Critical Care Medicine Fellowship

The Critical Care Medicine fellowship program at Saint Louis University School of Medicine offers a one- or two-year ACGME accredited critical care fellowship to graduates of approved residency or fellowship programs.  

The Saint Louis University School of Medicine critical care and pulmonary critical care fellowships run in parallel strengthening both programs by sharing faculty, rotations and educational experiences.  

Since 1979, more than 200 fellows have graduated from the critical care fellowship and are currently practicing critical care medicine nationally and internationally, including two past presidents of the Society of Critical Care Medicine. The fellowship focuses on a strong clinical experience to produce exceptional intensivists.  

During the fellowship, trainees perform the following procedures: central venous catheter, renal replacement catheter, arterial catheter, intracranial pressure monitor (Camino Catheter), intubation, tube thoracostomy, percutaneous dilational tracheostomy, thoracentesis, paracentesis and lumbar puncture.       

The fellowship is supported with daily lectures, monthly journal clubs, weekly grand rounds, monthly ultrasound video conferences, quarterly chest conferences, and three yearly symposia covering extra corporeal membrane oxygenation (ECMO), critical care ultrasound, the difficult airway and mechanical ventilation. The fellows are also assisted by critical care board intensivists and critical care advanced practitioners in-house 24 hours a day. The advanced practitioners are available to help support the fellow’s team with rounding, assessing patients and, if necessary, performing procedures.  

Curriculum

The fellows are offered a unique 12- or 24-month experience rotating between Saint Louis University and Mercy St. Louis hospitals with exposure to various intensive care unit populations including medical, surgical, trauma, neurological, neurosurgical, cardiac and vascular patients.  

Rotation Year 1 Year 2
Mercy Night Float Two months Two months
Elective SLU/Mercy Four months Four months
SLU Pulmonary Consult One month -
SLU Medical ICU - One month
Telemedicine One month One month
Respiratory/Nutrition - One month
Anesthesia One month -
Mercy Medical Surgical ICU One month One month
Mercy Neuro-Trauma ICU One month One month
Mercy CVICU One month One month

Rotations

Medical/Surgical Intensive Care Unit

The Mercy Hospital St. Louis medical/surgical intensive care unit rotation exposes the fellows to medical and surgical pathophysiology. The intensive care unit team includes a fellow, resident, student and critical care faculty member responsible for the daily multidisciplinary teaching rounds. The team is responsible for the care of complex medical and surgical patients including the performance of various invasive procedures. The night coverage is provided by the night float team that includes fellows, physician extenders and back up supervision by the in-house telemedicine critical care faculty member.

Neuro-Trauma Intensive Care Unit

The Mercy Hospital St. Louis neuro-trauma intensive care unit provides care to patients sustaining multiple trauma, traumatic brain injury, acute stroke, subarachnoid hemorrhage, spinal cord injury, post operative brain and spine surgery and neurologic disorders requiring respiratory support. Working closely with the trauma surgeons and neurosurgeons, the neurointensivists provide bedside care of these patients including placement of intra-cranial pressure monitors.  Mercy Hospital St. Louis is a comprehensive stroke center and a level I trauma center. The majority of critical care attending faculty have completed the neurocritical care subspecialty certification from the United Council for Neurologic Subspecialties.    

Medical Intensive Care Unit

The Saint Louis University Medical Intensive Care Unit (MICU) rotation provides comprehensive care to patients with life-threatening or potentially life-threatening medical illnesses of all major organ systems. The two fellows assigned to pulmonary disease/critical care medicine or critical care medicine are the team leaders for the monthly rotation block-assigned medical residents. In conjunction with the MICU attending physician, fellows actively participate in patient care including performance and supervision of all ICU-related invasive procedures.

Telemedicine

The Mercy Hospital St. Louis Virtual Care Center supports one of the largest telemedicine programs in the country. The critical care and pulmonary critical care fellows learn ICU telemedicine skills during this rotation, covering several intensive care units alongside the critical care attending faculty and nursing staff. The fellows develop expertise navigating electronic medical records, bedside monitoring systems and the video capabilities of virtual care. The fellows learn the advantages and limitations of critical care telemedicine.

Cardiovascular Intensive Care Unit (CVICU)

During the CVICU rotation, the fellows care for patients with ischemic coronary syndromes, challenging arrhythmias, vascular surgery, cardiogenic shock and post-cardiac arrest hypothermia. In addition, patients requiring extracorporeal membrane oxygenation (ECMO) are managed in the CVICU in collaboration with the ECMO team. This team includes an ECMO intensivist, cardiovascular perfusionist, cardiothoracic surgeon, specialized intensive care unit nurses and respiratory practitioners.  

