July IM intern, interested in PCCM. I love the high level clinical thinking and ability to manage multiple conditions that my attendings have.

I question whether I'm good enough to be an intensivist, I don't even know if I good procedural skills yet. How to know if I have what it takes.

Hello guys, I am looking for J1 waiver in critical care, any leads or openings?

I just accepted my first nursing position in a cardiac icu that accepts both pulmonary and cardiology patients. We manage CRRT, ventilators, arterial lines, CVLs, PA catheters, and different types of titratable medications. During my first several weeks of orientation I have noted that there is more of a gap in my level of understanding than I would like. Though I understand this is to be expected I would like to self study on my time off to help speed up my interventions in practice since time is key. I'm really struggling to manage time due to constantly asking for help and I don't want to be a liability to my team. Does anyone have a compiled list of resources I can easily access for free that can provide information of the equipment, medications, and diseases I may encounter?

Wondering how other providers handle end of life conversations with family members that default to “it’s in gods hands”. Ex: Patient in 4 pressor shock with no hope of recovery, clearly suffering. My team is great at communicating with family’s from admission on so usually these conversations are not a “surprise” to the family.

Not to disrespect any religion at all, but this answer feels like a cop out way to avoid making these end of life decisions. I’d never want to be in any of their shoes.

I’ve heard colleagues reply with “well I’m preventing god from taking your loved one with all these machines” and the response is a mixed bag of answers…

ICU nurse here. Any docs able to share their thoughts on what works best for them:
- nurse has non urgent question
- nurse has urgent question/concern
- how frequently you expect to address non emergent issues in a 12 hour shift or 24 hour period
- what is the best way to convey you have a question that’s not urgent?

I’ve been in my unit for years and I am noticing a lot of frustration lately around these things.

Where are we supposed to write about procedural experience in my eras cv

What would you guys consider fair? Can give by $/hr or per 12 or 24hr shift.

US East Coast mid-sized city

I'm an intern at a mid-sized community hospital, I've really liked my ICU rotation so far and think it's what I want to pursue. I'm going to try to commit early, do as many procedures as I can and put out some quality publications.

My program has an in house PCCM fellowship, but I'm wondering if I should try to reach for a few bigger academic centers. I don't care about pay or prestige, I just want to know a lot and get all the skills I need to be comfortable treating patients independently.

Hi everyone! I'm a medical student at a Canadian medical school looking to join any surgery-related or Critical Care-related systematic reviews, scoping reviews or meta-analyses. I've worked on a lot of these in the past so I have quite a bit of prior experience in this domain and would be happy to help with screening, data extraction, risk of bias, or manuscript writing. Please message me if you're looking for another collaborator

I graduate from an ABSN program next May and am hoping to land an acute care position in a different state in the one I am currently in (due to family). Obviously connections are important, but other than that how can I set myself apart?

Hello,
I’m starting my new grad RN job at CVICU. I want to start studying to feel a little more confident or comfortable.

I understand that it will be overwhelming as a new grad & that I will never know everything because it’s a unit where we learned every single day.

What are some tips that you would give to a new grad?
Any report sheets that have worked for you?

I was thinking to start studying on hemodynamics, EKGs and ICU medical on YouTube.

I will be placed in Medical ICU for my first 6 months and then transferred to CVICU

The heart fascinates me and I love learning about the heart but I’m also really nervous to start.

When I started as a PCCM fellow, the growth curve was STEEP. I by no means consider myself as someone who’s learnt everything at this time. But the fact is, I can ‘get by’ my workday just fine with whatever I know.

ICU admissions, consults, Pulm clinic for the most part have become bread/butter. I know that’s the point of training. But at the same time, I don’t want to get complacent and stop learning.

Don’t mean to sound like a podcast bro, but I am wondering how have other folks on this sub (MDs, RNs, RTs, pharmacists etc.) challenged themselves to raise the bar? How do you push yourself to be and do better?

Would love to hear any tips/anecdotes!

