Pulmonary Consultation Service
Fellows spend six to nine months of the three-year fellowship on the consultation service. Patients from the medical, surgical, neurologic, and obstetric units are seen, including critically ill patients in the surgical and neurological ICUs and the cardiac care unit. A sleep disorders consultation service is also provided. The fellows perform bronchoscopies, thoracentesis, and chest tube insertions under supervision of the attending physician. Emphasis is placed on the fellow’s professional development into an expert in inpatient pulmonary consultation. This does not only include medical knowledge and patient communication. The expert consultant develops proficient skills in interprofessional communication (chest radiology and primary teams), documentation, coordination of care, and proper triage.
Pulmonary Procedure Rotation
Fellows spend a month each year as a dedicated procedural fellow. In this capacity, they work closely with our procedurally based attendings performing advanced bronchoscopic techniques including EBUS, navigational bronchoscopy, and airway stenting. This rotation spaced throughout the whole fellowship allows our fellows to increase their proficiency with bronchoscopic techniques that are becoming the cornerstone of a pulmonary specialist who performs bronchoscopy as part of their practice as attendings.
Intensive Care Units
The Pulmonary/Critical Care fellows spend at least six months in the medical intensive care unit, caring for critically ill patients with complicated medical problems. Admissions come from the medical wards, the Emergency Department Room, and transfers from outside referring to other hospitals in the referral area. Fellows evaluate and treat both common and unusual critical care disorders cases under the guidance of the critical care medicine board-certified attending faculty, who are all Critical Care Board Certified. Extensive experience is gained in ventilator management and hemodynamic monitoring techniques, including balloon floatation Swan-Ganz and arterial catheter placement. The fellows also develop skill in intubation, ultrasound-guided central venous catheter insertion access, chest tube thoracostomy, and percutaneous thoracotomy and tracheostomy. Emphasis is also placed on critical care ultrasound.
The critical care experience is broadened by rotations through non-medical intensive care units including time spent in the Surgical-Trauma Intensive Care Unit, Neurologic Intensive Care Unit, and Coronary Care Unit. In these units, pulmonary fellows care for patients with trauma, postoperative complications, strokes, and spinal cord injury, as well as cardiovascular diseases. Finally, as part of the hospital’s response to the COVID-19 pandemic, a Special Pathogens Unit (SPU) has been developed and our fellows rotate on this service as well.
Physiology and Pulmonary Function Laboratory
A clinical physiology rotation is a unique opportunity to learn the foundations of pulmonary function testing under expert supervision. Rotations such as these were once commonplace in pulmonary fellowships. However, increasing service needs and a general de-emphasis of physiology has led them to be dropped from programs. We would like to provide our fellows with this exposure because we believe a solid understanding of pulmonary physiology remains essential to understand the effects of disease, and that pathophysiology bride between cellular events and the patient’s experience.
This rotation requires extensive outside reading on the part of the fellow in addition to providing hands-on training in the pulmonary function, exercise testing, laboratory management, and quality control. The fellows will also meet individually with attending who have a background in physiology and pulmonary function testing. These meetings will review the pulmonary function testing and will provide an opportunity to discuss a variety of physiology topics.
Outpatient Pulmonary Clinic
The Pulmonary Outpatient Clinic sees 4000 patients annually. Pulmonary fellows have one half-day continuity clinic per week, seeing 2 new patients and several returning patients. Fellows follow their patients throughout the three-year fellowship. The fellow’s clinics are staffed by one of the Pulmonary/Critical Care attendings available specifically for the fellow’s outpatient clinic.
The fellows spend one month with Dr. Max Weder or Dr. Hannah Mannem, seeing patients in all stages of the lung transplant process. This includes those waiting for a transplant as well as recent and long-term post-operative patients. In addition, the fellows will see adult cystic fibrosis patients both inpatient and in the clinic.
In the first year, the Pulmonary/Critical Care fellows have the opportunity to rotate on the Anesthesiology Service where they achieve proficiency in airway management and intubation.
The Pulmonary Division’s multidisciplinary Sleep Disorders Center, directed by Dr. Daniel O’Hearn, works closely with the pediatric, otolaryngology, neurology, and psychiatry departments. The sleep laboratory is a state-of-the-art, eight-bed laboratory that performs 150 to 190 overnight evaluations each month of adults and children with sleep-related problems. Although sleep apnea syndromes make up a large part of the caseload, all types of sleep disorders are seen. There is ongoing research in the treatment of obstructive sleep apnea. Pulmonary fellows gain experience in patient evaluation and in the techniques and interpretation of nocturnal polysomnography while rotating on their sleep rotation. More recently the sleep rotation has been bested with the Physiology and PFT rotation.