Pulmonary & Critical Care Fellowship

After completing their fellowship, fellows are eligible to take the American Board of Internal Medicine’s Pulmonary Medicine and Critical Care Medicine examinations.

Roughly half of our graduates go into academic positions, and the other half go into private practice. See where fellows go here.

PCCM fellows ready to learn

Pulmonary and Critical Care Fellowship program goals:

1. Develop fellows’ competencies in the specialty of pulmonary disease through a comprehensive training experience in which they encounter and treat a broad spectrum of patients with pulmonary disease in both hospital and outpatient settings and in close collaboration with division faculty. In addition to an ambulatory continuity clinic, fellows may elect to rotate through the pulmonary subspecialty clinics. Each fellow will receive at least 12 months of clinical pulmonary training in the fellowship.
2. Develop fellows’ competencies in the specialty of critical care medicine. While most of the critical care experience is in the Medical Intensive Care Unit, each fellow rotates through non-medical intensive care units. Fellows lead by running our medical ICU teams with our faculty, where they develop competencies over a wide spectrum of diseases. Each fellow receives at least 12 months of clinical critical care medicine training during the fellowship.
3. Develop fellows’ competencies in conducting basic and clinical medical research and provide additional training opportunities for fellows planning to pursue a career in academic medicine with a research focus. This portion of the fellowship is designed to immerse fellows in a protected period of up to 18 months.

Pulmonary Consultation Service

Fellows spend at least four months 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. The fellows perform bronchoscopies, thoracentesis, and chest tube insertions under the supervision of the attending physician. Emphasis is placed on the fellow’s professional development into an expert in inpatient pulmonary consultation. The fellow consultant develops proficient skills in:

• Medical knowledge
• Patient communication
• Interprofessional communication (chest radiology and primary teams)
• Documentation
• Coordination of care
• Proper triage

Interventional Pulmonary Rotation

Fellows spend a month each year as a dedicated IP fellow. In this capacity, they work closely with our procedurally based attendings performing, with appropriate use of ultrasound:

• Advanced bronchoscopic techniques, including EBUS
• Navigational bronchoscopy
• Advanced pleural procedures

This rotation allows our fellows to obtain proficiency with advanced bronchoscopic techniques that are becoming the cornerstone of a pulmonary specialist who performs bronchoscopy as part of their practice.
Procedures are performed in the intensive care units, UVA operating room, and the multidisciplinary endoscopy unit.

Intensive Care Units

Fellows spend at least six months in the medical ICU, where they evaluate and treat common and unusual cases under the guidance of the critical care medicine board-certified attending faculty. As a part of the daily responsibilities, fellows are expected to:

• Organize and lead teaching/work rounds.
• Formulate care plans with attending supervision.
• Facilitate communication between the ICU team and surgical services, consultative services, and family members.

Extensive experience is gained in:

• Ventilator management
• Hemodynamic monitoring techniques, including balloon floatation Swan-Ganz and arterial catheter placement
• Intubation
• Ultrasound-guided central venous catheter insertion
• Chest tube thoracostomy
• Percutaneous 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:

• Thoracic and Cardiac Surgery Intensive Care Unit
• Neurologic Intensive Care Unit
• Coronary Care Unit
• Surgical Intensive Care Unit

In these units, pulmonary fellows care for patients who presented with trauma, postoperative complications, strokes, spinal cord injury, cardiovascular diseases, or who are on ECMO.

Outpatient Pulmonary Clinic

Pulmonary fellows have one half-day continuity clinic weekly, seeing two new 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.

Third-year fellows also have the opportunity for further experience in ambulatory subspecialty clinics of their choice, which include:

• Asthma
• COPD
• Cystic Fibrosis
• Interstitial Lung Disease (one of only 45 national Pulmonary Fibrosis Foundation Care Centers)
• Sarcoidosis
• Sleep Disorders
• Lung Transplant
• Pulmonary Hypertension
• Post-ICU COVID-19

Clinics Rotation

As pulmonary medicine has become more specialized, we understand that fellows may not be exposed to the full breadth of outpatient pulmonary medicine in their continuity clinic. The Clinics Rotation is a pure outpatient rotation that allows our fellows to rotate through subspecialty pulmonary clinics, including those for CF and non-CF bronchiectasis, severe asthma, Advanced COPD, Pulmonary Hypertension, ILD, and Sarcoid.

Lung Transplant

The fellows spend nearly two months on lung transplant rotation, seeing patients in all stages of the transplant process. This includes those undergoing evaluation for transplant, listed and waiting for a transplant, and recent and long-term post-operative patients. In addition, the fellows will see adult cystic fibrosis patients, both inpatients and in the clinic.

Anesthesiology Elective

In the second and third years, the Pulmonary/Critical Care fellows can rotate to the Anesthesiology Service, where they achieve proficiency in airway management and intubation.

Sleep Medicine Elective

The rotation includes activities at the Sleep Disorders Center with its associated Sleep Lab. Although sleep apnea syndromes make up a large part of the caseload, all types of sleep disorders are seen during clinic in this rotation. Ongoing research, particularly in treating obstructive sleep apnea, is discussed. Pulmonary fellows gain experience in patient evaluation and the techniques and interpretation of nocturnal polysomnography.