Conferences

Fellows are required to attend conferences and grand rounds regularly.

  • ICU Daily Didactic Conferences
    Essential core ICU topics are presented.
    Weekdays: 1 p.m.
  • ICU Grand Rounds
    Topic reviews and research presentations presented by critical care faculty, subspecialty faculty, critical care fellows and invited guest speakers.
    Tuesday: 12 p.m.
  • Chest Conference
    Case presentations and interactive discussion presented by the Mercy Hospital St. Louis pulmonary attending teaching staff
    Quarterly

Symposia

Critical care doctors offer additional courses for fellows interested in specific medical issues and technologies. 

Critical Care Ultrasound Course

This formal ultrasound course includes didactic and practical sessions presented and directed by the critical care department including Dr. Jan Kasal, who co-chaired the Society of Critical Care Medicine ultrasound course, and Dr. Chakradhar Venkata, both certified by the National Board of Echocardiography (Testamur). The course includes echocardiography, DVT assessment, lung and chest ultrasound, and abdominal FAST examination. The 3D Systems Ultrasound Mentor provides an ultrasound simulation environment for the fellows to sharpen and test their skills.

Difficult Airway Course

This formal airway course presented with a multidisciplinary approach including representation from critical care medicine, pulmonary medicine, emergency medicine, trauma surgery, pharmacy and anesthesia. The course provides didactics, practical sessions, and an evaluation of the latest airway equipment. The SimMan 3G used in this course provides lively interactive and educational simulation sessions.

Mechanical Ventilation Course

The mechanical ventilation course is a combination of didactic lectures and a hands-on practical evaluation of mechanical ventilators with test lungs. Case scenarios are presented and discussed at several learning stations. The course focuses on applied pulmonary physiology in the setting of mechanical ventilation.

ECMO Education Course

The ECMO education course provides the fellows and staff with the foundation for the clinical practice of ECMO. This course includes didactic lectures and practical sessions with a functional ECMO circuit presented by cardiovascular perfusionists, ECMO intensivists and ECMO specialists.

Monthly Presentations

Fellows present and attend conferences, meetings and textbook reviews on a monthly basis. 

Journal Club

Fellows present journal articles following the evidence-based medicine approach. The critical care faculty responsible for journal club presentations completed the EBM workshop sponsored by Duke University Medical Center.

Video Ultrasound Conference

This is a combined Mercy Hospital St. Louis and Saint Louis University Hospital video ultrasound conference that provides a platform for the fellows to present and discuss ultrasound cases with the pulmonary and critical care attendings. Focused ultrasound topics are presented and reviewed.

Fellows/Director Meeting

This is a monthly meeting between the fellows and the program director to discuss any elements of the fellowship.

QI Conference

The Critical Care QI conference is administered by the fellows to address quality and safety issues pertaining to the ICU. The APACHE Outcomes database provides physiologic and outcome data on all ICU admissions and is presented during this meeting for review and to assess for trends of care.

Critical Care Textbook Review

Each month, the fellows are expected to read a section of a selected critical care textbook and then answer questions that the attendings have written for that reading. The questions are presented and discussed during the conference. The goal of the review is to complete a critical care textbook every two years in preparation for the critical care ABIM certifying examination.

Research

Clinical research is conducted at Saint Louis University Hospital and Mercy Hospital St. Louis. The critical care fellows are encouraged and mentored to develop a clinical research proposal including the Institutional Review Board submission and presentation of their research findings at local or national meetings. Annually, the department sponsors the Robert W. Taylor, M.D., Mercy Research Colloquium that provides a local venue for presentation of research projects from the fellows, residents and attendings. The department also participates in industry and government-sponsored research.

Requirements

The critical care fellowship program does not participate in the National Resident Matching Program (NRMP). Applications are accepted yearly starting in the spring.  Application materials should be scanned and emailed to  kayla.carns@mercy.net and interviews are conducted in late summer and early fall.  

Application Materials

  • Application form
  • Two letters of recommendation (one from the program director or current department chair)
  • Medical school transcript
  • Personal statement
  • Recent photograph (at least two inches squared)
  • UMSLE transcript or COMLEX transcript MSPE

Faculty 

Our faculty work in critical care medicine, internal medicine, pulmonology and sleep medicine.