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APP Critical Care Fellowship - How We Learn

Care team collaboration

The APP Critical Care Fellowship Program focuses on hands-on, clinical experiences across all five ICUs in addition to key acute care specialties as the foundation for critical care practice. In addition to clinical rotations providing patient experiences across each specialty ICU, the core critical care curriculum provides continuity and skill development focusing on 15 aspects of essential critical care skills throughout the 12-month program. In addition to clinical education, the fellowship integrates the APP Fellowship Core Professional Curriculum in collaboration with all programs.

The fellowship program structure integrates the APP Phased Onboarding program including behaviorally-based milestones, and is formatted on technology platforms for education delivery, scheduling, and evaluations.

Didactic Education

The program integrates additional multi-faceted didactic opportunities to enhance the clinical learning experience including:
  • In-person lectures
  • Skills lab
  • Case presentations
  • Online didactics and learning modules
  • Self-reflective journaling
  • Specialty focused didactics including lectures, M&M, and journal clubs

Core Critical Care Curriculum

  • Hemodynamics
  • Respiratory failure
  • Sedation and analgesia
  • Altered mentation and delirium
  • Renal failure
  • Metabolic and electrolyte abnormalities
  • Glycemic management during critical illness
  • Acid/base disorders
  • Sepsis and infections
  • Hemorrhage and coagulopathy
  • End-of-life
  • Assessment and management of critically-ill patients
  • Critical care nutrition
  • Critical care quality
  • APP critical care practice and team-based care
Certification Courses
  • Society of Critical Care Medicine Fundamental Critical Care Support Course
  • BCLS
  • ACLS
  • ATLS (as available)

Procedural and Skills opportunity

  • Skills labs
    • Suturing
    • Central Line Insertion
    • Lumbar puncture
    • Mechanical Ventilation Management
  • Basic and Advanced EKG

  • Ultrasound
    • Online didactic
    • Clinical experience

  • Hands on clinical experience in all rotations in addition to the procedural rotation

Critical Care Rotations

all
Fellowship Onboarding - 3 weeks
Introduction to the APP Critical Care Fellowship program and participation in provider onboarding to prepare APP fellows for clinical experience including fellowship onboarding, organizational overview, EMR and technology training, introductory education for critical care, and foundational professional skills.
Critical Care Anesthesia CCA - Cardiovascular ICU - 6 weeks
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.
Critical Care Intensive - 4-6 weeks
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.
Critical Care Medicine - 6 weeks
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.
Critical Care Neurology - 6 weeks
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 hours shifts during the week and approximately 8 hour shifts on the weekend.
Critical Care Surgery and Trauma - 6 weeks
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.
Fellowship Elective - Variable weeks
Opportunity to select and rotate in a critical care, specialty, inpatient service, emergency medicine, or other qualifying experience with program director approval.
Infectious Diseases - 3-4 weeks
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.
Mini-rotations - 1 week each
Critical Care Nutrition
  • 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.
Palliative Care - 3 weeks
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.
Transplant Surgery - 6 weeks
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.

Case Presentations

  • All critical care fellows present at least 3 case presentations and lead an academic discussion to enhance learning and professional development within the fellowship team.
  • Topics have covered a variety of clinical patient experiences including acute biliary pancreatitis, DRESS, end-of-life, molar pregnancies, clinical assessment of fluid balance, rejection after liver transplant, infective endocarditis, and more.

Fellowship Projects

  • Integration of Self-reflective Journaling into the APP Fellowship Program - Elizabeth Siegel, PA-C

  • Facilitating APP Fellowship Rotation Hand-offs - Sarah Tybring, MSN, AGACNP-BC, APNP

  • Optimization of Critical Care Patient and Family Communication - Justine Emerson, PA-C & Elise Rippelmeyer, MSN, ACACNP-BC, APNP
    • Pilot of MD/APP Team Patient Cards in the TICU
    • APP Critical Care Fellowship Patient & Family Communication Curriculum Development
  • Family Experience in the ICU – Qualitative assessment of family survey responses - Laura Mark, MPAS, PA-C, MPH

  • Development of an APP Preceptor/Learner Training Program for APP Fellowships - Joy Ikeri, DNP AGACNP-BC, APNP

  • Optimization of the External APP Fellowship Website - Driving Change from the Viewpoint of the Applicant - Ravi Dholakia, PA-C

Day in the life of an APP Critical Care Fellow

ICU rotation (Times vary by rotation)
  • Each day, APP fellows are assigned an APP preceptor to work with and are integrated into the academic, multi-professional critical care team.
  • Daily education varies from bedside teaching, academic rounds, and rotation lectures to fellowship skills labs, journal clubs, and online didactics.

0630: Arrive in the ICU team room and confirm your patient assignment for the day

0645:
Get sign-out from the overnight team

0700-0800: Pre-round

  • Review data, assess your patients, and discuss any updates with the bedside nurse
  • Prepare for rounds and formulate a plan of care for the day.
0800-1100: Academic critical care team rounds
  • Participate in academic patient care teaching
  • Present your patients to the multidisciplinary team
  • Collaborate with the critical care team to facilitate workflows and patient management

1100-1900: Critical Care Management

  • Continue to assess and manage critically-ill patients
  • Complete procedures
  • Write critical care notes
  • Service specific lectures, chalk talks, simulations, or other education
  • Transfer, discharge, and admit patients

1900-1930: Hand-off to the night ICU team

Contact Us

Gabrielle Pollard

APP Fellowship Recruitment
gpollard@mcw.edu

Sarah Vanderlinden, MPAS, PA-C, DFAAPA

APP Fellowship Director and APP Critical Care Program Director
svanderl@mcw.edu