Dr. Ramesh talks about UPMC Harrisburg Critical Care Fellowship. Dr. Ramesh explains the kind of medicine and care provided in a critical care unit, what types of patients and procedures are in this unit, and why is this particular discipline important.
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UPMC Harrisburg Critical Care Fellowship
Featuring:
Navitha Ramesh, MD, FCCP
Dr. Ramesh most recently served as intensive care unit (ICU) medical director for UPMC Susquehanna. She completed her fellowship in pulmonary and critical care medicine at Mount Sinai Beth Israel in New York. Dr. Ramesh is board-certified in pulmonary medicine, critical care medicine, and internal medicine. Transcription:
Bill Klaproth (host): The Critical Care Fellowship at UPMC Harrisburg is a two-year ACGME-approved program that offers three positions each year for candidates who have completed an ACGME-accredited residency in internal medicine or emergency medicine. It's mission is to combine an innovative, evidence-based, multidisciplinary learning experience with a compassionate, patient-centric approach to healthcare, reflective of the core values of its faculty and leadership, mindful of the importance of a good work-life balance for the trainee, with strong advocacy for equality, diversity, and inclusion.
It's an exciting new program beginning in July 2023 in close partnership with the world's first dedicated critical care training program founded in 1961 at the University of Pittsburgh Medical Center. So let's learn more about the UPMC Harrisburg Critical Care Fellowship with Dr. Navitha Ramesh. She's the critical care medicine fellowship program director at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Ramesh, thank you for your time. We're all interested in learning more about the critical care fellowship at UPMC, so thank you for your time. And let me first start off by asking you, if you can explain the kind of medicine and care provided in a critical care unit, what types of patients and procedures are in this unit, and why is this particular discipline so important for both patients looking for the best care and for providers who deliver that level of care?
Dr. Navitha Ramesh: That's a great question, Bill. So critical care medicine is otherwise known as intensive care medicine. And as the name implies, it's critical or intensive. So the patients we see in the critical care units are pretty sick. They could be the sickest patients in the hospital, sickest patients within our network or sickest patients even in the region who come to the hospital for healthcare. So these patients need specialized monitoring, special attention and treatment. This could be related to multiple illnesses, life-threatening illnesses such as, you know, they could have had a heart attack or a stroke. Postoperatively, after surgery, they need monitoring. They could have respiratory issues, kidney issues. There are so many different specialties involved in critical care medicine. So it's basically not an organ system. It's looking at the patient from the head to toe and taking care of the patient as a whole. And also, the other aspect of critical care medicine is supporting the families, the loved ones, as they go through this process along with the patients. So that's basically what critical care medicine comprises of.
Bill Klaproth (host): And then how about from the provider's point of view?
Dr. Navitha Ramesh: So when you look at it from the provider's end, critical care medicine is a tough field, both physically and mentally. So the providers are some of the most resilient providers or physicians we've seen in healthcare. And critical care is multidisciplinary, it's teamwork. And our providers work with great nurses, respiratory therapists, physical therapists, all of whom are fully invested. And our goal is to get this patient better as much as we can and also, like I said, supporting the families as well.
Bill Klaproth (host): So when we talk about a multidisciplinary learning experience, combined with a compassionate patient-centric approach, there it is right there. So Dr. Ramesh, why would a medical resident or physician want to pursue a fellowship at UPMC in central PA. Tell us about what is offered to these candidates that would be appealing to choose this area and this health system for their fellowship training.
Dr. Navitha Ramesh: Sure, Bill. That's a great question. The UPMC Harrisburg Critical Care Fellowship Program is a brand new program. It's a two-year ACGME-approved program. Our goal is to train physicians who have already trained in internal medicine or emergency medicine. They've already had that basic training. We want to refine their critical care education, so they can be more comfortable taking care of patients who are very sick and in a high stress environment while also taking care of themselves, being mindful that, you know, we need to take care of ourselves while we take care of our patients.
