(1080) Variations of Procedural Requirements in Critical Care Fellowship

Introduction: Critical care trainees enter fellowship with varying exposure to pathology and procedural competency. While fellows participate in subspecialized critical care training, the majority of intensivists practice in a mixed specialty intensive care units. These patients often require urgent interventions testing the intensivist's procedural knowledge and capabilities. While the Accreditation Council for Graduate Medical Education (ACGME) outlines milestones regarding critical care practice, there is no standardization of procedural requirements amongst different fellowships. This study aims to delineate the variations amongst procedural training between critical care fellowship programs.

Methods: A review of ACGME common program requirements for critical care fellowships in anesthesia critical care (ACC), surgical critical care (SCC), medical critical care (MCC) and neurocritical care (NCC) was performed. Information regarding discreet procedural knowledge and tasks was collected and qualitative analysis was completed. Emphasis was placed on procedures required and assessment methods.

Results: All programs identify procedures within their ACGME Common Program Requirements. All programs required familiarity with airway procedures. ACC, MCC, and SCC also required skills in thoracentesis and central venous catheter placement. There was more variability regarding procedural familiarity with gastrointestinal access (NCC, SCC), bronchoscopy (ACC, SCC), chest tube placement (ACC, SCC) and pacemaker placement (ACC, MCC). Few procedures were only required by one specialty highlighting the pathology most often addressed by that team. Only SCC fellowship required a procedural log with minimum case numbers.

Conclusions: This study highlights the differences in procedural requirements during critical care fellowship training. As critical care fellows have varying procedural experience, this lack of standardization among fellowship programs may result in inadequate exposure and training. This variation in assessment of procedural competency during fellowship must be addressed to ensure all fellowship graduates are prepared to independently care for the critically ill. Additional research should identify and create a uniform set of critical care procedural requirements for all fellowship programs.