Can anyone explain functionally how DDD vs DDI differ? I know what the different letters mean in terms of pacing, sensing, and inhibit. But what are you gaining/losing with each mode compared to the other.

Thanks much.

In my practice a hospitalist independently manages a subset of ICU patients. I am available for consultation and escalation, but we do not routinely round together, I do not see every patient, and I do not cosign notes.

For those who have worked in similar models, how is liability generally viewed for the ICU attending? If you’re available in a supervisory/consultative role but not directly involved in a patient’s care, how much responsibility do you carry for decisions made by the primary hospitalist?

Recently out of training and wondering how this is handled at other institutions.

Current IM resident. I've been going back and forth for the past half year on what specialty I want to do. I genuinely enjoy the subject of critical care, but I've become pretty burned out on patient care and have been thinking of even switching specialties to interact with patients/families less as it can be incredibly draining. However, I think I'm coming to realize that the easiest path to the life I want is CCM fellowship.

I realized that I just want to clock in and clock out. I want to be able to choose when and how much I want to work. I want to be able to walk out and find another job without having to establish a patient panel. I don't want to deal with 500 inbox tasks every day on top of a full patient panel. And I want to be able to hit >400k comp without leaving the east coast. This + me liking critical care makes me lean towards CCM fellowship despite not liking patient contact as much.

In terms of lifestyle, the main non-negotiables for me are portability (able to pick up and move whenever I feel like admin screwed me over too much), flexibility (ability to flex up/down FTE as much as I need in a given year), and >400k compensation (important because I want to have the ability to go part time then maybe chubbyFIRE if I feel like it)

However, I'm worried about the lifestyle, and especially how difficult it will get if I choose to have a family down the line. I'm not sure how much I'll be able to tolerate constant 84 hour weeks, day/night flips, working 26 weekends every year, missing holidays every year. Especially as I age, working 12 hours 7 days in a row every other week with no end in sight will get hard on my body. I'll barely be there for my family half the year, and even when I'm at home I might be too exhausted to do anything. Locums is a dealbreaker because it would require me to be physically away from my family, which is arguably worse.

But I don't really know any other option that will give me the lifestyle non-negotiables above. I know many people do PCCM and then switch to pulm later in life but I'm less interested in doing pulm because it doesn't hit any of the 3 non negotiables above.

Anyone have any advice?

Hi everybody!

I am a high school student currently conducting a research project on simulation-based training and the cognitive biases that may influence ER triage decisions. While I created a simulation for this project, my main focus is the science behind decision-making and understanding what biases are most prevalent in high-pressure situations. I would greatly appreciate your feedback and testing to help make the project as accurate as possible. If there is anything you think I should improve or any information you believe would be relevant, please feel free to share it.

I know everyone is busy, so please participate whenever you have the time. If you know someone who may be interested, I would really appreciate you sharing this with them as well.

Please DM me for the link. The form contains additional information about the project, participation, and the opportunity to be recognized as a beta tester in the final research paper.

If you work in critical care or a related healthcare field and would like to be recognized in the research paper for your testing, feedback, advice, or contributions, you can opt in through the Google Form or contact me directly through DM.

Thank you so much for your time and support!

the CCRN is not actually testing your clinical knowledge as much as your clinical decision making, and figuring that out is what got me through round two.

context for credibility. CVICU nurse, 6 years bedside, sat for CCRN twice. failed by a small margin first time, passed comfortably second time. came out of the second attempt thinking the actual content of what I knew didn't change much, what changed was how I was reading the questions.

here's what I mean. on round one I was answering questions like a knowledge test. saw a scenario, identified the pathophys, picked the option that matched what I'd seen at bedside. on round two I started treating every scenario as a decision tree. what is the most life-threatening thing in this picture, what is the next step that addresses that, and which option in the list represents that next step. shifted my practice scores by 8 to 10 percent.

three filters I now run on every clinical scenario before I read the options. what is the most acute issue in this picture, not the most interesting one what is the next intervention this pt needs in the next few minutes, not the workup over the next shift which option represents appropriate scope for the bedside ICU nurse, not what a physician would order

most of the time the keyed answer is the option that survives all three filters. when I miss it, it's because I picked the more clinically interesting answer when AACN wanted the more time-critical one.