The fellowship itself, you know, as I mentioned, we look at the patient from head to toe and it's a high degree of acuity with almost every organ system. And our goal with the fellowship is to have our trainees look at the patient again as a whole. We look at the head to toe, the neurology, cardiology, pulmonology. So it's paying attention to details, which we may not have done before.
Bill Klaproth (host): Yeah. So that is really thorough intensive training. That's one of the reasons why someone may choose the critical care fellowship at UPMC Harrisburg. The other one is the area. I mentioned that work-life balance for the trainee. Can you talk about the area, how beautiful Harrisburg is?
Dr. Navitha Ramesh: So UPMC Harrisburg is located at the heart of Harrisburg, which is the capital of Pennsylvania. It's a beautiful city. There's a lot of activities around Harrisburg, outdoor activities. There are several trails. You can go on hiking, boating, fishing, a lot of outdoor activities. And also we're not too far away from, let's say, New York City, Pittsburgh, Baltimore, Washington DC. So you finish your work, you're done with your clinical duties, you always have somewhere to go to.
Bill Klaproth (host): And that is very appealing, a really big selling point. So thank you for saying all of that. That really is important. So let's talk about who should apply now for a critical care fellowship at UPMC Harrisburg. What types of qualities and interests should a fellowship candidate have to be considered?
Dr. Navitha Ramesh: So our fellowship is a two-year ACGME-approved program. So it's an American College of Graduate Medical Education-approved program. We offer three positions every year for candidates who have already completed an internal medicine or emergency medicine residency prior to coming here.
Our goal is to train the physicians in a very robust clinical environment. We are not very heavy on bench research, but we do clinical research, quality improvement, performance improvement. A lot of importance is given to QI. And our goal is to have the clinicians come out as a physician educator. That's our goal.
And who should apply? That's a great question. So in addition to having all these requirements, we are looking for candidates who have an open mindset, who come in wanting to learn. My mindset as a program director is you never know enough. There's always something that we don't know, so having the mindset of "I'm coming here to learn something new" and having this passion for education. Also, as I mentioned before, some confident humility, we could be confident in our skills, but also the degree of humility is needed because we're dealing with life and death every day. So you can never know everything. It's just having that open mindset and critical care is hard. So we're looking for candidates who are willing to work hard, keeping in mind that the patient is everything, right? We are doing our best for our patients and I would care for the patient, just like how I would care for my family member.
Bill Klaproth (host): Yeah. You said the goal is to have physician educators at the end, so that is the goal of the program. So you said it's a two-year program. Can you talk about some of the other aspects of the program, like the advanced training, the collaborative environment, access to the latest technology and things like that? Can you describe the program a little bit more?
Dr. Navitha Ramesh: So just to walk you through the program, as I mentioned, it's a two-year fellowship. Our first year, we want our fellows to get used to the area, get used to Harrisburg, get used to our ICU. Our main flagship hospital is UPMC Harrisburg. We also have other community setting hospitals where the fellows will rotate. But in the first year, they will primarily be at UPMC Harrisburg, where we have the top-notch equipment required for critical care. So we have our intubation video laryngoscopy. We have point-of-care high-end ultrasound machines, which help us to make clinical decisions in a very timely manner. We are also starting a percutaneous tracheostomy program where at the bedside, the patient needs a tracheostomy, critical care would be able to do it at bedside without having to move the patient to the operating room in appropriate patients. We also provide training with other procedures such as advanced airway central line placement, even Swan-Ganz catheter placement. So we are a very procedure-heavy hands-on program. So most of this training is going to be at Harrisburg the first year.
And then, when you look at the faculty training with our fellows, you know, they are critical care certified and they also have other board certification such as neuro-critical care, pulmonary medicine, emergency medicine, nephrology, anesthesia. So they get the perspective from all these physicians. The training will be diverse, getting input from different specialties, which I think is great for someone who's in training to get all the aspects of critical care at one spot. And also they will have elective rotations, such as, you know, if they are more interested in anesthesia, they can have an elective with anesthesia. With critical care echo, if they want to get the expertise better, so they can do an elective in ultrasound, an elective in palliative care medicine. So all those are positive points for our trainees here.
