Intensive Care Unit Structure and Fellow Responsibilities
Patient care in the neurointensive care unit is delivered by an integrated, multidisciplinary team that includes Critical Care Medicine (CCM) fellows, medical students, interns, anesthesia and surgical residents, and CCM faculty. Both CCM faculty and the primary service faculty serve as concurrent attending physicians in the ICU.
ICU follows a collaborative care model in which the team develops a unified treatment plan each morning, guided by current evidence-based practices and local consensus protocols. All team members may perform patient care activities appropriate to their training and may intervene in emergencies or when a patient’s condition warrants urgent action. Any deviation from the established care plan must be promptly discussed with the CCM attending.
Because critically ill patients often have multiple consulting services, effective communication and coordination are essential. Fellows are expected to engage consultants during rounds and notify the attending physician immediately if a patient’s clinical status worsens.
Attending Supervision and Responsibilities
The CCM attending maintains ultimate responsibility for all medical decisions in the ICU. Attendings providing oversight and supervision of fellows and must be involved in all critical decisions in medical care and contacted for significant changes in patient status. All procedures in the ICUs are to be supervised by an ICU attending physician except in unusual, emergency situations. Fellows are required to maintain accurate procedure logs throughout their training.
Progressive Fellow Autonomy and Leadership Development
As fellows advance through the program, they assume increasing responsibility for patient care and team leadership. They are expected to lead rounds, guide clinical decision-making, and demonstrate growing independence. This progression culminates in the junior attending rotation, during which fellows are granted substantial autonomy while receiving focused feedback on leadership, clinical judgment, and decision-making skills.
For more information and to apply, contact John H. Kanter, MD.
Fellowship Director
Lori Shutter, MD
Fellowship Co-Director
John H. Kanter, MD