the only resource that actually changed how I read scenarios was PrepSolution's ICU Decision Framework, basically a structured read protocol you apply to every clinical scenario before looking at the options (recognize the most acute issue first, assess urgency, choose intervention, eliminate the traps). went through it twice between attempts and it changed how I approached every question. their Adaptive QBank also kept feeding me my weakest domains specifically, by mid round two I was getting almost only my weak-area scenarios instead of generic CCRN practice. tried Pocket Prep too, the mobile interface is clean and short-burst drilling between patients is what it's actually built for, just the rationales are too short to retrain a scenario read. Critical Care Academy's video reviews work well if you absorb material better through structured lectures, the content coverage there is comprehensive and they emphasize test-taking strategy. neither of them retrained my scenario reading the way the QBank rationales did, but for different study needs they each fit.

if you've been grinding more practice questions to fix a CCRN gap, stop. think about whether your problem is actually content gaps or whether it's how you're reading the questions. mine was the latter.

I go to a community program for IM, I’m a nonUS IMG on &1, have low scores step 1 pass, step 2- 22x, step 3- 20x

I believe I performed well in my CCM rotations and can secure a good LOR from the PD, APD

I have 10 posters in CHEST, and 4 other publications

What are my odds for matching given low step scores?

Hi everyone,

I’m a new grad starting in a Neuro ICU that cares for strokes, brain tumors, TBIs, seizures, spinal injuries, and other complex neurological patients.

I’ve spent most of my ICU time in cardiac and surgical trauma settings, and one of the things I love about critical care is caring for vented patients and titrating drips.

For those of you who work Neuro ICU, what is day-to-day nursing actually like? Do you see a lot of intubated patients, sedation, vasoactive drips, and other high-acuity critical care, or is the focus mostly on neuro assessments and monitoring?

I’d love to hear what Neuro ICU nursing is really like and what surprised you most about the specialty. Thanks!

Hi all! Going to start ccm fellowship next year. Looking for good study materials to flip through during this year! All recommendations welcome please!

posting because the timing on this exam catches more people off guard than the content does and I never see this written about. CCRN gives you 3 hours for 150 questions which sounds generous on paper but turns out tighter than it looks once you hit the long clinical scenarios.

context. about 90 minutes into my first attempt I looked at the question counter and realized I had answered 60 questions which means 90 questions left in 90 minutes no buffer for any question that needed extra thought. I rushed the back half made some panic choices on questions I would have gotten right with another 30 seconds and finished feeling like I lost the exam in the timing rather than the content. failed by 4 points. score breakdown told the story my misses were heavy in the second half classic fatigue pattern. I was furious at myself afterward because I knew the content.

what I rebuilt for round two was specifically my pacing before I added a single new content review hour.

PrepSolution's Exam Mirror gives you 3 full-length mocks 150 questions each which mirrors the actual CCRN structure. I did all 3 under timed conditions in my last 4 weeks before the retake. their Adaptive QBank has enough volume that I never ran into repeats across mocks plus regular prep.

AACN review book stayed open for content gap-fill, it's the framework reference and you can't really skip it. shorter Pass CCRN blocks for content-specific drilling, fine for that, not a full prep solution. also did some BoardVitals questions early in prep, their question volume is decent and the adaptive component is fine, just leaned on PrepSolution's Exam Mirror for the actual timed pacing work.

the timing piece nobody tells you. CCRN questions are not uniform length. some are short knowledge recall some are longer clinical scenarios that need a full read and the longer ones eat your buffer fast if you don't budget for them upfront. once you've done one full timed mock you'll know your own ratio.

if you have CCRN coming up and you have not done a full timed mock yet do that this weekend. you'd rather find out about your pacing now than mid-test.

I don’t know if this is the right place to ask this…I am about to start gearing up to study for the critical care boards. I am torn between using CHEST seek vs SCCM question bank. Which do you think is better/do you recommend?