Clinical Training - Pulmonary and Critical Care Medicine Fellowship
The Pulmonary and Critical Care Medicine Fellowship Program at the University of Maryland is a three year combined pulmonary and critical care medicine training program. The fellowship is structured to provide broad clinical training in pulmonary and critical care medicine as well as related clinical and basic research. Successful completion of the fellowship leads to board eligibility in Pulmonary Medicine and Critical Care Medicine.
The outline below gives a summary of our major clinical rotations. Additionally, our current rotation schedule and overview of our three year curriculum can be seen by clicking on the following link: Representative Three Year Rotation Schedule.
Clinical Rotations at the University of Maryland Medical Center (UMMC), the Baltimore VA Medical Center (VA), and the University of Maryland Midtown Medical Center:
UMMC Medical Intensive Care Unit (MICU)
The UMMC MICU is a 29 bed state-of-the-art facility. Fellows are responsible for the care of all patients admitted to the MICU, including performing procedures appropriate in critically ill patients (eg. endotracheal intubation, bronchoscopy, right heart catheterization). Fellows are responsible for supervision of medical house staff and medical students. In the MICU, fellows learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system disease.
UMMC Consult Service
On the UMMC Pulmonary Consult Service, fellows perform pulmonary consultations on patients with a variety of pulmonary diseases, and perform bronchoscopy on inpatients and outpatients. Each fellow can expect to perform between 150 and 200 bronchoscopy procedures over the entire three year fellowship period. 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 medical house staff and medical students, and for preparation of conferences.
VA Medical Intensive Care Unit (MICU) / Consults
On the combined VA MICU and consult service rotation, fellows are responsible for the care of all patients admitted to the VA MICU, and are responsible for performing procedures appropriate in critically ill patients (eg. endotracheal intubation, bronchoscopy, right heart catheterization). On the consult portion of this rotation, fellows perform pulmonary consultations on patients admitted to the general medical wards of the VA. Bronchoscopy and interpretation of pulmonary function tests are key components of this rotation. As with the other services, supervision of residents/students and preparation for conferences is required.
Midtown Medical Center ICU
The ICU at Midtown Medical Center has an 18 bed medical-surgical ICU. Our Division is responsible for attending and fellow coverage in this ICU, and this ICU provides fellows with an additional patient population experience different from UMMC and the VA. Fellows are responsible for supervision of medical house staff and medical students. In the ICU, fellows learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system disease.
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 core components of the care of pre- and post lung transplant patients.
The one month Trauma Anesthesia rotation has become a standard rotation in our Fellowship Program curriculum during the first year of fellowship training. During this month, the fellow learns basic and advanced airway management skills under the direct supervision of a Trauma Anesthesiologist. Most of our fellows who have participated in this rotation have performed 50-60 intubations in this one month time frame either in the operating room or in the Trauma Resuscitation Unit. This rotation creates a foundation of airway management skills which the fellow can build upon during the remainder of their fellowship.
In addition to the core clinical rotations above, numerous pulmonary medicine electives are available for fellows at each of the three institutions, and include rotations in thoracic radiology, pulmonary physiology, pulmonary rehabilitation, pulmonary pathology, interventional bronchoscopy, thoracic surgery, sleep medicine, pulmonary hypertension, and pediatric pulmonary medicine. The fellows generally have two elective months in their first year, and are required to complete 2-3 electives in their third year to fulfill the ACGME program requirements.
Non-Medical Critical Care
In addition to caring for patients in standard medical intensive care units (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. Critical care rotations other than the MICU include the Cardiac Surgery ICU (CS-ICU), the general surgical ICU (SICU), three critical care units at Shock Trauma (the Neuro-Trauma Unit, the Multi-Trauma Unit, and the Select Trauma Unit), and the Neurosurgical ICU. 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 the fellows a milieu to learn the principles of critical care within the respective disciplines.
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 Faculty Practice at UMMC and at the Baltimore VA, and see patients in subspecialty clinics (Cough/Dyspnea, COPD/Asthma, ILD, Transplant, Lung Mass) as well.
Again, our current rotation schedule and overview of our three year curriculum can be seen by clicking on the following link: Representative Three Year Rotation Schedule.
Nighttime and Weekend Call
The Division provides 24 hour per day service throughout the year. Fellow call during the fellowship varies by clinical service, and varies based on the year of fellowship training. Nighttime and weekend call in the UMMC MICU is provided on a rotating basis by the four fellows assigned to the MICU each month. Faculty and fellows cover this MICU 24 hrs a day on a shift-work model, so there is no traditional 24-30 hour overnight call for fellows in this MICU. For the VA and for Midtown ICUs, 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, and has MICU weekend coverage as described above when each fellow is on the MICU rotation. Holiday coverage is shared equitably among the first year fellows. During the upper years of fellowship training, nighttime and weekend call is substantially less frequent.
During the three years of fellowship training, we strictly adhere to duty hour rules and regulations as outlined in detail by the ACGME. Overall, we believe our nighttime and weekend call schedule to very reasonable and not unduly burdensome. A major priority of our fellowship program director is to ensure that nighttime and weekend call responsibilities continue to be very reasonable and appropriate for the overall curriculum of the fellowship program.