Pulmonary and Critical Care Fellowship Curriculum

PCCM fellows will have the opportunity to customize their schedules to a certain extent. The following represents the major areas of training throughout the fellowship.

Goals

The overall goals are competency-based, and we strive to provide trainees with the proper education to:

• Provide patient care that is compassionate and effective.
• Develop a solid knowledge base in the basic and clinical science of pulmonary and critical care medicine.
• Cultivate a commitment to professionalism, with regard to all professional responsibilities, adherence to ethical principles and sensitivity to diverse populations of patients to whom they will provide clinical care and/or research.
• Pursue a lifelong commitment to practice-based learning and improvement so that they may continue to improve their patient care and research practices, and improve their skills to provide state-of-the-art education to medical students, physicians and other health care professionals.
• Build interpersonal and communication skills that result in effective interactions with their patients, families, colleagues and other health care professionals.
• Function in multiple capacities and/or settings, including: primary provider of care, consultant to other physicians, leader of a multidisciplinary health care team and teacher.
• Develop expertise not only in basic bedside intensive care unit (ICU) procedures, but also in the use of advanced technologies such as point of care ultrasound, navigational bronchoscopy and endobronchial ultrasound.

Years at a glance

All fellows will split their time among inpatient, outpatient and research experiences. A sample of the three-year schedule is shown below:

Year 1: Three months of medical ICU (MICU), four months of pulmonary inpatient consults and one month of each of the following: anesthesia, sleep, cardiothoracic ICU, echocardiography and research.

Year 2: Two months of MICU, two months of pulmonary inpatient consults, two months of a two-week split rotation of research and night float, one month of research and one month each of the following electives: advanced lung disease (at a transplant institution in Philadelphia), trauma ICU (at Lehigh Valley Hospital [LVH]–Cedar Crest, a Level I Trauma Center), neurocritical care ICU and one elective of the fellow’s choosing.

Year 3: Two months of MICU, two months of pulmonary inpatient consults, one month interventional pulmonary, five months of research and two months of electives.

Over the three-year experience, fellows will attend one half-day session weekly of Pulmonary Fellow Continuity Clinic.

Medical ICU Service

Fellows will have the opportunity to take ownership of and lead a multidisciplinary team of residents, interns, medical students, pharmacists, nursing colleagues and respiratory therapists during their MICU rotations.

As the referral centers for the network, both LVH–Cedar Crest and LVH–Muhlenberg receive a large volume of the most complex critically ill patients in the Lehigh Valley and beyond. Fellows will direct the team’s medical plans for patients and triage new admissions with the guidance of their attending physician. Fellows are expected to lead their team not only in rounding but in discussion of problems and with teaching house staff. The fellow will be expected to develop themselves as the acting attending of the service over their years at LVHN.

Fellows will have first preference of completing multiple procedures for their patients. This includes, but is not limited to, placement of central venous catheters, placement of arterial lines, performing thoracentesis and paracentesis, placement of chest tubes and performing lumbar punctures. All required bronchoscopy procedures will be performed by the fellow with the assistance of the attending physician. Intubations will be performed by the fellow during all daytime shifts.

Pulmonary Inpatient Consult Service

The Pulmonary Inpatient Consult rotation provides fellows with a breadth of pathology as well as unique management challenges and opportunities. Similar to the MICU rotation, the fellow is expected to be the main orchestrator of the service.

Fellows will be able to interact with and treat patients with obstructive lung disease, pleural disease, hemoptysis, pulmonary malignancy, acute and chronic respiratory failure, interstitial lung disease and a wide array of infectious pulmonary cases including PJP, MAI, and Strongyloides. Procedures on the service, including thoracentesis, chest tube placement and bronchoscopy, will be at the discretion of the fellow and be performed by the fellow on service.

The rotation offers a great opportunity for further professional growth. Not only does the rotation offer development of critical thinking and organizational skills, but also direct collaboration with attending physicians allows for frequent teaching opportunities and appreciation for the nuanced management pulmonary patients often require.

Bronchoscopy Experience

Pulmonary Critical Care fellows have a unique opportunity of being immersed in advanced bronchoscopy while training at LVHN.

Fellows promptly gain access to general bronchoscopy when they first arrive and often complete > 50 cases within the first six months of their fellowship. Fellows quickly become proficient in airway inspection, bronchoalveolar lavage/bronchial wash and transbronchial biopsy.

Upon progression of their skills, fellows then gain competency with endobronchial ultrasound (EBUS) sampling of lymph node tissue and with navigational bronchoscopy using Ion robotic bronchoscopy. These opportunities allow for further understanding of procedural pulmonology and provide a professional, competitive experience to carry into the job market.

Additionally, fellows gain experience with bronchoscopic lung volume reduction (BLVR) while at LVHN. This not only includes participating in placement of the valves but following each patient’s post-procedural management and possible complications with the procedure.

These bronchoscopy experiences are accumulated during MICU and pulmonary consults months, specific scheduled bronchoscopy days on lighter rotations and during a fellow’s IP month third year. All in all, fellows will easily complete over 150 bronchoscopies during their training at LVHN, many of which requiring the advanced techniques noted above.

Call schedule

Fellows do not take home call or provide long call coverage. Each month, the two fellows who are on their MICU and Inpatient Pulmonary Consult rotations at LVH–Cedar Crest will split coverage of 10-hour in-house Saturday overnight shifts (9 p.m.-7 a.m.) at that campus. The allotment of these shifts is at those two fellows’ discretion.

Night Float

Second-year fellows will complete two two-week night-float blocks (Sunday-Friday), and each third-year fellow will complete one two-week night-float block. During these rotations, the fellow will work alongside the resident team from 9 p.m. to 7 a.m., overseeing all new admissions, procedures and the care of patients already on the service.

The fellow will be supervised by the faculty member working in the advanced ICU, with an on-call physician available to come to the bedside as needed. Fellows will gain progressive autonomy as they advance through their training.

In order to support first-year fellows with didactics and academic activities, there is no night float during first year of training except for the Saturday night call described above.

Elective rotations

Fellows will have an opportunity to take elective rotations in infectious diseases, nephrology, rheumatology, echocardiography and cardiology, among others.