Duke University Hospital
Duke University Hospital is a tertiary care referral center for complex medical and surgical cases. In addition, Duke serves as the primary referral center for Durham County and surrounding counties. Duke University Hospital is a 900+ bed hospital that has an average census of approximately 800 patients. It is a verified Level I Trauma Center and a multi-state surgical referral center for many surgical disciplines, including hepato-biliary and other upper gastrointestinal surgery, colorectal surgery, oncologic surgery, vascular surgery, transplantation, urologic surgery, head and neck surgery, orthopaedic surgery, neurologic surgery, plastic surgery, pediatric surgery, and cardiothoracic surgery. As a referral center, Duke University Hospital treats patients with a wide variety of conditions, ranging from routine to complex.
Duke University Hospital Surgical Intensive Care Unit (SICU)
The Surgical Critical Care fellow is based at Duke University Hospital’s SICU, a 24-bed unit (currently 18 beds open) with an average daily census of 16 patients. Admissions average about 100 / month. There is a wide diversity of patients from a number of surgical specialties, including general surgery, vascular surgery, trauma, otolaryngology, plastic surgery, urology, obstetrics / gynecology, and orthopaedics. The SICU is not a “closed” unit, so patients are managed jointly by the primary service and the SICU team. Faculty coverage is multi-disciplinary, consisting of intensivists certified in critical care from the disciplines of surgery and anesthesiology. The SICU is staffed 24/7 by an in-house faculty intensivist, thus the fellow currently does not have overnight call duties or on the weekends when he/she is on the SICU rotation. This multidisciplinary group of physicians is committed to all aspects of critical care, including the education and training of the next generation of academic critical care physicians. Therefore, the educational environment is nurturing, fertile, diverse, and directly supervised with clear lines of responsibility. In-house call may be required of the fellow who is rotating through other intensive care units or who may be doing an elective rotation. Duke University also has an accredited graduate medical education program in Anesthesia Critical Care, also based primarily in the Duke SICU. Fellows from these two departments do not share primary responsibility for patient care at any time in the SICU, thereby ensuring an adequate patient : fellow ratio.
There is a 24-hour on-site Respiratory Therapy, Doctor of Pharmacy, and Acute Cardiac Care support. The Duke Health System has a central, integrated Laboratory with on-site facilities for urgent and emergent turnaround of laboratory tests and results.
Convenient and adequate space for conferences and study is available to the fellow and staff. There is a dedicated office for the Critical Care fellow that has full Internet and Hospital Information System capability.
The fellow is expected to be involved in teaching rotating residents and medical students. Surgery residents and anesthesiology residents provide the on-call housestaff coverage of the SICU. Fourth-year Duke medical students frequently cite the SICU elective as a valuable educational opportunity.
In addition to bedside teaching on daily rounds, didactic teaching sessions are held twice weekly. Surgical Grand Rounds and Morbidity/Mortality conference are held weekly. A multidisciplinary Critical Care Conference is held once a week, with a variety of formats, including Grand Rounds presentations, pro-con debates, ethics lectures or case studies, etc. The fellow takes the SCCM MCCKAP exam in the Spring to help in preparation for the board exam.