic or regular mail)
5. Copies of either USMLE (part I & II are required) or FLEX examination scores
6. Visa status information if pertinent

Personal Interview [ Top ]

Applications will be reviewed only after receipt of all required materials. The Director of the Fellowship initiates interview requests, and not all applicants are granted interviews. An on-site interview is required before consideration for acceptance. Intangibles such as evidence of scholarship, judgment, maturity, motivation, and interpersonal skills are all considered. All applicants who are granted interviews will be required to sign their e-mail submitted application form to confirm that the above answers are true and complete to the best of their knowledge.

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