Medical Intensive Care
In the medical intensive care unit, pulmonary fellows learn to manage patients with multi-system failure and a variety of life-threatening illnesses. The medical intensive care unit offers a challenging patient mix and exceptional learning opportunities. Each unit team consists of on average four PGY-1 residents, two senior residents, a subspecialty fellow and the teaching attending. The pulmonary fellow in conjunction with the unit attending conduct daily management rounds and conferences for the medical residents.
Our designation as a Level 1 Trauma Center and participation in a helicopter transport program ensure a broad experience for fellows. Active programs in pulmonary and hepatobiliary disease, infectious disease and transplantation also ensure outstanding learning opportunities for fellows. A state of the art ultrasound scan is available for line placement and cardiac evaluation. We have a night float system and our fellows are present in the MICU 24/7. There is no home call.
Pulmonary Consult Service
On the pulmonary consult service, subspecialty fellows become adept at performing fiberoptic bronchoscopy, thoracentesis and interpreting chest X-rays and CT scans. In addition, subspecialty fellows interact frequently with house staff and medical students enabling them to acquire substantial teaching experience.
The pulmonary consult service team is comprised of the teaching attending, subspecialty fellow, one or two medical residents and one or two medical students. Consults are seen throughout the hospital on the medical-surgical service, rehabilitation unit, long term ventilator unit and the medical step down unit. Ample time is provided to exam the patient, review pertinent clinical and radiographic data prior to presentation to the attending. Comprehensive teaching rounds are held daily and cases are presented at Pulmonary Grand Rounds conference each Thursday. A bronchoscopy simulator is available for the training of fiberoptic bronchoscopy.
Pulmonary Function Rotation
During the pulmonary function rotation, subspecialty fellows learn the methodology behind and the performance and interpretation of spirometry, lung volumes and diffusing capacity. In addition, cardiopulmonary exercise and metabolic cart studies to evaluate nutritional needs are available.
Bronchoprovocation studies with methacholine are performed. A body box plethysmograph as well as gas dilution studies are used to assess lung volumes.
Each day all studies are reviewed with the attending physician. The subspecialty fellow assigned to this rotation will give a seminar devoted to pulmonary physiology each month.
Surgical/Trauma Intensive Care Unit
Two weeks of the training program is devoted to the care of critically ill surgical patients. During this rotation, the trainee will have an opportunity to round with CT surgery, place chest tubes and spend two weeks in a burn unit at one of our affiliates. Time will be spent evaluating thoracic surgical patients, observing VATs and assessing patients with post-operative respiratory problems.
All fellows are assigned to attend the difficult airways course given by the Department of Anesthesiology. Fellows will acquire experience and proficiency in the management of the airway with particular attention to techniques of endotracheal intubation, laryngeal airway masks and use of the glide scope. Our fellows are tasks of doing all the intubations in the ICU under direct supervision of our anesthesiologists.
Sleep Medicine Rotation
A robust sleep center is available on our campus supervised by our sleep director Dr Bhavna Sharma.
The fellows will develop an understanding of the techniques available to monitor and diagnose a variety of sleep disorders with special emphasis on cardiopulmonary disorders. The physiology of sleep and sleep disorders will be emphasized. The fellow will understand the indications for a number of different studies offered in a sleep laboratory and to distinguish between obstructive and central sleep apnea. The opportunity to score and interpret complex polysomnographic recordings is available to pulmonary and critical care fellows. Two months of training in sleep is part of the curriculum.
Ambulatory Outpatient Pulmonary Clinic
In order to provide the trainee with the opportunity to follow patients with chronic illnesses a mandatory ½ day per week ambulatory clinic is required. To maintain continuity of care each fellow will have a book of patients, which will be his roster to follow over the three years. Additions will be made from the discharges from the hospital as well as referrals coming from other medical and subspecialty clinics. The fellow will make all scheduled appointments with the patient and clinic staff and arrange for all pulmonary function tests, radiographic studies and procedures as required. Fellows are excused from clinic only while in the MICU, on Night Float and at the off campus rotations.
Fellows will learn the subtleties in the physical examination of the pulmonary patient and arrive at a differential diagnosis and treatment plan of the patient. Fellows will gain an appreciation for the chronic nature and long term management of the pulmonary patient following hospitalizations with particular attention to continuity of care. Fellows will communicate with the patient's family and referring physician with particular attention to ethical end-of-life issues, smoking cessation counseling, vaccination, and the scheduling of procedures.
EPH: Elkins Park Hospital
The Einstein faculty has recently assumed responsibility for care of patients at our Elkins Park Division. Responsibilities include caring for a 7-bed Med/Surg ICU, performing consults and working with an electronic remote ICU which monitors patients 24/7. This provides the fellow with a unique opportunity in dealing with new technology in a systems-based practice.
University of Pennsylvania Rotations
There are two rotations available to Fellows at the Hospital of the University of Pennsylvania. The only required one is Advanced Lung Disease (Transplant) offered in the second-year of fellowship training. This will enable the fellow to develop experience in the evaluation and care of patients with advanced lung disease undergoing lung transplantation, a skill that will be assessed by the ABIM Pulmonary Boards. The other rotation is Pulmonary Hypertension, a 1-month elective that consists of both outpatient and inpatient exposure to the diagnosis and management of patients with advanced pulmonary hypertension.
Thomas Jefferson University Hospital ECMO rotation
Our 3rd year fellows spend a month at the Cardiothoracic ICU at Thomas Jefferson University hospital. The fellow will be responsible for patients on ECMO as well as patients with recent thoracic surgery. This rotation serves to familiarize the fellow with routine preoperative and postoperative care of ECMO patients, advanced cardiac life support chest as Intra-aortic balloon pumps, LVAD and Impellas. The fellow is expected to assist in the institution and the management of ECMO. Our fellows will also attend and participate in the educational activities of the teaching methods provided by the CT/ECMO faculty.