Fellowship Program Structure

Division of Pulmonary, Critical Care, and Sleep Medicine

Fellowship Training Program

Overview

The fellowship is structured to provide clinical and research experience in Pulmonary and Critical Care Medicine over three years for all trainees. The first year experience is primarily clinical, with a focus on pulmonary medicine. It should be noted, however, that 3 months of the first-year fellows’ time is allocated to research. The second year is split between research and clinical work, with 6 months of either clinical or basic research under the supervision of one of the faculty. The third year is focused primarily on Critical Care medicine and 6 to 7 months dedicated to continuation of research work begun in the second year. Rotations in anesthesia, PFT/pulmonary exercise, surgical ICU, cardiac surgery ICU, CCU and lung transplantation are required. Electives are offered in thoracic surgery, chest radiology, pathology, NSICU and pulmonary rehabilitation.

Structure

The educational curriculum includes both hands-on clinical training and didactic sessions at all of the participating institutions. This experience includes:

  • Daily Consultation Rounds: Rounds are led by a full-time faculty member on a weekly rotation basis. Pulmonary physiology, pathophysiology and clinical correlation are stressed. The fellows are trained in and develop expertise in the interpretation of chest roentgenograms, thoracic CT studies, lung scans and pulmonary arteriography. Fellows are trained in and perform all pulmonary diagnostic techniques including thoracentesis, bronchoscopy, transbronchial biopsy, EBUS, FNAclosed thoracostomy, chest tube management and out-patient right heart catheterization. All procedures are performed with attending physician instruction and back up. Fellows are also trained in the appropriate use of ultrasonography and fluoroscopy. All inpatients seen in consultation are discussed at Pulmonary Morning Report, two mornings per week, to give weekend and night covering staff familiarity with the cases in house. In addition, difficult diagnostic or management problems are discussed at the weekly Case Conference.
     
  • Critical Care Rotations: The twelve months of critical care training required for board eligibility are integrated into the three-year Pulmonary and Critical Care Medicine Program. A total of 6 months of the experience are in the medical ICU at GUH. The Medical Intensive Care Unit is a 19-bed unit (with frequent overflow) focused on acutely ill patients, medical and cardiac, with multi system failure. The ICU attending and fellow direct the care of these patients, supervising a house staff team consisting of three medical residents, five medical interns and two to four medical students. Daily morning rounds and evening sign-out rounds are led by the ICU fellow and attending. On-site radiology is incorporated into rounds. Fellows are trained on ICU procedures including intubation, bronchoscopy, right heart catheterization, chest tube placement and percutaneous tracheostomies.

    Additionally, fellows spend one month at the Washington Hospital Center (WHC) in the Surgical Intensive Care Unit where they experience level I trauma, neurocritical care and burn patients.

    Specialized cardiac critical care training is provided at WHC, where fellows rotate one month in the 14-bed CCU with high acuity cardiology patients and an additional month in the cardiovascular surgical ICU, taking care of post-operative cardiac patients. Fellows become familiar with the management of IABP and LVADs.
     

  • Outpatient Experience: Each fellow is assigned one half day per week to see outpatients with a full-time attending in an office setting. Fellows have the opportunity to see new outpatient consultations, follow up their own recent hospital discharges, and follow selected patients longitudinally over the three-year fellowship. Third-year fellows also add on a second session in a specialty clinic. This is weekly for 6 months, interspersed during the third year. Patients are seen in a physicians' office building with outpatient radiology and laboratory facilities. The pulmonary function laboratory is located within the clinic, facilitating immediate PFT services.
     
  • Pulmonary Function Training: Fellows interpret all PFTs with daily full-time faculty member supervision. In July of the first year, fellows observe demonstrations of spirometry, flow volume loops, DLCO, body plethysmography for thoracic gas volume and lung compliance determinations, and arterial blood gas analysis in the pulmonary function laboratory. Fellows also observe and interpret pulmonary exercise studies.
     
  • Sleep Laboratory: Fellows have the opportunity to learn to read and interpret polysomnograms, MSLT's and home screening readings for sleep apnea with six board certified sleep specialists on our faculty. Additionally, a monthly multi-disciplinary sleep conference provides didactic education in sleep disorders.
     
  • Procedure training: In addition to standard flexible bronchoscopy with biopsy, fellows gain experience in EBUS, FNA, 3-dimensional navigation system, fiducial placement for stereotactic radiotherapy, percutaneous tracheostomy, medical thoracoscopy, chest tube placement, management and placement of tunnelled chest tubes, and right heart catheterization. Also, they learn the appropriate use of ultrasonography and fluoroscopy.

Participating Hospitals

The primary teaching institution for the fellowship program is MedStar Georgetown University Hospital. Fellows also rotate through the Washington Hospital Center (WHC) and INOVA Fairfax Hospital.

MedStar Georgetown University Hospital is a 500-plus bed tertiary care facility with a full complement of diagnostic and clinical services. Rotations at Georgetown include experience on the pulmonary consultation service on the general medical and surgical floors of the hospital, the medical intensive care unit, a 19-bed unit directed by the Pulmonary and Critical Care Medicine Division, and a critical care/respiratory therapy consultation service in surgical, cardiovascular surgical and neurosurgical intensive care units. The independent Bronchoscopy suite has fluoroscopic capability, as well as state of the art electromagnetic bronchoscopy. The division directs the pulmonary function and pulmonary exercise laboratory and runs a fully accredited sleep disorders center. The division also has the responsibility for the medical directorship of the respiratory therapy service, SICU and NSICU at MedStar Georgetown.

Washington Hospital Center (WHC) is one of our sister Hospitals in the MedStar system which has 800 beds. WHC performs around 2500 open heart cases a year and is one of the area’s level one trauma centers. The fellow spends one month in their first year in the CCU becoming familiar with advanced cardiac critical care including LVADs and IABP. Additionally, they spend two months rotating during their senior year in the SICU gaining experience in trauma, neurocritical care, burns and post-operative cardiac care.  In addition to that, they also spend a month at Washington Hospital Center rotating with the anesthesia team.

Lastly, fellows spend one month during their senior year at INOVA Fairfax Hospital with Dr. Steven Nathan in the lung transplant program. There, they gain an understanding of the pre-transplantation work up as well as the management of post-transplant patients.

Teaching Experience

In addition to the participation in the conferences outlined above, fellows are intimately involved in resident and medical student teaching. For example, fellows are responsible for informal resident teaching sessions on the clinical service and in the ICU. Fellows also serve as preceptors in lectures given to first- and second-year medical students in the "Introduction to Clinical Science" and "Physical Diagnosis" courses.

National Meetings

The Division sponsors trips to national meetings for fellows when their original work is accepted for presentation.