Pulmonary Hypertension Elective

In the final year of fellowship training, interested fellows can take a four-week elective in pulmonary hypertension. This rotation utilizes the expertise of one of our faculty, Dr. Andrew Mihalek. It involves both an inpatient and outpatient pulmonary hypertension experience. It also includes dedicated time working with ECHO technicians in the hospital and reading room time with cardiology faculty reading ECHOs. There is an opportunity to spend time in Nuclear Medicine reading V/Q scans. Finally, Dr. Mihalek performs RHCs on Fridays, and the fellow assists with these procedures.

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 have led to their dropping from programs. We would like to provide our fellows with this exposure because we believe a solid understanding of pulmonary physiology remains essential to understanding the effects of disease and that pathophysiology bridges 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:

• Pulmonary function
• Exercise testing
• Laboratory management
• Quality control

The fellows will also meet individually with attendings with a physiology and pulmonary function testing background. These meetings will review the pulmonary function testing and provide an opportunity to discuss various physiology topics.

Global Health Curriculum and Elective

This e-curriculum was developed by one of our fellows. Its overarching goal is to expose interested fellows to the complexities surrounding global health practice, research, education, and policy in the context of anesthesia, pulmonary medicine, and intensive care. Phase 1 of the curriculum involves active participation by the PCCM Global Health Journal Club. This is open to all our fellows. For those fellows who would like to make Global Health the focus of their research time, Phase 2 involves identifying a mentor in Global Health and actively participating with that mentor in their team meetings and research. Those fellows who participate in Phase 1 and 2 fellows can travel to a partner site in Rwanda, South Africa, or Tanzania for four weeks to foster cultural exchange and bidirectional learning.

Goals for Training & Development

Our goal in selecting and training pulmonary critical care fellows is to produce the next generation of both academic and non-academic leaders. Such individuals must not only demonstrate excellence and dedication to patient care, but also the ability to translate scientific innovation to the bedside.

Learn more about the division’s research endeavors here.

Roadmap

Fellows spend approximately 9-12 months performing research with close supervision from a primary mentor and mentorship advisory team. Examples of recent research efforts by fellows with senior PCCM mentors include:

• Examination of the genomics of fibrotic lung disease and short telomeres
• Pulmonary MRI abnormalities in COPD
• Innate immunity in patients with asthma
• Development of a novel ‘flipped classroom’ educational curriculum for fellows

For fellows with broader interests, there are exceptional opportunities to pursue specialized research and/or additional coursework across divisions and departments in diverse fields, such as:

• Public and global health
• Allergy and immunology
• Medical education
• Clinical informatics
• Leadership

For example, the division has supported fellows in arranging combined fellowships, such as with clinical informatics, and advanced degree programs. In addition to the breadth of subjects for research, there is an abundance of research opportunities in basic science and clinical and translational research.
Fellows also have access to resources through iTHRIV (the Integrated Translational Health Research Institute of Virginia) and the Health Sciences Library to facilitate their research work. Many of our graduates have thriving careers in academic medicine and research positions.

First-Year Preparation & Mentorship

To assist fellows with career planning, each fellow is assigned a faculty mentor at the onset of their fellowship. Program leaders work to tailor career development plans aligned to each fellow’s professional goals.

We hold a research training week in the winter of Year 1, and first-year fellows have time dedicated to research thereafter, with additional meetings to plan and develop the direction of their research. By the end of the first year, each fellow will have a primary research mentor of their choosing, their assigned faculty mentor, and several sponsors and co-mentors to support their progress.

Manuscripts and Grants

Fellows are encouraged to pursue academic research in their areas of interest and to submit their research proposals for external funding via grant submission. The division has R01 grant researchers who support fellows who aspire to apply for F32 grants through the NIH.

Fellows are supported to present their results at national meetings, culminating in one or more manuscripts prepared and submitted during the third year. Fellows receive frequent feedback via research-in-progress and research committee meetings and receive grant writing support through a grant writing workshop led by PCCM faculty.

An after-hours grant writing workshop is open to all fellows and faculty. In particular, as it pertains to fellowship career development and research, the workshop provides support and structure for each second-year fellow to present their specific aims and other related research documents. This engaging forum assists with outlining each fellow’s research approach and career development over the second half of the fellowship program.

Pulmonary Grand Rounds

Designed to focus on topics in pulmonary and critical care medicine in which management and research are actively evolving. Our faculty and invited speakers from throughout the department and School of Medicine present such topics weekly. We also have invited guest speakers who are experts in their respective fields.

Chest Imaging and Ultrasound Case Conferences

This weekly conference, run by the fellows, highlights interesting or challenging cases on the pulmonary consultative service and medical ICU. The format alternates every other week between a chest radiology case conference, in which fellows gain experience in interpreting unknown chest radiographs, and an ultrasound case conference, in which a fellow presents ultrasound images from critically ill patients. The conferences are moderated by faculty members committed to education and clinical reasoning and expertise in US acquisition and interpretation.