So when they move on to second year, we want them to be a little bit more confident in their ability to care for critically ill patient. So in their second year, our fellows will be rotating at UPMC Harrisburg. In addition, they would go to our other ICU's in the system as well, which is UPMC West Shore, UPMC Community Osteopathic and UPMC Memorial Hospital. So they are community hospitals where the fellow would almost serve as a junior attending. So the fellow will be given autonomy to make medical decisions and also knowing that they have the backing of the attending on campus, but the fellow will independently perform there, getting feedback from the attendings, which I think the feedback loop is important. And that's one thing that our fellowship focuses on a lot, is our doors are always open to feedback. Fellows assess the program, we assess the fellows. So that way, there's constant improvement as the fellowship progresses.
Bill Klaproth (host): Yeah, that's very thorough. And I like how you talked about that, the experience that someone would get being able to make the decisions with them and have the feedback loop, which is really important as well. Well, this has really been interesting, Dr. Ramesh. As we wrap up, any additional thoughts about the critical care fellowship at UPMC Harrisburg?
Dr. Navitha Ramesh: Thank you, Bill. Thanks for your time. I think the final thoughts would be, you know, our fellows here, they will be strongly supported by our faculty from, I said, diverse backgrounds. we focus a lot on mentorship. Each fellow will be assigned a faculty mentor and the fellows are also free to reach out and seek other mentors in your areas of interest. We also believe in constant evaluation 360 degrees. They evaluate the program, the program evaluates the fellow. So it's overall betterment. So that's basically what they will get in our program. You know, you will be a strong clinician as well as having the open mindset of constant improvement and constant learning.
Bill Klaproth (host): Which again is really important as we said earlier. But that work-life balance also is critical to this and being in that beautiful Harrisburg area. It's kind of a win-win. Dr. Ramesh, thank you so much for your time. This has really been informative. We really appreciate it. Thanks again.
Dr. Navitha Ramesh: Thank you so much for having me, Bill.
Bill Klaproth (host): And once again, that's Dr. Navitha Romesh. And for more information, please visit upmc.com/cpacriticalcare. That's upmc.com/cpacritical care. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (host): The Critical Care Fellowship at UPMC Harrisburg is a two-year ACGME-approved program that offers three positions each year for candidates who have completed an ACGME-accredited residency in internal medicine or emergency medicine. It's mission is to combine an innovative, evidence-based, multidisciplinary learning experience with a compassionate, patient-centric approach to healthcare, reflective of the core values of its faculty and leadership, mindful of the importance of a good work-life balance for the trainee, with strong advocacy for equality, diversity, and inclusion.
It's an exciting new program beginning in July 2023 in close partnership with the world's first dedicated critical care training program founded in 1961 at the University of Pittsburgh Medical Center. So let's learn more about the UPMC Harrisburg Critical Care Fellowship with Dr. Navitha Ramesh. She's the critical care medicine fellowship program director at UPMC.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Dr. Ramesh, thank you for your time. We're all interested in learning more about the critical care fellowship at UPMC, so thank you for your time. And let me first start off by asking you, if you can explain the kind of medicine and care provided in a critical care unit, what types of patients and procedures are in this unit, and why is this particular discipline so important for both patients looking for the best care and for providers who deliver that level of care?
Dr. Navitha Ramesh: That's a great question, Bill. So critical care medicine is otherwise known as intensive care medicine. And as the name implies, it's critical or intensive. So the patients we see in the critical care units are pretty sick. They could be the sickest patients in the hospital, sickest patients within our network or sickest patients even in the region who come to the hospital for healthcare. So these patients need specialized monitoring, special attention and treatment. This could be related to multiple illnesses, life-threatening illnesses such as, you know, they could have had a heart attack or a stroke. Postoperatively, after surgery, they need monitoring. They could have respiratory issues, kidney issues. There are so many different specialties involved in critical care medicine. So it's basically not an organ system. It's looking at the patient from the head to toe and taking care of the patient as a whole. And also, the other aspect of critical care medicine is supporting the families, the loved ones, as they go through this process along with the patients. So that's basically what critical care medicine comprises of.
