Clinical Training - Pulmonary and Critical Care Medicine Fellowship
The Pulmonary and Critical Care Medicine Fellowship Program at the University of Maryland is structured to provide comprehensive clinical training. Our fellows develop personally and professionally by acquiring expertise in the diagnostic evaluation and therapeutic intervention of a wide range of pulmonary and critical care diseases.
- Inpatient rotations at the University of Maryland Medical Center (UMMC) include the medical intensive care unit, pulmonary medicine consults, critical care anesthesiology, interventional pulmonology, and lung transplant services.
- The primary inpatient rotation at the Baltimore VA Medical Center (VA) is the combined MICU and pulmonary medicine consult service.
The outline below gives a summary of our major clinical rotations. Our current rotation schedule and overview of our three-year curriculum can be viewed at Three Year Rotation Schedule.
UMMC Medical Intensive Care Unit (MICU)
The UMMC MICU is a 29-bed state-of-the-art facility. As a quaternary referral center, the MICU is one of the highest acuity units in the United States. Fellows are responsible for the care of all patients admitted to the MICU, including performing procedures (e.g. endotracheal intubation, bronchoscopy, pulmonary artery catheter placement, critical care ultrasound). They learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system diseases, as well as the “art of triage.” The unit is staffed 24/7 by both attendings and fellows along with a team of residents, interns, and APPs.
UMMC Pulmonary Medicine Consult Service
On the UMMC Pulmonary Consult Service, fellows perform pulmonary consultations on patients with a variety of pulmonary diseases. Each fellow can expect to perform at least 100 bronchoscopy procedures by the end of their fellowship. Detailed understanding and accurate interpretation of pulmonary function tests (PFTs) is an integral part of this rotation. Fellows are also responsible for the supervision of medicine house staff and medical students and for conference presentations.
UMMC Critical Care Anesthesia
The one-month Critical Care Anesthesia rotation is a standard rotation in our curriculum during the first year of fellowship training. Fellows learn basic and advanced airway management skills under the direct supervision of an Anesthesiologist. Most of our fellows who have participated in this rotation have performed 30-40 intubations. This rotation creates a foundation of airway management skills, which the fellow can build upon during the remainder of their fellowship.
UMMC Interventional Pulmonology
The Interventional Pulmonology (iPULM) program at UMMC is an integral part of our Division. Fellows participate in the evaluation and management of pleural disease and benign and malignant airway disease. They learn to perform ultrasound-guided assessment and interventions of the pleural space, such as thoracenteses, pigtail catheters, and tunneled pleural catheters. Procedural experience includes endobronchial ultrasound and advanced diagnostic and therapeutic bronchoscopy. In addition, fellows participate in VA Lung Mass Clinic and Multi-disciplinary Thoracic Oncology Tumor Boards.
UMMC Lung Transplant
On the UMMC Lung Transplant rotation, fellows participate in all aspects of care related to lung transplantation. Fellows assist with the care of inpatients who are post-lung transplant and participate in the evaluation and management of outpatients who are being actively evaluated for lung transplantation. Bronchoscopy on post-lung transplant patients is an integral part of this rotation. A core curriculum of reading materials has been developed to ensure fellows learn the foundations of the care of pre- and post-lung transplant patients. Fellows learn appropriate indications and contraindications for lung transplantation, acquire knowledge of the pathophysiology of transplantation and its complications, and learn the appropriate use of specialty procedures in the evaluation and management of transplant patients.
On the combined VA MICU and consult service rotation, fellows are responsible for the care of all patients admitted to the VA MICU. On the consult portion of this rotation, fellows perform pulmonary consultations on patients admitted to the general medical wards at the VA. Bronchoscopy and interpretation of PFTs are key components of this rotation. As with the other services, supervision of residents/students and preparation for conferences is required.
In addition to the core clinical rotations above, numerous pulmonary medicine electives are available for fellows among the various institutions. Fellows generally have two elective months in their first year and complete at least 2-3 electives in the remaining years to fulfill the ACGME program requirements.
