Physician Directory
Make a Gift Online
Curriculum
The goal of the Pulmonary Disease/Critical Care Medicine (PD/CCM) training program is to enable fellows to acquire knowledge, skills, and experience in the six core competencies as they relate to the two disciplines. The training program is three years in duration with a minimum of 24 months devoted to clinical training. All of the educational experiences and program content explicitly required for training in each area are present in the combined program. It is expected that the fellows demonstrate a greater depth of medical knowledge, judgment and procedural competence as they progress through the program. Specifically, they are expected to demonstrate greater skills and independence in decision-making regarding patient management and resource utilization. The program provides a minimum of nine months of clinical experience in pulmonary disease and at least nine months of meaningful patient care responsibility in the intensive care unit, with at least six months spent caring for critically ill medical patients and three months devoted to the care of non-medical ICU patients.
The schedule is divided into 12 months for each year. The typical schedule for each year of training is listed below. Over-night continuity of care is provided by a night float team, with in-house overnight call limited to the Medical Intensive Care Unit (MICU).
Program Curriculum
| Year 1 (PGY-4) Rotation | Months |
| Research | 4 |
| Medical ICU | 2 |
| Consults | 2 |
| Lung Transplant | 1 |
| Sleep Medicine | 1 |
| Radiology | 1 |
| Thoracic Surgery ICU | 1 |
| Year 2 (PGY-5) Rotation | Months |
| Research | 3 |
| Medical ICU | 2 |
| Consults | 2 |
| CCU | 1 |
| Trauma/surgical ICU | 1 |
| Lung Transplant | 1 |
| Sleep Medicine | 1 |
| Pathology/Infectious disease | 1 |
| Year 3 (PGY-6) Rotation | Months |
| Research | 5 |
| Medical ICU | 2 |
| Consults | 2 |
| Lung Transplant | 1 |
| Trauma/surgical ICU | 1 |
| Sleep Medicine | 1 |
Over the course of the 3-year fellowship, each fellow has a weekly continuity clinic. In addition, there is ambulatory experience in Pulmonary Hypertension/Interstitial Lung Disease Clinic and Thoracic Oncology Clinic.
Primary Training Rotations
Critical Care In-patient Service
Pulmonary Disease and Critical Care Medicine (PD/CCM) fellows actively participate in all aspects of the care of medical ICU patients, including evaluation and management, procedures, family meetings, communication with referring and consulting physicians, and discharge planning. Fellows learn the indications, complications, contraindications, and techniques of procedures commonly performed in the ICU. They acquire a knowledge base pertinent to critical care including the physiology of cardio-respiratory disease and an understanding of the operation of bedside hemodynamic monitoring systems. They learn how to obtain valid hemodynamic measurements at the bedside. As the fellows progress they assume increasing responsibility for patients and education and mentoring of internal medicine residents assigned to the ICU service. Fellows ensure that residents perform procedures safely and according to the highest technical standards. Each third-year fellow is expected to conduct one performance / quality improvement project and present the results to the Pulmonary Disease and Critical Care Section.
Pulmonary Disease Consult Service
During the six months of the Pulmonary Consult Rotation, the fellow is exposed to a very wide variety of pulmonary diseases in a diverse population. The rotation includes formal instruction, clinical experience, and the demonstration of competence in the prevention, evaluation, and management of pulmonary diseases. During this rotation, the PD/CCM fellows participate in all aspects of care. The fellow on the inpatient consult service is called initially for all pulmonary consultation requests. The fellow then either sees the patient or assigns a student, intern, or resident to see the patient. Regardless of who sees the patient first, the fellow is responsible for the final content of the presentation of each patient to the attending physician, who sees every patient. The fellow is responsible for daily follow-up and all care either primarily or after discussion, and verification of all events with other students or residents on the consult service.
Lung Transplantation and End-Stage Lung Diseases
The goal of this rotation is to help the fellow acquire the skills and knowledge necessary to care for patients with end-stage lung disease and to learn the role of transplantation in their management. Fellows care for patients referred for potential transplant as well as both pre- and post-transplant patients. They participate in care in both inpatient and outpatient settings. Additional goals include obtaining an understanding of the role of cardiopulmonary exercise testing, developing an ability to interpret exercise testing, and acquiring an improved understanding of hemodynamic monitoring.
The Thoracic Surgery Rotation is designed to provide the PD/CCM fellow with the clinical skill and knowledge base necessary to provide competent clinical consultation (evaluation and management) and care to patients prior to and following thoracic surgical procedures. Expertise in outpatient preoperative evaluation and postoperative late follow-up care are provided during regularly scheduled weekly Thoracic Surgery Clinic. Each fellow spends approximately 1 month formally involved in this rotation during the fellowship.
The Trauma Intensive Care/Surgical Intensive Care rotation is designed to provide the PD/CCM Fellow with experience in perioperative care for critically ill patients undergoing general surgical procedures and in the care of victims of trauma. Each fellow spends approximately two months formally involved in this rotation during the fellowship. The PD/CCM fellow functions as a member of the TICU/SICU team during this month. The PD/CCM fellow does not attend continuity clinic during this period but does attend both PD/CCM lectures and surgical didactic sessions. The PD/CCM fellow experience is enhanced by interaction with peers in the SICU, as the fellow acts in conjunction with and parallel to the Surgical Critical Care fellows.
Pulmonary Disease Out-patient Clinics
Continuity Clinic: The fellows evaluate and treat new and established patients in weekly, one-half day continuity clinics. Faculty physicians attend all clinics and discuss the fellow's assessment and plans before the patient is discharged.
Thoracic Oncology Clinic: Fellows evaluate patients with clinical suspicion of lung cancer and arrange for diagnostic procedures or appropriate follow-up. Fellows present the results of the diagnostic evaluation at the weekly, multidisciplinary Thoracic Oncology Clinical Case Conference and participate in the decision-making process that leads to a treatment recommendation for each patient. The clinic meets weekly for one-half day.
Sleep Clinics: Fellows attend a consultative clinic during the Sleep Rotation where they evaluate patients with sleep related complaints. They attend a CPAP Clinic for patients who are initiating CPAP treatment or have problems with CPAP tolerance. The consultative clinic meets weekly for one-half day, and the CPAP Clinic meets twice weekly for one-half day each time.
Pulmonary Hypertension/Interstitial Lung Disease Clinic: Fellows see outpatients with pulmonary hypertension/ILD under the supervision of a faculty member with special expertise in this area. They learn about different state of the art evaluation and management of this diverse population. The fellows attend this clinic every other week while not on an ICU or Transplant rotation.
Fellows are expected to be involved in scholarly activity and spend 11 months doing research, three months in the first two years and five in the third year of training. Research electives may be taken as a 1-3 month block. At the start of a research elective, the fellow must have an approved project. The fellows continue to take part in the weekly continuity clinic, twice monthly Pulmonary Artery Hypertension Clinic, and twice monthly Thoracic Oncology Clinic during the research elective, as well as take part in all educational activities of the division including conferences, journal club, etc. Fellows are expected to complete and submit at least one manuscript to a peer reviewed journal .
Procedures
The fellows are trained in all aspects of procedures pertaining to the specialty, including but not limited to:
- Fiberoptic bronchoscopy:
- Argon plasma coagulation
- Trans-bronchial biopsies under fluoroscopy
- Trans-bronchial and endo-bronchial brushing
- Endo-bronchial ultrasound guided biopsies
- Broncho-alveolar lavage
- Pulmonary artery catheterization
- Ultrasound guided thoracentesis and pigtail drainage catheter placement
- Ultrasound guided central venous catheter placement