A road diverged

OHSU APOM offers a traditional track fellowship in critical care medicine for physicians who have completed their residency in either anesthesiology or emergency medicine. This program focuses on training superlative intensivists from those who come to us with an already strong background and skill set following their residency. At this stage in their training, fellows can focus on developing their sub-specialty knowledge and expertise in critical care medicine.

Alternatively, for those applying to anesthesiology residency who are also sure in their resolve to pursue further training in critical care medicine, we offer an integrated 5-year program which, upon completion, affords the graduate the opportunity for board certification in both Anesthesiology and Critical Care Medicine. This style of blending longitudinal training in Critical Care Medicine into Anesthesiology residency was pioneered here at OHSU, and our experience has resulted in a robust program that endeavors to support our budding intensivists professionally, financially and personally.

OHSU critical care

OHSU is an ever-expanding 576 bed quaternary care hospital with partner hospitals throughout the metro area and close ties to the skybridge-linked VA Portland Medical Center. We are one of only two level one trauma centers in Oregon, with the next closest level one centers in Seattle and Northern California. As such, we serve an expansive and largely remote trauma population from Oregon, to southern Washington, northern California, Idaho, Montana and northern Nevada.

Similarly, our neurocritical care service is a primary resource for these same areas. We have an accomplished solid organ transplant program and are the only liver transplant center in Oregon. Our advanced heart failure program has grown dramatically and has a strong track record of complex mechanical circulatory support, ventricular assist device therapy and heart transplantation, all of which we care for each day in our cardiovascular ICU. Furthermore, we boast a busy ECMO program which provides VA and VV ECMO, as well as mobile retrieval services to patients as far away as Alaska who require emergent support.

Fellowship experience

Critical care fellowship at OHSU is a demanding and rewarding experience. OHSU regularly boasts one of the highest case mix indices among academic medical centers largely because, as we are a small hospital relative to our large catchment area with a strong triage system which can divert less critical patients to partner hospitals, our ICUs then only take care of the sickest of the sick. Fellows rotate most frequently through our cardiovascular ICU and neuroscience ICU, both of which are owned and largely staffed by anesthesiologist intensivists. Fellows also work in OHSU’s trauma/surgical ICU and the medical ICU. These rotations afford a broader exposure to various pathologies, deepen learning from intensivist colleagues with different backgrounds, as well as afford time in primary ICU triage and teaching roles.

Fellows attend a broad range of protected didactic experiences. These include weekly collaborative multi-institutional lectures focused on high-yield critical care topics as well as smaller monthly journal clubs and fellow conferences. We also work closely with the medicine and surgical critical care programs to offer cross specialty didactic experiences — including airway labs, high level nuanced ventilator management teaching and a beloved multi-day communication for challenging conversations workshop.

In addition, our fellows have the opportunity to further tailor their subspecialty training during their tenure by choosing elective experiences to curate additional skills and knowledge. These can include dedicated rotations in ECMO, echocardiography, infectious disease, transfusion medicine, palliative care, interventional radiology and electrophysiology, amongst others. Some fellows opt to rotate again through the medical or trauma/surgical ICUs or join our virtual ICU intensivist team if they desire. Our program is actively building a community ICU elective for those who are interested in experiencing a different practice model elsewhere in the city or state. We also welcome fellows to create their own elective experiences, if they feel that it would be an asset to their education or future practice.

Finally, I would be remiss if I did not comment on the quality of our ICU attendings and teachers. OHSU fosters a very collegial workplace and our division is a true testament to that. The Anesthesiology ICU fellowship in particular is fortunate to have a group of attending physician intensivists who are excellent clinicians, educators, advocates and human beings.

Portland

Most of what you may have heard about Portland is true, in a good way. Portland is the major metropolitan area of northern Oregon and as such offers the kind of culinary, entertainment and cultural opportunities often only found in larger, denser cities. Within its city limits Portland boasts the 29th most green space per capita of any city in the country. Scenic beaches, glaciated peaks with ski areas, rivers, waterfalls and more than a lifetime's worth of trails lie within a short drive. Portland’s professional sports teams are regularly competitive in their various leagues and there are countless recreational league opportunities for those interested. Arts and cultural events abound and the food and beverage scene in Portland is appropriately renowned. These make Portland an ideal setting to spend a few years of training or perhaps the rest of a lifetime, as many have chosen.

Again, I thank you for taking the time to learn more about what OHSU Anesthesiology and Perioperative Medicine offers physicians interested in critical care training. Choosing a training program is a nuanced and personal experience and as such, if ever there are other questions or considerations that arise, our education team are more than happy to address these to the best of our ability. Sincerely,

Kara M. Paul, MD
welchmad@ohsu.edu
APOM OSP CCM Chief