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 science research. Successful completion of the fellowship leads to board eligibility in Pulmonary Medicine and Critical Care Medicine. The clinical training program is a busy program. 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. There are more than sufficient numbers of pulmonary and critical care patients and pulmonary and critical care procedures. The major inpatient rotations at the University of Maryland Medical Center include the medical intensive care unit (MICU), the pulmonary medicine consult service, critical care anesthesiology, interventional pulmonology, and lung transplant services. The primary inpatient rotation at the Baltimore VA Medical Center is the combined MICU and pulmonary medicine consult service, and the primary inpatient rotation at the Midtown Medical Center is the medical-surgical ICU service.
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 (e.g. endotracheal intubation, bronchoscopy, pulmonary artery catheter placement). Fellows are responsible for the 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. The UMMC MICU is staffed 24/7 by both attendings and fellows.
UMMC Pulmonary 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 at least 150 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 medical house staff and medical students and for conference presentations.
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.
Midtown Medical Center ICU
The ICU at Midtown Medical Center has an 18-bed medical-surgical ICU, which provides fellows with a different patient population experience. Fellows are responsible for the 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.
Critical Care Anesthesia
The one-month Critical Care Anesthesia rotation is 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 an Anesthesiologist. Most of our fellows who have participated in this rotation have performed 40-60 intubations. This rotation creates a foundation of airway management skills, which the fellow can build upon during the remainder of their fellowship.
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. Fellows learn appropriate indications and contraindications for lung transplantation, acquire knowledge into the pathophysiology of transplantation and its complications, and learn the appropriate use of specialty procedures in the evaluation and management of transplant patients.
The Interventional Pulmonology program at UMMC is an integral part of our Division. On the IP inpatient rotation, fellows participate in the evaluation and management of pleural disease and benign and malignant airway disease, Fellows 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 the VA Lung Mass Clinic and Thoracic Oncology Tumor Boards.
In addition to the core clinical rotations above, numerous pulmonary medicine electives are available for fellows at each of the three 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. In the Pulmonary Rehabilitation Program at the Midtown Medical Center campus, fellows gain experience in the care of patients requiring continued care beyond the acute MICU setting. Fellows learn principles of care related to chronic ventilator management, management of longer-term tracheotomy 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 a team approach, working with physicians, nurses, respiratory therapists and physical therapists, psychologists, and dietitians.
- Seep Medicine is led by a full-time faculty member within our Division who is the Director of the Sleep Disorders Center of the University of Maryland. Fellows may choose to participate in the care of patients in the Sleep Medicine Clinic at the Midtown Medical Center, a multidisciplinary sleep disorders clinic which evaluates patients with a variety of respiratory and non-respiratory sleep disorders. Fellows on this rotation gain significant experience in the clinical approach to patients with sleep disorders and significant understanding into the interpretation of polysomnography (PSG).L
- Thoracic Surgery
- Additional Lung Transplant and Interventional Pulmonology rotations
- Pulmonary Consult Service at the NIH in Bethesda, MD. This rotation is an unusual opportunity to see rare diseases and a wide variety of immunosuppressed conditions. There is also the opportunity to participate in the 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 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. 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.
- Critical Care Ultrasound (required during 1st year)
- Cardiac Surgery ICU
- Critical Care Resuscitation Unit
- Lung Rescue 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, and see patients in subspecialty clinics (Cough/Dyspnea, COPD/Asthma, ILD, Lung Transplant, Lung Mass) as well. The Lung Mass clinic gives the fellow substantial experience in the evaluation of patients with suspected intrathoracic malignancy and provides further experience in the use of diagnostic bronchoscopy.
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 year of fellowship training. Nighttime and weekend shifts 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 hours a day on a shift-work model, so there is no traditional 24-30 hour overnight call or any home call for fellows in this MICU. For the VA and 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 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.
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 be 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.