- Chest Radiology (required during 1st year)
- Lung Pathology
- Pediatric Pulmonology
- Pulmonary Hypertension
- Pulmonary Rehabilitation and Ventilator Weaning at the Midtown campus. Fellows learn principles of care related to chronic ventilator management, long-term tracheostomy care, and rehabilitation services. Fellows develop an understanding of how combining exercise training and behavioral and educational programs helps patients with pulmonary diseases control symptoms and improve day-to-day activities. They gain experience in the use of an interprofessional team approach, working with nurses, respiratory therapists, physical therapists, psychologists, and dietitians.
- Seep Medicine is an integral part of our Division, Sleep Disorders Center of the University of Maryland. At the Midtown campus, fellows participate in a multidisciplinary sleep disorders clinic, which evaluates patients with a variety of respiratory and non-respiratory sleep disorders. Fellows gain significant experience in the clinical approach to patients with sleep disorders and substantial understanding of polysomnography (PSG) interpretation.
- Thoracic Surgery
- Additional Lung Transplant and Interventional Pulmonology rotations
- Pulmonary Medicine Consult Service at the NIH Clinical Center in Bethesda, MD. This rotation offers the opportunity to see rare diseases and a wide variety of immunosuppressed conditions. Fellows participate in clinical research specialty clinics and inpatient rounds for greater exposure to these disorders.
Non-Medical Critical Care Rotations
In addition to caring for patients in standard MICUs, the ACGME requires that fellows complete three one-month rotations in non-medical critical care units. At the University of Maryland, we are fortunate to have the Maryland Shock Trauma Center, which is the prototype trauma hospital in the United States. These non-medical ICU rotations expose the fellows to a wide array of critical illnesses, which are often not seen in the medical ICUs, and provide a milieu to learn the principles of critical care within the respective disciplines.
- Critical Care Ultrasound (required during 1st year)
- Cardiac Surgery ICU
- Critical Care Resuscitation Unit
- Lung Rescue Unit, a dedicated VV-ECMO unit
- Multi-Trauma ICU
- Neurosurgical ICU
- Neuro-Trauma ICU
- Surgical ICU
- Trauma Anesthesia
The ambulatory experience in our Fellowship Program is designed to instruct fellows in the approach to the pulmonary outpatient, including the integration of the history, physical examination, imaging, laboratory and pulmonary function data, and the subsequent synthesis of a coherent plan. The focus of patient care is on both the careful and complete evaluation of new respiratory complaints as well as appropriate and efficient follow-up of chronic conditions. The ambulatory experience within our program is comprehensive.
Fellows see new and established patients in continuity clinics at our University of Maryland Center for Pulmonary Health located at the UMMC Midtown campus (faculty practice) and at the Baltimore VA Pulmonary Clinic (fellows’ clinic). In addition, fellows see patients in subspecialty clinics (Cough/Dyspnea, COPD, Asthma, Sarcoidosis, ILD, Lung Transplant, Lung Mass, Sleep, Pulmonary Hypertension, Post-ECMO/Post-COVID) as well. The VA Lung Mass clinic gives the fellow substantial experience in the evaluation of patients with suspected intrathoracic malignancy and in the use of diagnostic bronchoscopy.
Nighttime and Weekend Call
Fellow call during fellowship varies by clinical service and year of fellowship training. Nighttime and weekend shifts in the UMMC MICU are provided on a rotating basis by the four fellows assigned to the MICU each month. Faculty and fellows cover this MICU 24 hours a day on a shift-work model, so there is no traditional 24-hour overnight call or any home call for fellows in this MICU. For the VA ICU, nighttime call is home call, and weekend call is a traditional weekend coverage model on a rotating basis.
Each first-year fellow currently works approximately 6-7 weekends of traditional weekend call during the first year, in addition to the MICU weekend coverage as described above while on the MICU rotation. Holiday coverage is shared equitably among the first-year fellows. During the subsequent years of fellowship training, nighttime and weekend call is substantially less frequent, approximately 3-5 weekends per year.
We strictly adhere to ACGME duty hour rules and regulations.