Graduate Medical Education (GME): Critical Care Medicine
National Institutes of Health - Research Triangle Park, NC

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Graduate Medical Education (GME): Critical Care Medicine

Dorothea McAreavey, MD
Entry Id: TP-52

Welcome to the Critical Care Medicine Fellowship Program at the National Institutes of Health's Clinical Center , America's research hospital. Please explore the information below and contact us if you have any questions about the benefits of training here.

Overview

Structure of the Clinical Training Program

Structure of the Research Training Program

Program Faculty and Research Interests

Examples of Recent Papers Authored by Program Faculty

Program Graduates

Eligibility Criteria

Application Information

NIH Loan Repayment Program
Overview

The Critical Care Medicine Department of the 240-bed NIH Clinical Center offers a two-year fellowship in critical care medicine, with the opportunity for additional years of training to expand the research experience and/or attain dual board certification (e.g., critical care with pulmonary disease or infectious diseases). The program is designed to provide clinical training in the care of patients with multisystem organ dysfunction and to produce independent clinical investigators through advanced research training. As a fellow of the Critical Care Medicine Program, you can apply to receive loan repayment for up to $35,000 per year of qualified educational debt.

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Structure of the Clinical Training Program

The first year of the fellowship is entirely clinical, with approximately one-half of the time spent in the intensive care units of the NIH Clinical Center, and one-half spent in the intensive care units of other area teaching hospitals, including Washington Hospital Center, National Naval Medical Center, Children's National Medical Center, and the University of Maryland Medical Center. Critical care physicians in the NIH Clinical Center ICU have primary patient responsibility, and work closely with referring physicians and consultative services.

Clinical training is directly supervised by departmental senior staff who have received subspecialty training in critical care, pulmonology, cardiology, infectious diseases, allergy and immunology, and anesthesiology. In addition to an extensive program of weekly conferences and a didactic lecture series, the program provides broad experience in the care of critically ill patients and teaches a wide variety of procedures necessary for critical care. The fellows perform all invasive procedures, including pulmonary artery catheterization, arterial lines, bronchoscopy, and order continuous renal replacement therapy, etc. The ICU also has capability for advanced data analysis, noninvasive cardiac diagnostic studies (echocardiography, nuclear scanning), intraaortic balloon counterpulsation, and pulmonary function studies.

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Structure of the Research Training Program

For those interested in the critical care subspecialty alone, full-time research activities commence at the beginning of the second year of the fellowship. For those interested in dual board eligibility, the second year is individually designed and consists of the clinical rotations that are required for board eligibility in the particular subspecialty; typically, this is in either pulmonary medicine or infectious diseases. For these fellows, full-time research activities usually commence at the beginning of the third year.

The Critical Care Medicine Department conducts active programs in bedside clinical investigation, research in animal models, and molecular biology. Major topics of research interest include:

Studies of hemodynamics and cardiovascular function in different forms of shock

Immunopathogenesis of septic shock

Studies of immune cellular function in shock lung, asthma, and other forms of severe pulmonary disease

Biochemistry of pulmonary secretions

Opportunistic infections

Studies of immune cellular function and therapy of AIDS

Functional genomics (microarray) studies in sepsis, sickle cell disease and respiratory failure

Non-invasive cardiac imaging in sepsis and congestive heart failure

Fellows may participate in the research activities of their choosing and are encouraged to initiate independent projects. Each fellow will have a senior staff member guiding the investigations. The educational program includes regular seminars for the presentation of ongoing research in the department.

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Program Faculty and Research Interests

Henry Masur, Chief: HIV-related clinical trials; pneumocystis pneumonia.

James H. Shelhamer, Deputy Chief: Mechanisms of lung inflammation; control of lipid mediator generation.

Amisha Barochia: Sepsis, inflammation, and sepsis therapies, asthma.

John Beigel: Influenza, other respiratory viruses, and emerging infectious diseases.

Daniel Chertow: Pathogenesis and treatment of severe influenza infection; translational research.

Robert L. Danner: Nitric oxide immunobiology; functional genomics (microarray) studies in critical illness.

Jason Elinoff: Nuclear receptor signaling in vascular inflammation, endothelial dysfunction in septic shock, and pulmonary hypertension.

