Overview
The Pulmonary and Critical Care Medicine Fellowship at Dell Medical School features a comprehensive curriculum that meets all the requirements set forth by the Accreditation Council for Graduate Medical Education and will qualify graduating fellows to sit for both the critical care medicine boards and the pulmonary medicine boards.
The curriculum is designed to include both inpatient and outpatient experiences over the 36 months of the program. Fellows will have intensive care unit rotations at both inpatient sites and continuity clinics at the Medical Park Tower. Additional outpatient clinics will be in the pulmonary subspecialty clinics, which include pulmonary hypertension, interstitial lung disease, sleep, cystic fibrosis and lung nodules. Fellows have several dedicated procedure months in which they will learn basic and advanced bronchoscopic techniques, intubations, right heart catheterizations and pulmonary function test interpretation. Rotations are typically four weeks long.
Program Highlights
What do the trainees and faculty value most about the program? View the program’s strengths:
- Dual hospital model with academic and private hospitals that enhance education by offering interaction with a diverse patient population and a glimpse into how the two experiences differ from each other.
- A culture of camaraderie thanks to highly-engaged, experienced and supportive faculty that are easily accessible for mentorship.
- Great teaching with a robust didactic experience including strong multidisciplinary conferences, journal clubs and basic science lecture series.
- High-quality niche experiences including pulmonary hypertension, right heart catheterization, cystic fibrosis, interstitial lung disease, advanced asthma, airway management with anesthesia, neurological critical care and more.
- Primary ECMO experience as well as extensive exposure to cardiac critical care and advanced interventions like mechanical support devices.
- Breadth of patient demographics resulting in a mix of pathology and extraordinarily strong outpatient exposure and curriculum.
- Close collaboration on cardiac ICU patients with cardiology and cardiothoracic surgery providing great exposure to complex heart failure patients, mechanical circulatory support devices and extra corporeal membrane oxygenation platforms.
- High, yet appropriate, level of autonomy with management of patients and freedom to make decisions while having support to navigate through mistakes.
Rotations
Fellows will gain the experience and confidence needed to manage and teach on a traditional MICU service with medical residents and medical students. The level of education during this rotation is graded to allow for learning at all levels of training (student, resident and fellow). Fellows serve primarily as team manager and teach residents about pulmonary and critical care medicine and respective procedures. Fellows will have at least one block on this rotation each year of their fellowship and are expected to take on more responsibility for the management of medically complex intensive care unit patients. In turn, the attending physician will give more independence to the fellow each year of the fellowship. Fellows will not have their continuity clinic while on this rotation.
Fellows will lead residents and students on this service and perform indicated pulmonary procedures (e.g., thoracentesis and bronchoscopies). Fellows will also provide critical care consultations throughout the hospital. If ICU admission is required, fellows will be in charge of triage and safe transfer. Fellows will have on average three four-week blocks of this rotation over the course of the three years, and will have a weekly continuity clinic during this rotation.
Fellows will rotate on the SICU, trauma and burn service under the guidance of critical care attendings, and will gain experience in managing surgical critically ill patients. Fellows will have one block of this rotation typically in either the second or third year of their fellowship. They will not have a weekly continuity clinic during this rotation.
Fellows will work one-on-one with a pulmonary and critical care medicine attending physician during this block. The aim of this rotation is to gain independence and confidence in managing critically ill patients at a tertiary care hospital. In general, patients at this MICU are more complex than at Dell Seton, however, the level of supervision with the faculty is still very close. Since fellows will work so closely with an attending, the level of education will be a notch higher. Fellows will also learn about veno-venous and venoarterial extracorporeal membrane oxygenation. Almost all pulmonary and critical care medicine-related procedures will be done by fellows on this rotation. Fellows will have about three four-week blocks of this rotation during their fellowship, and will have a weekly continuity clinic during the rotation.
Fellows will manage a consult service for general inpatient pulmonary medicine and will interact closely with the other two fellows at this hospital to help complete each day’s work. Fellows will coordinate with the procedure fellow regarding any and all indicated pulmonary procedures (e.g., thoracentesis and bronchoscopies) on the consult service. Generally, this service will consist of a one-on-one relationship with the attending physician, allowing for an in-depth pulmonary experience. Fellows will have about three four-week blocks during their fellowship and will have a weekly continuity clinic during this rotation.
Fellows will rotate with the advanced heart failure cardiology attending physicians on this rotation to learn about cardiogenic shock and advanced heart failure. Fellows will learn about mechanical circulatory support (including VA ECMO) and learn to manage the post-operative cardiac patient. This is a rotation in which close coordination of care occurs among cardiovascular surgeons, cardiologists and critical care attendings.
Fellows will have their continuity clinic at the Medical Park Tower. On average, fellows will have one half-day clinic per week except while they are on MICU, SICU or CCU rotations.
Fellows will have an average of two four-week blocks per year during their fellowship. They will see patients during the faculty’s subspecialty clinics, which include ILD, CF, PH, sleep and lung nodules. Fellows will continue to have a weekly continuity clinic during this rotation.
These clinical sites also benefit from an academic palliative care and hospice medicine training program complete with academic faculty and fellows. Third-year Pulmonary and Critical Care Medicine fellows will spend a block rotating with the service to gain first-hand knowledge and experience.
Texas State University Department of Respiratory Care Partnership
In addition to the fellowship’s robust and progressive core curriculum, fellows’ clinical experience is enriched through a partnership with Texas State University’s Department of Respiratory Care. This collaboration uniquely provides trainees with hands-on, one-on-one training from expert faculty in basic to advanced topics in pulmonary and critical care medicine.
From this collaboration, trainees gain familiarity of the different modes of ventilator support and patient-ventilator interactions using mechanical graphics. Other focuses of training include hands-on experience with a variety of noninvasive positive pressure ventilatory support devices, airway clearance techniques, pulmonary rehab and sleep medicine.
Alongside advancing education in this field, the program aims to strengthen the physician-respiratory therapist relationship and foster a career-long partnership promoting a strong, interdependent relationship in pulmonary and critical care medicine.
Partnership Structure
- Fellows receive lectures, simulation, direct supervision, and mentorship on basic and advanced management of respiratory failure using invasive, non-invasive respiratory and chest physiotherapy devices at the Texas State University.
- Trainees are expected to give lectures on predetermined topics and to engage in simulation based teaching to respiratory therapists students.
- PGY-4/first-year fellows visit Texas State University for at least 2 sessions during their research months.
- PGY-5/second-year fellows visit Texas State University for at least 2 sessions during their research months.
- PGY-6/third-year fellows have the opportunity to visit Texas State University during their research months.