Bill Klaproth (host): And then how about from the provider's point of view?
Dr. Navitha Ramesh: So when you look at it from the provider's end, critical care medicine is a tough field, both physically and mentally. So the providers are some of the most resilient providers or physicians we've seen in healthcare. And critical care is multidisciplinary, it's teamwork. And our providers work with great nurses, respiratory therapists, physical therapists, all of whom are fully invested. And our goal is to get this patient better as much as we can and also, like I said, supporting the families as well.
Bill Klaproth (host): So when we talk about a multidisciplinary learning experience, combined with a compassionate patient-centric approach, there it is right there. So Dr. Ramesh, why would a medical resident or physician want to pursue a fellowship at UPMC in central PA. Tell us about what is offered to these candidates that would be appealing to choose this area and this health system for their fellowship training.
Dr. Navitha Ramesh: Sure, Bill. That's a great question. The UPMC Harrisburg Critical Care Fellowship Program is a brand new program. It's a two-year ACGME-approved program. Our goal is to train physicians who have already trained in internal medicine or emergency medicine. They've already had that basic training. We want to refine their critical care education, so they can be more comfortable taking care of patients who are very sick and in a high stress environment while also taking care of themselves, being mindful that, you know, we need to take care of ourselves while we take care of our patients.
The fellowship itself, you know, as I mentioned, we look at the patient from head to toe and it's a high degree of acuity with almost every organ system. And our goal with the fellowship is to have our trainees look at the patient again as a whole. We look at the head to toe, the neurology, cardiology, pulmonology. So it's paying attention to details, which we may not have done before.
Bill Klaproth (host): Yeah. So that is really thorough intensive training. That's one of the reasons why someone may choose the critical care fellowship at UPMC Harrisburg. The other one is the area. I mentioned that work-life balance for the trainee. Can you talk about the area, how beautiful Harrisburg is?
Dr. Navitha Ramesh: So UPMC Harrisburg is located at the heart of Harrisburg, which is the capital of Pennsylvania. It's a beautiful city. There's a lot of activities around Harrisburg, outdoor activities. There are several trails. You can go on hiking, boating, fishing, a lot of outdoor activities. And also we're not too far away from, let's say, New York City, Pittsburgh, Baltimore, Washington DC. So you finish your work, you're done with your clinical duties, you always have somewhere to go to.
Bill Klaproth (host): And that is very appealing, a really big selling point. So thank you for saying all of that. That really is important. So let's talk about who should apply now for a critical care fellowship at UPMC Harrisburg. What types of qualities and interests should a fellowship candidate have to be considered?
Dr. Navitha Ramesh: So our fellowship is a two-year ACGME-approved program. So it's an American College of Graduate Medical Education-approved program. We offer three positions every year for candidates who have already completed an internal medicine or emergency medicine residency prior to coming here.
Our goal is to train the physicians in a very robust clinical environment. We are not very heavy on bench research, but we do clinical research, quality improvement, performance improvement. A lot of importance is given to QI. And our goal is to have the clinicians come out as a physician educator. That's our goal.
And who should apply? That's a great question. So in addition to having all these requirements, we are looking for candidates who have an open mindset, who come in wanting to learn. My mindset as a program director is you never know enough. There's always something that we don't know, so having the mindset of "I'm coming here to learn something new" and having this passion for education. Also, as I mentioned before, some confident humility, we could be confident in our skills, but also the degree of humility is needed because we're dealing with life and death every day. So you can never know everything. It's just having that open mindset and critical care is hard. So we're looking for candidates who are willing to work hard, keeping in mind that the patient is everything, right? We are doing our best for our patients and I would care for the patient, just like how I would care for my family member.