Peter Q. Eichacker: Immunomodulation of sepsis and acute lung injury in animal models.

Joseph A. Kovacs: Molecular biology of Pneumocystis and Toxoplasma; HIV-related clinical trials.

Dorothea McAreavey, Director, Fellowship Program: Sudden death; cardiomyopathies; nuclear cardiology.

Charles Natanson: Pathogenesis and therapy of sepsis in a canine model; clinical trial evaluation.

Naomi P. O’Grady: Nosocomial infections in the ICU.

Michael A. Solomon: Pulmonary Hypertension; Heart transplantation/rejection.

Anthony F. Suffredini: Endotoxin, cytokines, and other mediators of sepsis.

Parizad Torabi-Parizi: Innate and adaptive immune responses to bacterial (Pseudomonas aeruginosa) and viral (Influenza) pneumonias in animal models.

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Examples of Recent Papers Authored by Program Faculty

2012

Barochia AV, Cui X, Sun J, Li Y, Solomon SB, Migone TS, Subramanian GM, Bolmer SD, Eichacker PQ. Protective antigen antibody augments hemodynamic support in anthrax lethal toxin shock in canines. J Infect Dis 2012;205:818-829.

Chertow DS. Contribution of bacterial coinfection to severe influenza infection. Crit Care Med 2012;40:1664-1665.

Chertow DS, O'Grady NP. Room for improvement in central venous catheter postinsertion care. Crit Care Med 2012;40:1962-1963.

Eberlein M, Permutt S, Chahla MF, Bolukbas S, Nathan SD, Shlobin OA, Shelhamer JH, Reed RM, Pearse DB, Orens JB, Brower RG. Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome. Chest 2012;141:451-460.

Elinoff JM, Danner RL. ACP Journal Club. Hydroxyethyl starch 130/0.42 increased death at 90 days compared with Ringer's acetate in severe sepsis. Ann Intern Med 2012;157:JC4-6.

Falade-Nwulia OO, Dhaliwal G, Schreiber MP, Saint S, Shorr AF. A 36-year-old Haitian man with coma, acute kidney injury, lactic acidosis, and respiratory failure. Chest 2012;142:798-801.

Fodi E, McAreavey D, Abd-Elmoniem KZ, Ohayon J, Saba M, Elagha A, Pettigrew RI, Gharib AM. Pulmonary vein morphology by free-breathing whole heart magnetic resonance imaging at 3 tesla versus breathhold multi-detector computed tomography. J Magn Reson Imaging 2012.

Gordin FM, Masur H. Current approaches to tuberculosis in the United States. JAMA 2012;308:283-289.

Gormley NJ, Bronstein AC, Rasimas JJ, Pao M, Wratney AT, Sun J, Austin HA, Suffredini AF. The rising incidence of intentional ingestion of ethanol-containing hand sanitizers. Crit Care Med 2012;40:290-294.

Hicks CW, Sweeney DA, Danner RL, Eichacker PQ, Suffredini AF, Feng J, Sun J, Behrend EN, Solomon SB, Natanson C. Efficacy of selective mineralocorticoid and glucocorticoid agonists in canine septic shock. Crit Care Med 2012;40:199-207.

Kastenmuller W, Torabi-Parizi P, Subramanian N, Lammermann T, Germain RN. A spatially-organized multicellular innate immune response in lymph nodes limits systemic pathogen spread. Cell 2012;150:1235-1248.

Klein HG, Natanson C. Red blood cell transfusion. Ann Intern Med 2012;157:753-754.

Miller DL, O'Grady NP. Guidelines for the prevention of intravascular catheter-related infections: recommendations relevant to interventional radiology for venous catheter placement and maintenance. J Vasc Interv Radiol 2012;23:997-1007.

Morrow DA, Fang JC, Fintel DJ, Granger CB, Katz JN, Kushner FG, Kuvin JT, Lopez-Sendon J, McAreavey D, Nallamothu B, Page RL, 2nd, Parrillo JE, Peterson PN, Winkelman C. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation 2012;126:1408-1428.

O'Grady NP, Murray PR, Ames N. Preventing ventilator-associated pneumonia: does the evidence support the practice? JAMA 2012;307:2534-2539.