Didactic Lecture Series

This weekly series covers core topics in pulmonary and critical care medicine. The series runs through an 18-month cycle and focuses on the topics covered on medical boards. The format further subdivides into more specialized areas with mini-series (1-2 months) on topics such as:

• Lung cancer
• Interstitial lung disease
• Lung transplantation
• ICU (ventilator and non-ventilator) topics
• Outpatient pulmonary medicine

Quarterly Skills Days

The skills days are afternoon sessions that occur at least once per quarter and focus on high-yield areas of critical care medicine. They are led by expert faculty from inside and outside the division. In the past year, topics included a cricothyroidotomy lab, hands-on experience with ECMO circuits and cannulae, and a difficult airway skills session.

Literature Review Conference

In the monthly journal club, fellows present recent articles that provide up-to-date outcomes studies in pulmonary and critical care medicine and develop the fellow’s skills in critically interpreting the literature. We use a structured format to guide the fellow in interpreting and presenting an article and assigning preceptors with a background in epidemiology and study design. Emphasis is placed on break-out articles that will immediately impact the field and various studies covering various study designs.

Microscopic Pathology Conference

Fellows and attendings meet in a multidisciplinary format with members of the Pathology and Radiology Department to review pathology specimens from lung and pleural biopsies. The fellows become proficient in interpreting lung disorders from cytopathologic and histopathologic specimens. The conference structure promotes a multidisciplinary dialogue focusing on ILD, lung cancer, and other disease processes.

MICU/QI Conference

This monthly conference brings together members of the MICU team, quality assurance leadership, and hospital team members to review quality assurance issues in the MICU, pulmonary service, and other related fields. The fellows learn skills related to quality assurance assessment and participate in systems analyses about patient outcomes.

Research Conference

Fellows and faculty present new proposals, work in progress, and completed research projects. The conference is focused on the second and third years of fellowship, during which fellows are given significant protected time for scholarly activities. Fellows present at least twice yearly detailing their work in progress and interim results. We understand that scholarly activity during fellowship can feel daunting and disorganized. This conference is meant to provide clear and attainable milestones.

Research Week

The week’s goal is to give first-year fellows an overview of research opportunities within the division, the areas of synergy in the department, and the school of medicine overall. This will help fellows develop a research question they can further develop and immerse themselves in over the second and third years. Topics discussed include:

• Faculty research interests and current projects
• Library and data resources
• Mentorship
• Evidence-based medicine research

At the end of the week, first-year fellows present a ‘mini-proposal’ of what they think they would like to pursue over the next two years.

See information on salary and benefits on the GME website.

Fellow wellness is a top priority of our program and is a factor in all decisions related to the fellowship program. There is an abundance of resources available. See information on GME well-being resources and learn more about the Faculty & Employee Assistance Program.

The UVA Pulmonary and Critical Care Fellowship Program participates in ERAS and the National Resident Matching Program. We do not accept fellows outside of the match.

Applicants must have completed an accredited residency within the last five years.

Current UVA Health System Policy on Occupational Health: All current Team Members must be fully vaccinated with a COVID-19 vaccine listed on the World Health Organization (WHO) Emergency Use List (EUL). Team Members who are not fully vaccinated (including those who have been granted an exemption under the policy) must comply with all directives of the Hospital Epidemiologist, including weekly testing, masking, etc. Please note that we are not asking for your vaccination status. Please do not send us your vaccine record. Should you match with us, that information will be collected during onboarding.

We sponsor J1 visas; however, we do not sponsor H1B visas. To be appointed as a resident or fellow, all graduates of international medical schools must hold a valid certificate issued by the Educational Commission for Foreign Medical Graduates (ECFMG), following the ACGME and VA Board of Medicine requirements.

We do not currently offer a fellowship program in pulmonary medicine or critical care medicine.

Trainee appointment is conditional based on the approval of the Clinical Staff Credentials Committee (CSCC) and the Clinical Staff Executive Committee (CSEC) and based on successful completion of credentialing, including but not limited to our review and acceptance of information from the criminal background check, successful completion of the pre-employment drug screen, passing practical medical licensing exams, receipt of a Virginia Medical License (if applicable), honest and accurate completion of all required paperwork and training modules before Orientation. For more information, please see this sample GME Contract.

In alignment with the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), our national professional society, and to ensure a uniform interview process equitable to all applicants, our fellowship interviews for applicants in 2023-2024 will be held exclusively virtually. We will not offer in-person site visits. The full recommendation is available here.

Application is a two-step process:

1. Enter ERAS application information once open. Documents will be accepted from ERAS only.
2. Submit your ERAS application to the specific institution of your choice (i.e., University of Virginia). We begin reviewing applications on the third Wednesday in July, and interviews are completed by the end of October.

The following documents must be submitted to the ERAS system before we will evaluate your application:

• Common application form
• Personal statement
• Medical school transcript
• Three letters of recommendation (one from your program director and two others from your current institution)
• Wallet-sized color photograph
• ECFMG status report (foreign medical graduates only)

Contact Taylor Lloyd, Fellowship Coordinator, with questions:
Email – BHD5WG@uvahealth.org
Phone – 434-924-9610