The 12-month Critical Care Advanced Practice Provider Fellowship (CCAPP) at Dartmouth Hitchcock Medical Center (DHMC) is comprised of rotations in ICU, skills, and electives. The curriculum has clinical, didactic, and procedural components.
Clinical curriculum overview
Core ICU rotations
- Medical ICU (4 x 4-week blocks)
- Surgical ICU (2 x 4-week blocks)
- Nights (3 x 1 week)
- Neuro Critical Care Unit (6 weeks)
- Cardiovascular Critical Care Unit (2 weeks)
Core skills rotations
- Airway (2 weeks)
- Interventional Radiology (1 week)
- Palliative Care (2 weeks)
- Fellow's Choice (4 x 2 weeks)
CCAPP fellows' clinical responsibilities include functioning as the first-call provider for the patients they are assigned. Daily expectations of the CCAPP fellow include but are not limited to pre-rounding data gathering, daily physical exam, rounding presentation, completion of daily progress notes, admission history and physical notes as well as transfer and discharge summaries, calling consults, consenting for procedures, updating families, following up on labs, imaging, procedural results, and daily sign out. CCAPP fellows will typically be responsible for an increasing number of patients during the course of their fellowship but are not expected to shoulder all of the daily work of the ICU. Please see Appendix C and D for presentation and report templates.
During your Critical Care fellowship , you will have a primary physician assistant or nurse practitioner who will provide longitudinal mentorship throughout the year. You will also be mentored by the attending physicians, physician assistants, nurse practitioners and critical care physician fellows with whom you will work clinically. You will meet individually with the fellowship program director and medical director throughout the program with formalized feedback at three, six, nine months and upon completion of the program.
Didactic curriculum overview
The purpose of the didactic curriculum is to guide CCAPP fellows through foundational critical care education and current literature to foster curiosity, independent education, and a structure for lifelong learning.
The curriculum is broken down into an orientation period followed by education modules throughout the course of the academic year. The curriculum will incorporate reading from The Textbook of Critical Care 7th Edition, articles from the medical literature, case-based discussion, web-based learning activities, high fidelity simulation-based education, hands-on workshops, and journal club discussion. An individual question-based assessment will happen once or twice per month and is intended to be an assessment of the CCAPP fellow's knowledge.
Procedural curriculum overview
The supervised procedural scope of the CCAPP fellow includes the core procedures listed below. Fellows will be evaluated on each procedure they perform or assist. Fellows will have extensive exposure to common critical care procedures as well as simulation-based skills learning and a one-week Interventional Radiology rotation to hone their procedural skill.
Critical care procedures
- Arterial line
- Central venous catheter
- Chest tube
- Hemodialysis catheter
- Lumbar puncture
- PA catheter
- Pacing wire/external pacing