Ombrello MJ, Remmers EF, Sun G, Freeman AF, Datta S, Torabi-Parizi P, Subramanian N, Bunney TD, Baxendale RW, Martins MS, Romberg N, Komarow H, Aksentijevich I, Kim HS, Ho J, Cruse G, Jung MY, Gilfillan AM, Metcalfe DD, Nelson C, O'Brien M, Wisch L, Stone K, Douek DC, Gandhi C, Wanderer AA, Lee H, Nelson SF, Shianna KV, Cirulli ET, Goldstein DB, Long EO, Moir S, Meffre E, Holland SM, Kastner DL, Katan M, Hoffman HM, Milner JD. Cold urticaria, immunodeficiency, and autoimmunity related to PLCG2 deletions. N Engl J Med 2012;366:330-338.

Prasad P, Sun J, Danner RL, Natanson C. Excess deaths associated with tigecycline after approval based on noninferiority trials. Clin Infect Dis 2012;54:1699-1709.

Seam N, Meduri GU, Wang H, Nylen ES, Sun J, Schultz MJ, Tropea M, Suffredini AF. Effects of methylprednisolone infusion on markers of inflammation, coagulation, and angiogenesis in early acute respiratory distress syndrome. Crit Care Med 2012;40:495-501.

2011

Altaweel L, Chen Z, Moayeri M, Cui X, Li Y, Su J, Fitz Y, Johnson S, Leppla SH, Purcell R, Eichacker PQ. Delayed treatment with W1-mAb, a chimpanzee-derived monoclonal antibody against protective antigen, reduces mortality from challenges with anthrax edema or lethal toxin in rats and with anthrax spores in mice. Crit Care Med 2011;39:1439-1447.

Barochia A, Solomon S, Cui X, Natanson C, Eichacker PQ. Eritoran tetrasodium (E5564) treatment for sepsis: review of preclinical and clinical studies. Expert Opin Drug Metab Toxicol 2011;7:479-494.

Chen LY, Eberlein M, Alsaaty S, Martinez-Anton A, Barb J, Munson PJ, Danner RL, Liu Y, Logun C, Shelhamer JH, Woszczek G. Cooperative and redundant signaling of leukotriene B(4) and leukotriene D(4). Allergy 2011:66:1304-1311.

Gonzales DA, De Torre C, Wang H, Devor CB, Munson PJ, Ying SX, Kern SJ, Petraitiene R, Levens DL, Walsh TJ, Suffredini AF. Protein expression profiles distinguish between experimental invasive pulmonary aspergillosis and Pseudomonas pneumonia. Proteomics Clin Appl 2011;5:460.

Huskins WC, Huckabee CM, O'Grady NP, Murray P, Kopetskie H, Zimmer L, Walker ME, Sinkowitz-Cochran RL, Jernigan JA, Samore M, Wallace D, Goldmann DA. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:1407-1418.

O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad, II, Randolph AG, Rupp ME, Saint S. Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis 2011;52:1087-1099.

O'Grady NP, Chertow DS. Managing bloodstream infections in patients who have short-term central venous catheters. Cleve Clin J Med 2011;78:10-17.

SSuffredini AF, Munford RS. Novel therapies for septic shock over the past 4 decades. JAMA 2011;306:194-199.

Sweeney DA, Hicks CW, Cui X, Li Y, Eichacker PQ. Anthrax infection. Am J Respir Crit Care Med 2011;184:1333-1341.

2010

Barochia AV, Cui X, Natanson C, Eichacker PQ. Risk of death and the efficacy of eritoran tetrasodium (E5564): design considerations for clinical trials of anti-inflammatory agents in sepsis. Crit Care Med 2010;38:306-8.

Barochia AV, Cui X, Vitberg D, Suffredini AF, O'Grady NP, Banks SM, Minneci P, Kern SJ, Danner RL, Natanson C, Eichacker PQ. Bundled care for septic shock: an analysis of clinical trials. Crit Care Med 2010;38:668-78.

Berrington de Gonzalez A, Kim KP, Smith-Bindman R, McAreavey D. Myocardial perfusion scans: projected population cancer risks from current levels of use in the United States. Circulation 2010;122:2403-10.

Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, Laghi F, Magder S, Papazian L, Pelosi P, Polderman KH. An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med 2010;181:1128-55.

Cui X, Su J, Li Y, Shiloach J, Solomon S, Kaufman JB, Mani H, Fitz Y, Weng J, Altaweel L, Besch V, Eichacker PQ. Bacillus anthracis cell wall produces injurious inflammation but paradoxically decreases the lethality of anthrax lethal toxin in a rat model. Intensive Care Med 2010;36:148-56.

Gonzales DA, De Torre C, Wang H, Devor CB, Munson PJ, Ying SX, Kern SJ, Petraitiene R, Levens DL, Walsh TJ, Suffredini AF. Protein expression profiles distinguish between experimental invasive pulmonary aspergillosis and Pseudomonas pneumonia. Proteomics 2010;10:4270-80.

Janka JJ, Koita OA, Traore B, Traore JM, Mzayek F, Sachdev V, Wang X, Sanogo K, Sangare L, Mendelsohn L, Masur H, Kato GJ, Gladwin MT, Krogstad DJ. Increased pulmonary pressures and myocardial wall stress in children with severe malaria. J Infect Dis 2010;202:791-800.

McAreavey D, Vidal JS, Aspelund T, Owens DS, Hughes T, Garcia M, Sigurdsson S, Bjornsdottir H, Harris TB, Gudnason V, Launer LJ, Plehn JF. Correlation of echocardiographic findings with cerebral infarction in elderly adults: the AGES-Reykjavik study. Stroke 2010;41:2223-8.

Shah NG, Tulapurkar ME, Singh IS, Shelhamer JH, Cowan MJ, Hasday JD. Prostaglandin E2 potentiates heat shock-induced heat shock protein 72 expression in A549 cells. Prostaglandins Other Lipid Mediat 2010;[Epub ahead of print].

Suffredini AF, Masur H, Lynch JP, 3rd. Update in pulmonary and critical care medicine. Ann Intern Med 2010;152:601-8.

Sweeney DA, Cui X, Solomon SB, Vitberg DA, Migone TS, Scher D, Danner RL, Natanson C, Subramanian GM, Eichacker PQ. Anthrax lethal and edema toxins produce different patterns of cardiovascular and renal dysfunction and synergistically decrease survival in canines. J Infect Dis 2010;202:1885-96.Sweeney DA, Natanson C, Banks SM, Solomon SB, Behrend EN. Defining normal adrenal function testing in the intensive care unit setting: a canine study. Crit Care Med 2010;38:553-61.

2009

Barochia AV, Li Y, Cui X, Sweeney DA, Natanson C, and Eichacker PQ. Antithrombosis Trials: Should we test therapeutic heparin adjusted based on activated partial thromboplastin time in septic shock? Crit Care Med 37: 1486-1487, 2009.

Deans KJ, Minneci PC, Chen H, Kern SJ, Logun C, Alsaaty S, Norsworthy KJ, Theel SM, Sennesh JD, Barb JJ, Munson PJ, Danner RL, and Solomon MA. Impact of animal strain on gene expression in a rat model of acute cardiac rejection. BMC Genomics 10: 280, 2009.

Kovacs JA, and Masur H. Evolving health effects of Pneumocystis: one hundred years of progress in diagnosis and treatment. Jama 301: 2578-2585, 2009.

Li Y, Cui X, Su J, Haley M, Macarthur H, Sherer K, Moayeri M, Leppla SH, Fitz Y, and Eichacker PQ. Norepinephrine increases blood pressure but not survival with anthrax lethal toxin in rats. Crit Care Med 37: 1348-1354, 2009.

Minneci PC, Deans KJ, Eichacker PQ, and Natanson C. The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis. Clin Microbiol Infect 15: 308-318, 2009.

Moriyama B, Elinoff J, Danner RL, Gea-Banacloche J, Pennick G, Rinaldi MG, and Walsh TJ. Accelerated Metabolism of Voriconazole and its Partial Reversal by Cimetidine. Antimicrob Agents Chemother 2009.

Solomon SB, Minneci PC, Deans KJ, Feng J, Eichacker PQ, Banks SM, Danner RL, Natanson C, and Solomon MA. Effects of intra-aortic balloon counterpulsation in a model of septic shock. Crit Care Med 37: 7-18, 2009.

