Medical College of Wisconsin APP Critical Care Fellowship - How We Learn

The Froedtert Menomonee Falls ICU rotation offers fellows a unique opportunity to practice their critical care skills in a busy community setting. Through this rotation APP fellows gain exposure to APP practice and role in diverse settings, which is helpful when considering their career after the fellowship.

The CCA team functions as a co-management critical care team with Cardiothoracic Surgery and Cardiology, caring for patients in a 20-bed cardiovascular ICU. The CCA team provides whole-patient critical care assessment and management including: CT surgery post-operative, Cardiac arrest, Shock patients, Mechanical Circulatory Support, Advanced Heart Failure, Cardiac Transplant, and other surgical patient overflow such as Thoracic and Vascular. Unique experience on this service include the extensive mechanical circulatory support patient population: Veno Venous & Veno Arterial ECMO, LVAD, RVAD and BiVAD. APPs provide patient care in 13-hour blocks: days, nights, and with weekend coverage.

APP Fellows experience an intensive rotation at the end of the 12-month program including 50-60 clinical hours practicing on a critical care service integrated as an APP on the service. The goal is to have at least half night/weekend hours, and promote an experience to continue the professional development journey/transition to a clinical practicing APP. APPs will have another APP or attending as a resource/collaborator.

The MICU team is a large integrated academic team of residents, fellows, APPs and medical students providing care as a primary management team for all patients admitted to critical care with a non-surgical diagnosis. The MICU team averages >3000 admission per year and cares for populations including: Sepsis and septic shock, diabetic ketoacidosis, GI bleed, acute respiratory distress syndrome, COPD exacerbation, cardiac arrest and pulmonary embolism. APPs provide care in 12-hour blocks with day and weekend coverage.

The Neuro Critical Care team is a multidisciplinary team of attendings, fellows, APPs, and residents. The NICU team provides complete medical care to those with devastating neurological conditions including: traumatic brain injury, ischemic stroke, hemorrhagic stroke, neurovascular injury such as ruptured cerebral aneurysm and AVM, status epilepticus, spinal cord injury, and CNS infection. We also provide post-operative care for the neuro intervention and neurosurgery population. APPs provide collaborative care on a one week on/one week off schedule with day and weekend coverage; 12-hour shifts during the week and approximately 8-hour shifts on the weekend.

The critical care surgery team is an integrated multidisciplinary, academic team including residents, fellows, APPs and medical students primarily located in a 21 bed SICU. The team provides critical care management for trauma, acute care surgery, orthopaedics, ENT, surgical oncology, vascular surgery, thoracic surgery, and obstetrics patients. Froedtert hospital is the only level 1 trauma center in southeastern Wisconsin.

Opportunity to select and rotate in a critical care, specialty, inpatient service, emergency medicine, or other qualifying experience with program director approval.

The infectious disease rotation is an inpatient, multi-professional consulting service that provides experience across medical, surgical, and transplant patient populations. The experience provides opportunities to recognize and manage common infectious disease problems encountered in the quaternary, academic clinical practice, and provides experience on how to approach to the conditions as an infectious disease specialist.

The Interventional Radiology program at MCW is a robust service that provides non-surgical treatments for vascular and non-vascular disease in both the inpatient and outpatient setting. Procedures are performed for a broad range of conditions spanning gastrointestinal/hepatobiliary, gynecology, infectious disease, oncology, pain management, urology and venous and arterial disease. The procedures are performed using US, fluoroscopy, CT and MRI imaging. The Intervention Radiology rotation offers the APP fellow a chance to gain additional hands on procedural experience including venous access placement, paracentesis, thoracentesis, lumbar punctures and bone marrow biopsies and gain first hand exposure to advanced radiologic procedures commonly performed for critical care patients.

• Experience in-depth education and clinical experience with clinical dieticians in the critical care environment enhancing knowledge of critical care nutrition and promoting team-based patient care.

Diabetes Management

• A 1-week rotation on the multi-professional Diabetes Management Team providing APP fellows an immersed experience learning best practices for ICU glycemic control across critically-ill patient populations.

Procedure Rotation

• A 1-week rotation on the multi-professional internal medicine team providing APP fellows with the opportunity to perform frequent procedures in the inpatient and ICU patient populations.

The palliative care rotation provides a unique immersion opportunity on the multi-professional team to provide consultative assessments, recommendations, and management of patients at end of life. During this experience, fellows will gain knowledge of multi-faceted approaches to patient and family communication, symptom management, and active dying process. In addition, collaboration with the multi-professional team will increase knowledge and understanding of resources available to support patients, families and providers, and hospice.

The Transplant surgery rotation offers experiences providing critical care for unique set of patients in organ failure at various stages of transplant phase. The team integrates the entire multi-professional transplant surgery, medicine, and interdisciplinary team. Patient populations include abdominal solid organ transplants in pre-transplant with evaluation and listing, perioperative transplant care and complications post-transplant both acute and long term. APP fellows are integrated into the team providing 24/7 patient care in 13-hour shifts.