Is Acute Care Surgery the right specialty for you?

   If you are considering a career in Acute Care Surgery, it's important to explore the profession thoroughly before making any decisions. While there are numerous resources available to help you make an informed decision, one of the most valuable resources is speaking with surgeons who currently practice in this field. Experiences can vary widely at different hospitals, so don’t rely on just one opinion.

   Acute Care Surgery is a challenging specialty that will test you in ways you may never have imagined. It requires a high level of expertise in multiple clinical disciplines. As a surgical critical care fellow, you will face many challenges, such as long working hours, unpredictable workloads managing a mixture of high acuity critically-ill and injured patients, high patient mortality rates, and frequent exposure to severely injured patients. These challenges are not unique to Acute Care Surgery, but they are particularly profound in this field.

   One of the most significant challenges of this specialty is the emotional toll that it can take on practitioners. Managing patients in the ICU requires a high degree of empathy and compassion, and you will be required to deliver bad news to families and help them navigate difficult decision-making processes. It can be incredibly challenging to witness the suffering of patients and their loved ones, and it's essential to have a good support system in place to help you manage the emotional demands of the job.

   Despite these challenges, many surgeons find Acute Care Surgery to be an incredibly rewarding profession. Through their work, they have the opportunity to make a significant impact on the lives of their patients and their families. They develop strong relationships with patients and their loved ones, and they have the opportunity to witness the resilience of the human spirit in the face of adversity.

   If you are considering a career in Acute Care Surgery, it's essential to be well-prepared for the challenges that you will face. Seek out opportunities to speak with surgeons who practice in this field and learn from their experiences. Develop a strong support system that can help you manage the emotional demands of the job, and focus on developing the critical skills that are required to be successful in this challenging and rewarding specialty. With the right preparation and mindset, you can make a significant difference in the lives of your patients and their families as an Acute Care Surgeon.

How do I become an Acute Care Surgery fellow?

   While there are many one-year surgical critical care and two-year trauma/surgical critical care fellowships available, it's important to note that as of 5 October 2020, there were only 28 AAST-approved Acute Care Surgery Fellowships. The application process for these fellowships is centralized through SAFAS. This means that you will need to enter standard personal information, test scores, and personal statements. Additionally, you will need to obtain several letters of recommendation. After you submit your application, programs will contact you if they are interested in offering you an interview. 

   When applying for these fellowships, it's important to cast a wide net and not limit yourself to just a few programs. This may seem daunting if you are applying during your final year of residency, and you are likely already very busy with patient care, managing your team, preparing for board examinations and completing the documentation required for residency completion. Before the COVID pandemic, fellowship interviews were in-person. This was expensive and time-consuming. Virtual interviews may ease this burden, but it’s still a time-consuming process.

   While you may have a short list of your top choices, I would encourage you to consider a broader range of options. Some programs have online resources that can provide valuable information about the program's strengths and focus areas. When selecting programs, consider your own priorities. Are you looking for a strong critical care focus or a high volume of operative trauma cases? Do you have specific research goals? Fellowship is a short and intense period of focused training to allow you to develop the clinical knowledge and procedural skillset to thrive in this field, so be prepared to commit yourself fully to this opportunity.

   It's important to note that no program will be a perfect fit for everyone. However, if you approach the application process with an open mind and invest time in your search, you can find a fellowship that sets you on a path towards a fulfilling career in acute care surgery.

Helpful Websites

AAST ACS Fellowship Applicants. Website with more detailed information about what an Acute Care Surgery Fellowship entails.

Approved Acute Care Surgery Fellowships.

American Board of Surgery. National organization for board certification in General Surgery, as well as subspecialties including Vascular Surgery, Pediatric Surgery, Surgical Critical Care, Hand Surgery, Surgical Oncology, and Hospice and Palliative Medicine.

This is one example of the experience of an ACS fellow at a Level 1 trauma center with a well-organized fellowship program and a well-developed research team. Please refer to "How to get involved" for more information.

Clinical Work

12 months of critical care based rotations

• 8 months of trauma/ surgical critical care (TICU/ SICU)

• 1 month of cardiac surgical critical care

• 1 month of medical critical care (MICU)

• 1 month of Emergency Department Ultrasound training

• 2 weeks with Nephrology

• 2 weeks of Research

12 months of surgical rotations

• 6 months of trauma

• 3 months of emergency general surgery (EGS)

• 1 month of transplant surgery

• 1 month of vascular surgery

• 1 month of cardiothoracic surgery

Research and Publications

• Two IRB approved research protocols.

• Lead author on 4 submitted manuscripts.

• 2 peer-reviewed publications (one as first author). Accepted literature review. Published personal essay. 

• Sub-Investigator on Chest Tube Insertion Trial

• Author of a book chapter on thoracic trauma management in the ICU

Presentations

• Presented basic science research at AAST Conference

• Presented process improvement project at department level research symposium

• Presented a personal essay presented at the EAST conference

• Nine formal department level lectures. Multiple ICU team lectures.

Educational Opportunities

• Attended operative rib fixation training course

• Attended training course on IVC filter placement

• Attended two AAST conferences and one EAST conference

• Attended critical care/ trauma outcomes committee meetings and trauma morbidity and mortality conferences

• Attended quality improvement symposium

• Involvement with local and state trauma advisory committee meetings