Bill Klaproth (host): Yeah. You said the goal is to have physician educators at the end, so that is the goal of the program. So you said it's a two-year program. Can you talk about some of the other aspects of the program, like the advanced training, the collaborative environment, access to the latest technology and things like that? Can you describe the program a little bit more?
Dr. Navitha Ramesh: So just to walk you through the program, as I mentioned, it's a two-year fellowship. Our first year, we want our fellows to get used to the area, get used to Harrisburg, get used to our ICU. Our main flagship hospital is UPMC Harrisburg. We also have other community setting hospitals where the fellows will rotate. But in the first year, they will primarily be at UPMC Harrisburg, where we have the top-notch equipment required for critical care. So we have our intubation video laryngoscopy. We have point-of-care high-end ultrasound machines, which help us to make clinical decisions in a very timely manner. We are also starting a percutaneous tracheostomy program where at the bedside, the patient needs a tracheostomy, critical care would be able to do it at bedside without having to move the patient to the operating room in appropriate patients. We also provide training with other procedures such as advanced airway central line placement, even Swan-Ganz catheter placement. So we are a very procedure-heavy hands-on program. So most of this training is going to be at Harrisburg the first year.
And then, when you look at the faculty training with our fellows, you know, they are critical care certified and they also have other board certification such as neuro-critical care, pulmonary medicine, emergency medicine, nephrology, anesthesia. So they get the perspective from all these physicians. The training will be diverse, getting input from different specialties, which I think is great for someone who's in training to get all the aspects of critical care at one spot. And also they will have elective rotations, such as, you know, if they are more interested in anesthesia, they can have an elective with anesthesia. With critical care echo, if they want to get the expertise better, so they can do an elective in ultrasound, an elective in palliative care medicine. So all those are positive points for our trainees here.
So when they move on to second year, we want them to be a little bit more confident in their ability to care for critically ill patient. So in their second year, our fellows will be rotating at UPMC Harrisburg. In addition, they would go to our other ICU's in the system as well, which is UPMC West Shore, UPMC Community Osteopathic and UPMC Memorial Hospital. So they are community hospitals where the fellow would almost serve as a junior attending. So the fellow will be given autonomy to make medical decisions and also knowing that they have the backing of the attending on campus, but the fellow will independently perform there, getting feedback from the attendings, which I think the feedback loop is important. And that's one thing that our fellowship focuses on a lot, is our doors are always open to feedback. Fellows assess the program, we assess the fellows. So that way, there's constant improvement as the fellowship progresses.
Bill Klaproth (host): Yeah, that's very thorough. And I like how you talked about that, the experience that someone would get being able to make the decisions with them and have the feedback loop, which is really important as well. Well, this has really been interesting, Dr. Ramesh. As we wrap up, any additional thoughts about the critical care fellowship at UPMC Harrisburg?
Dr. Navitha Ramesh: Thank you, Bill. Thanks for your time. I think the final thoughts would be, you know, our fellows here, they will be strongly supported by our faculty from, I said, diverse backgrounds. we focus a lot on mentorship. Each fellow will be assigned a faculty mentor and the fellows are also free to reach out and seek other mentors in your areas of interest. We also believe in constant evaluation 360 degrees. They evaluate the program, the program evaluates the fellow. So it's overall betterment. So that's basically what they will get in our program. You know, you will be a strong clinician as well as having the open mindset of constant improvement and constant learning.
Bill Klaproth (host): Which again is really important as we said earlier. But that work-life balance also is critical to this and being in that beautiful Harrisburg area. It's kind of a win-win. Dr. Ramesh, thank you so much for your time. This has really been informative. We really appreciate it. Thanks again.
Dr. Navitha Ramesh: Thank you so much for having me, Bill.
Bill Klaproth (host): And once again, that's Dr. Navitha Romesh. And for more information, please visit upmc.com/cpacriticalcare. That's upmc.com/cpacritical care. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.