Curriculum

Fellows will fulfill the required rotations in the medical intensive care unit, surgical and cardiothoracic intensive care unit, and pulmonary consultation service, as well as trauma, radiology/pathology, sleep and pulmonary function testing/pulmonary rehabilitation under the direct supervision of a Pulmonology Associate faculty member. Elective rotations will be offered during the third year of fellowship. In addition, fellows will have a weekly outpatient continuity clinic during which they will follow a panel of patients throughout the three years of their fellowship. A total of nine months will be dedicated to research, during which time fellows will have the opportunity to develop a clinical research project with the supervision of our pulmonary/critical care faculty or work on a basic science research project under the mentor-ship of our faculty at the Lankenau Institute for Medical Research.

Pulmonary and critical care rotation schedule

Typical three-year training schedule

Pulmonary and critical care rotations

Pulmonary consult service: seven months
The Fellow will be responsible for inpatient pulmonary consultation, care, and follow-up on all patients during the assigned month at Lankenau Medical Center. The consult team will often be made up of medical residents on elective rotation from Lankenau and a medical student often from Thomas Jefferson University or Philadelphia College of Osteopathic Medicine. Pulmonary attendings rotate on a weekly schedule and therefore the fellow will provide continuity of care but have the opportunity to interact and review care with several of our faculty. The consult service is active, often seeing between four to 10 new patients daily with 10–20 patients requiring follow-up daily. Over the course of the three-year fellowship, it is anticipated that the fellow will assume greater responsibility and independence.

Medical intensive care unit (ICU): six months
The fellow will be responsible for all patients assigned to our medical intensive care unit service. The ICU team is made up of two upper year medical residents, four first year residents, and one medical student. Our ICU attending faculty rotates on a weekly basis and therefore the critical care fellow will provide continuity of care, while having the opportunity to interact with several members of our attending staff. The Medical ICU team currently admits two to six new patients daily and averages a census of 10–20 patients. This demanding rotation often will require the fellow to work from 7:00 am–7:00 pm. Fellows are not required to take in-house call at this time. Night call once/week is shared among all the fellows. Over the course of the three-year fellowship it is anticipated that the fellow will assume greater responsibility and independence in the care of the critically ill patient.

Pulmonary function lab/bronchoscopy/pulmonary rehabilitation: three months
The fellow will have one month each year assigned to this rotation. Each Tuesday and Thursday the fellow will be assigned to the interventional bronchoscopy procedure room to gain more experience with diagnostic bronchoscopy. The fellow will be responsible for reading all pulmonary function tests performed during the month. During the pulmonary rehabilitation experience the fellow will be required to monitor the progress of assigned patients. A defined required exposure to exercise testing and airway reactivity testing will be met. A required reading list ensures adequate review of principles of pulmonary physiology

Sleep rotation: three months
The fellow will have one month each year devoted to sleep medicine. This experience will include a daily half day outpatient clinic where the fellow co-manages and assists the sleep medicine attendings in the care of patients with a variety of sleep disorders. The afternoon will be devoted to interpretation of sleep studies under the guidance of sleep technologists and attendings. Fellows will be expected to thoroughly understand sleep apnea equipment and how to monitor the effectiveness of treatment. Core lectures will be given during the bimonthly sleep conferences. A required reading list ensures adequate review of principles of sleep apnea and sleep medicine.

Cardiothoracic surgery/surgical intensive care (CT/SICU): three months
The fellow will be assigned to the CT/SICU for one month each year. The fellow will round with the CT/SICU attending each morning where they will serve as a resource to address issues related to medical critical care. In addition, the fellow will consult and follow general surgical ICU patients along with the assigned faculty attending. Fellows will also be scheduled to follow thoracic surgical cases in the operating room with our thoracic surgical attendings. During this month, the fellow will gain additional experience performing intubations with the anesthesia department.

Radiology: one month
During the first year of fellowship a radiology elective is designed to introduce the fellow to chest CT imaging, vascular ultrasound, and interventional radiology procedures. The fellow will acquire hands-on ultrasound training that will assist in critical care ultrasound procedures. Fellows will assist in the performance of IR procedures such as CT scan directed core needle biopsies, and will become familiar with the limitations and complications of these procedures.

Trauma: one month
During the first year of training the fellows will spend one month in the acute care surgical ICU at Thomas Jefferson University. The fellow will be assigned to the clinical care team and serve as a medical core resource for the trauma team. The goal of the rotation is to gain further experience in the care of the complex trauma patient with specific experience in utilizing various modes of mechanical ventilation.

Pediatrics: one month
During the second fellowship year, a pediatric rotation will provide the fellow with a variety of pediatric experiences. We have arranged for the fellow to round in the Lankenau neonatal ICU in the mornings to gain experience in the ventilator management of neonatal respiratory failure. The afternoons will be organized as a series of outpatient clinic experiences in pediatric allergy, pediatric ENT, and cystic fibrosis.