Clinical Training: Year 1
The first year of the fellowship is primarily a clinical year of training in both Pulmonary and Critical Care Medicine, care of inpatients and outpatients, and development of proficiency in various procedures including endotracheal intubation, chest tube insertion, bronchoscopy, thoracentesis, and interpretation of pulmonary function tests. Each fellow spends 6 months in the first year working in the University medical intensive care unit. During 3 of these months they also rotate through the pulmonary procedures laboratory ~3 afternoons per week performing bronchoscopy and ultrasound guided thoracentesis. 3 months are spent at the VA hospital - across the street from the University hospital. One month each is spent on the anesthesia, surgical ICU and thoracic surgery services.
Medical Intensive Care Unit (University Hospital)
The MICU is a 20-bed closed unit which averages >150 admissions per month. Two fellows are assigned to the MICU each month. They work closely with the attending physician and provide clinical oversight of the 6 house officers and senior medical students on the service. The fellows are responsible for performing and/or supervising all invasive procedures including endotracheal intubation, bronchoscopy, chest tube insertion, central line placement, etc. The pulmonary/critical division provides airway management services for the majority of our MICU patients – each fellow performs on average ~50 intubations during the first year of training.
Procedures (University Hospital)
During three of the six MICU months the fellow spends ~3 afternoons per week working in the procedures laboratory performing bronchoscopy, thoracentesis and chest tube thoracostomy. This is a state-of-the-art facility which opened in 2000. Fellows are trained in endobronchial ultrasound (EBUS) and participate in a variety of interventional bronchoscopy procedures. The average number of bronchoscopies performed during the F1 year is ~75 with over 200 done during the three years of fellowship training.
Each fellow spends 3 months at the VA hospital during their 1st year. Responsibilities include working with the attending physician supervising the care of patients in the medical intensive care unit, providing subspecialty consultation, performing procedures, interpreting pulmonary function tests and seeing patients in the clinic.
During this 1 month rotation the fellows make daily rounds with the attending thoracic surgeon and team, both in the surgical ICU and on the ward. They observe a variety of surgeries including lung resection, decortication of empyema, lung transplantation, and mediastinoscopy. They gain a thoracic surgical perspective on the placement and management of chest tubes. During the month the fellows are actively involved in the inpatient and outpatient evaluation of lung transplant candidates and recipients.
During this 1 month rotation fellows work in the operating room setting improving their airway management skills through training with our anesthesia colleagues. This includes assessment of airway difficulty, pre-oxygenation techniques, bag-mask ventilation, rapid sequence intubation, LMA placement, use of double lumen endotracheal tubes and other skills.
Each fellow spends 1 month in the surgical ICU working with a variety of patients from all the surgical services including orthopedic, trauma, neuro, cardiothoracic, vascular, urology, gynecology and general surgery. Each fellow oversees a 10-bed bay, working closely with a surgical critical care attending physician. During this month they gain a unique surgical perspective in the treatment of critical illness.
Each fellow receives 4 weeks of vacation/personal time per year. In the 1st year vacation is taken during the SNICU, TCV and anesthesia rotations.