Sweeney DA, Natanson C, and Eichacker PQ. Recombinant human activated protein C, package labeling, and hemorrhage risks. Crit Care Med 37: 327-329, 2009.

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Program Graduates

The following is a list of graduates, including their current appointments:

Hans Ackerman, MD, PhD, Staff Clinician, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD

Christopher Barnett, MD, Assistant Clinical Professor of medicine, Division of Cardiology, University of California San Francisco, San Francisco, California

Amisha Barochia, MD, Staff Clinician, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD

Michael Cuttica, MD, Assistant Professor of Medicine, Northwestern University, Chicago, Illinois

J. Perren Cobb, MD, Director, Critical Care Center, Massachusetts General Hospital, Boston, Massachusetts

Cameron Dezfulian, MD, Assistant Professor, Adult and Pediatric Critical Care; Scientist, Safar Center for Resuscitation Research; Faculty, Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA

Michael Eberlein, MD, PhD, Assistant Professor of Medicine, University of Iowa, Iowa City, IA

Oluwaseun Falade-Nwulia, MD, Medical Director, Baltimore City Health Department, Druid STD Clinic, Baltimore, MD

Bradley Freeman, MD, Assistant Professor of Surgery, Washington University, St. Louis, Missouri

Mark Gladwin, MD, Chief of the Pulmonary, Allergy and Critical Care Medicine Division at the University of Pittsburgh, Pittsburgh, Pennsylvania

Nicole Gormley, Deputy Clinical Director, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD

William Hoffman, MD, Director, Cardiac Surgical ICU, Massachusetts General Hospital, Boston, Massachusetts

Andrew Kalil, MD, Assistant Professor of Medicine, University of Nebraska Medical Center, Omaha, Nebraska

John McDyer, MD, Visiting Associate Professor of Medicine; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Ervant Nishanian, MD, PhD, Assistant Professor, Columbia University Medical Center, New York, New York

Zenaide Quezado, MD, Professor of Anesthesiology, Children’s National Medical Center, Washington, DC

Margaret Parker, MD, Professor, SUNY at Stony Brook, Stony Brook, New York

Paul Rogers, MD, Professor, Critical Care/Internal Medicine University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Jonathan Sevransky, MD, Assistant Professor of Medicine, Director of the Emory University Hospital MICU and Assistant Director for Medicine of the Emory Center for Critical Care, Emory Healthcare, Atlanta, Georgia

Nirav Shah, MD, Assistant Professor of Medicine, University of Maryland Medical Center, Baltimore, Maryland

Anthony Slonim, MD, DrPH, Executive Vice President and Chief Medical Officer of Barnabas Health

R. William Vandivier, MD, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Colorado

Antoinette Williams, MD, Assistant Professor, University of South Carolina, Columbia, South Carolina

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Eligibility Criteria

Qualified candidates must have completed three or more years of training in internal medicine or anesthesiology in the United States or Canada prior to entering the fellowship program. Eligible candidates should be US Citizens or US Permanent Residents. In some cases, a J-1 Visa may be accepted for a two-year critical care medicine fellowship only.

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Application Information

The Critical Care Medicine Fellowship Program is fully accredited by the Accreditation Council for Graduate Medical Education. Upon completion of this program, fellows are eligible to sit for either the American Board of Internal Medicine or the American Board of Anesthesiology examination in critical care medicine.

The deadline for submission of completed applications is September 1st of the year prior to beginning the program. There are four positions available each year. The fellowship is a minimum of two years in duration, with additional years of training available for selected fellows.

Electronic Application

This program participates in ERAS [ disclaimer ]. Please contact us for more information .

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NIH Loan Repayment Program

As a resident or clinical fellow enrolled in an ACGME-accredited training program at NIH, you can apply to receive loan repayment for up to $17,000 per year of your qualified educational debt or you may qualify for the "Competitive Loan Repayment Program" which could repay as much as $35,000 per year. The application deadlines are is April 1 and June 17, respectively. Prospective applicants are strongly encouraged to submit their electronic application upon acceptance into an ACGME-accredited training program.

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