Rotations | Pulmonary & Critical Care Fellowship

Pulmonary Inpatient Consultative Service

Fellows rotate on the Inpatient Pulmonary Consultation Service as part of their Pulmonary Medicine experience required by the Pulmonary and Critical Care residency review committee. Fellows assigned to this clinical service are responsible for providing comprehensive primary care of pulmonary inpatients, for pulmonary consultation, and learning competency in the relevant pulmonary medicine clinical procedures with attending supervision. Fellows assigned to this clinical service have responsibilities for teaching and supervision of residents and medical students assigned to the service.

Pulmonary Fellows’ Clinic

Fellow have clinic three to four half-days per month at the ambulatory pulmonary medicine facility at Chest Medicine Associates   

This provides the opportunity for the fellow to assess and manage, with progressive autonomy and responsibility, a wide variety of patients from the spectrum of pulmonary and sleep medicine.. Continuity clinics allow the fellow to learn the natural history of pulmonary and sleep disorders, as well as the effectiveness of therapeutic interventions. 

Discussion time is provided with the teaching attending linked to the fellow’s clinic for review of patient management. First year fellows are paired with one to two supervising clinic attending during their first year of fellowship. Senior fellows participate in the senior fellows clinic which is staffed by a rotating attending each week.

Pulmonary Outpatient Subspecialty Rotations

Fellows rotate on the pulmonary subspecialty service as part of their first fellowship year. Fellows assigned to this clinical service are responsible for providing consultative care of outpatients with a variety of subspecialty pulmonary disorders requiring expertise for diagnosis and management. The rotation includes the following pulmonary subspecialty programs: 

• Cystic Fibrosis
• Mycobacterial lung disease/TBs
• Interstitial lung disease

Sleep Disorders

This rotation includes experience in the evaluation and management of patients referred for a wide variety of sleep disorders. Fellow responsibilities include developing expertise in overnight polysomnography and multiple sleep latency testing, interpretation of study results, completion of study reports, and communication with referring physicians. 

Fellows develop familiarity with the various technical components of sleep medicine including nasal CPAP, BiPAP, oral devices, and other therapeutic equipment. Fellows participate in Advanced Clinical Sleep clinic during this rotation with board certified sleep physicians.

Pulmonary Function Laboratory

This rotation is designed for the fellow to learn the physiologic basis for pulmonary function and cardiopulmonary exercise testing (CPET) and develop a technical proficiency in conducting the studies. This rotation includes clinical experience and performance of spirometry, static lung volume determinations, measurements of gas diffusion, bronchoprovocation studies, impedance plethysmography, and CPET, as well as interpreting and reviewing studies with the responsible attending physician.

Pulmonary Medicine Elective/Research

This time is devoted to the fellow's programmatic needs not included in the general curriculum. Possibilities include, but are not limited to, exposure to the related clinical disciplines of pulmonary medicine (e.g., chest radiology, allergy/immunology, pathology, interventional pulmonology, etc.) and research activities. Elective rotations are proposed by the fellow in writing, with a teaching attending of record identified and approved in advance by the program director.

Critical Care Inpatient Service

Fellows assigned to this clinical service are responsible for providing comprehensive primary care of the critically ill patient, and for critical care medicine consultation, while learning competency in the relevant critical care medicine clinical procedures. Fellows assigned to this clinical service are responsible for the teaching and supervision of residents and medical students assigned to the service.

Cardiovascular Critical Care

Fellow rotate in the cardiac intensive care unit and cardiothoracic intensive care unit to gain experience in management of critically ill patients with heart disease and gain exposure to management of acute cardiac ischemia, mechanical support, and cardiac perioperative care. Fellows assigned to this clinical service participate participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.

Neurocritical Care

Fellows assigned to this clinical service will obtain clinical experience with the neurocritically ill, including patients with stroke, neurotrauma, brain infections, hypoxic-ischemic brain injury, status epilepticus, and neuromuscular respiratory failure. Fellows assigned to this clinical service participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.

Trauma - Surgical Critical Care

Fellows assigned to this clinical service obtain clinical experience with critically ill surgical, shock/trauma, and burn unit patients, while learning competency in the relevant trauma critical care clinical procedures. Fellows assigned to this clinical service participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.

Each fellow is assigned three to four half-days per month to the ambulatory pulmonary medicine facility at Chest Medicine Associates for outpatient consultations and patient follow-up. Clinical rotation and research responsibilities are suspended during this assigned time. 

This provides the opportunity for the fellow to assess and manage, with progressive autonomy and responsibility, a wide variety of patients from the spectrum of pulmonary, sleep and critical care medicine. Continuity clinics allow the fellow to learn the natural history of pulmonary and sleep disorders, as well as the effectiveness of therapeutic interventions. 

Discussion time is provided with the teaching attending linked to the fellow’s clinic for review of patient management. First year fellows are paired with one supervising clinic attending during their first year of fellowship. Senior fellows participate in the senior fellows clinic which is staffed by a rotating attending each month.