Acute Care Surgery & Adult Trauma

Acute Care Surgery & Adult Trauma
Division of Acute Care Surgery, Trauma & Critical Care Trauma

Our Mission
An Integrated Fellowship
Faculty
The Future
Admission
The Application Process
Personal Interview
For More Information

The first Intensive Care Unit (ICU) in the world, a postoperative neurosurgical unit, was developed at The Johns Hopkins Hospital in 1928 by Walter Dandy, M.D. Today, the Johns Hopkins Hospital operates six Adult ICUs, a Pediatric ICU, and a Neonatal ICU. Our affiliate, Johns Hopkins Bayview Medical Center (JHBMC), has five Adult ICUs , including the Regional Burn Unit, and one Pediatric ICU.

Surgical Critical Care offers one of the original fellowship programs in surgical critical care with accreditation by the Accreditation Council for Graduate Medical Education (ACGME) since 1989. For uniquely qualified individuals a second year in trauma care, trauma systems, and investigation may be offered. Our training program focuses on training highly qualified surgeons who will lead academic surgical care units around the world. An overriding principle behind these programs is that one does not specialize but "generalizes" in  Surgical Critical Care. This multidisciplinary tenet resounds through all levels of these fellowship programs.

Our Mission

To provide an educational environment optimized for the development of clinician/basic science leaders in multidisciplinary surgical critical care

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
• Medicolegal issues
• Ethical dilemmas
• Administrative duties
• Educator responsibilities and benefits

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.

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An Integrated Fellowship

This program is an integrated fellowship with the Department of Anesthesiology and Critical Care Medicine’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, 15-beds) and the Weinberg Intensive Care Unit (Weinberg ICU, 20-beds). Patients, representing more than 5,000 patient-days, are admitted from the adult trauma, transplant, vascular, thoracic, orthopedic, plastic, obstetric, gynecologic-oncology, endocrine and general surgical services. Additional rotations in the Cardiac Surgical ICU, Medical ICU, Neurosciences Critical Care Unit and Oncology ICU are routinely provided. Rotations through the Pediatric 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.

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The Faculty

The SICU and Weinberg ICU are covered by nine faculty members  (all BC/BE) members of the Departments of  Surgery and ,  Departments of Anesthesiology and Critical Care Medicine (ACCM).

These include:

Primary appointment in Surgery:

Pamela A. Lipsett, M.D., F.A.C.S., F.C.C.M.
Professor
Departments of Surgery and Anesthesiology/CCM  and Nursing
Co-Director, SICU & Weinberg ICU
Director, Surgical Critical Care Fellowship

David Efron, M.D., F.A.C.S.
Assistant Professor
Department of Surgery

Adil Haider, M.D., M.P.H.
Assistant Professor
Co-Director, Trauma Outcomes Research Group
Department of Surgery

Elliott R. Haut, M.D., F.A.C.S.
Assistant Professor
Department of Surgery

Alicia Kieninger, M.D.
Instructor
Department of Surgery

Kent A. Stevens, M.D.
Assistant Professor
Department of Surgery

Albert Chi, M.D.
Assistant Professor
Department of Surgery

Primary appointment in Anesthesiology and Critical Care Medicine:

Todd Dorman, M.D., FCCM
Associate Professor
Departments of Anesthesiology/CCM, Medicine & Surgery 
Associate Professor School of Nursing Director, Adult Critical Care Medicine Division Co-Director, SICU & Weinberg ICU Director, Adult Postanesthesia Care Units Medical Director, Johns Hopkins Medicine Critical Care Information Systems

Sean Berenholtz, M.D.
Assistant Professor
Department of Anesthesiology/CCM, Surgery

Theresa Hartsell, M.D., Ph.D.
Assistant Professor
Department of Anesthesiology/CCM, Surgery

Pedro Mendez-Tellez, M.D.
Assistant Professor
Department of Anesthesiology/CCM, Surgery

Peter J. Pronovost, M.D., Ph.D., F.C.C.M.
Associate Professor
Department of Anesthesiology/CCM, Surgery, and Health Policy and Management

Adam Sapirstein, M.D.
Assistant Professor
Department of Anesthesiology/CCM, Surgery

Bradford J. Winters, M.D., Ph.D.
Assistant Professor
Department of Anesthesiology/CCM
Associate Residency Program Director

A total of 9 fellows are accepted each year from the primary specialties of Surgery (2) and  Anesthesiology (7) into a variety of 1 and 2 year fellowship tracks 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.

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Ongoing Research

Clinical Sciences:

Sepsis

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

 ARDS

• Low lung volume ventilation
• ARDS network participant

 Acute Renal Failure

• CVVHD- high and low volume

 Cardiovascular

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

 Critical Care Outcomes

• Long term outcome of critical illness in prolonged stay surgical ICU patients
• Evidence-based approach to extubation decision making
• ICU structure and process relationships to clinical and economic outcomes
• Remote intensivists impact on clinical and economic outcomes
• Patient safety and quality improvement processes

 Informatics

• Computer-based point of care patient records (EMTEK)
• 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

 Dysrhythmia mechanisms

• Cellular mechanisms of cachexia

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 MICU-SICU case conferences further enhance the educational environment.

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The Future

Construction on a new Critical Care Tower.Cardiovascular/Emergency Services is under planning and should open with five years. This facilities will house both new operating rooms, new ICU’s, and a new Emergency Department.

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Admission

Nine fellow are accepted each year from the primary specialties of  Surgery (2) and Anesthesiology into a variety of one- and two-year fellowship tracks in straight Critical Care Medicine.
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 more well-rounded and who is better equipped for critical care medicine in the next century.

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The Application Process

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
3. Three letters of recommendations
4. Completed application (either electronic or regular mail)
5. Copies of either USMLE or FLEX examination scores

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Personal Interview

Applications will be reviewed only after receipt of all required materials. Interview requests are initiated by the Director of the fellowship 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. 

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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For More Information

If Applying Through Anesthesiology/Critical Care Medicine 
If Applying Through Surgery

Pamela A. Lipsett, M.D. Professor 
Departments of Surgery and Anesthesiology/Critical Care Medicine and Nursing 
Co-Director, Surgical Intensive Care Unit 
Director, Surgical Critical Care Fellowship 
Johns Hopkins Medical Institutions 
Blalock 685 
600 North Wolfe Street 
Baltimore, Maryland 21287-4685

Todd Dorman, M.D. 
Associate Professor 
Departments of Anesthesiology/CCM, Medicine and Surgery 
Director, Adult Critical Care Medicine Division
Johns Hopkins Medical Institutions
Meyer 298
600 North Wolfe Street
Baltimore, Maryland 21287-7294

The Johns Hopkins University and The Johns Hopkins Health System do not discriminate on the basis of race, color, sex, religion, sexual orientation, national or ethnic origin, age, disability or veteran status in any student program or activity administered by the university or with regard to admissions or employment. Defense Department discrimination in ROTC programs on the basis of sexual orientation conflicts with this university policy. The university is committed to encouraging a change in the Defense Department policy. 

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