The Division of Pulmonary and Critical Care Medicine provides a comprehensive training program that exploits the resources of the Division as well as other Divisions of the Department of Medicine, other Departments and Schools on the University of Maryland, Baltimore campus and other local institutions, including the National Institutes of Health and the Johns Hopkins University. All facilities in which our fellows train are located on the University of Maryland, Baltimore campus in the Camden Yards, M & T Bank (Ravens) Stadium, Inner Harbor neighborhood of downtown Baltimore.
University of Maryland Medical Center is a major tertiary and primary care facility with 689 beds. The Medical Center cares for more than 32,000 inpatients and 300,000 outpatients each year.
In each unit, doctors, nurses, students, clinical pharmacists and support staff work as a team to promote unified and comprehensive care for every patient.
There are ten medical teams at UMMC, including 5 medical services, Medical Intensive Care Units (MICU), Critical Care Unit (CCU), Telemetry Unit, and the Solid Tumor and Leukemia Services. The medical residents, under the supervision of either the private or teaching attending, or hospitalists provide the patients' primary care. Subspecialty fellows serve as consultants and participate in specialized care, but do not serve as primary care providers on the inpatient ward services.
In January 1993, the new Baltimore VA Medical Center opened adjacent to University of Maryland Medical Center (UMMC).
Both hospitals are conveniently connected by a walk-way which facilitates integration of educational and clinical activities.
The VA Medical Center is a 324 bed facility, built and equipped at a cost of more than $100 million. The hospital contains a fully digitalized radiology department, making it the first filmless medical center in the world. The computer system gives physicians ready access to clinical data, discharge summaries and laboratory results on computer monitors available in all team conference rooms and nursing units. Now that the VA is a fully paper-less hospital with all write-ups, progress notes and orders entered electronically, residents can easily retrieve and enter information for their patients.
The Baltimore facility is only one of two VA Medical Centers in the country that have two large federally funded programs in geriatrics -- the Geriatric Research Education Clinical Center (GRECC) and a Claude D. Pepper Older Americans Independence Center. It is ranked among the top 5% of VA Medical Centers in VA-funded research.
The Baltimore VA Medical Center serves as the central referral hospital for pulmonary and GI problems for an area serving West Virginia, central Pennsylvania, Maryland and Delaware.
University Specialty Hospital is part of the University of Maryland Medical Systems, located a few blocks from the University of Maryland Medical Center in downtown Baltimore.
It offers 180 beds, 70 of which are dedicated to the ventilator/weaning unit. The ventilator unit cares for patients with a wide spectrum of diseases, of which COPD is the most common reason for admission. At present, of the approximately 180 admissions per year, 30% will be weaned from mechanical ventilation. We expect this weaning success rate to improve further due to new revisions in our weaning and rehabilitation protocols.
University Specialty Hospital has traditionally housed one of the biggest chronic ventilator units in the state of Maryland and its weaning rates are consistent with national data. Recently, however, University Specialty Hospital has embarked on a mission to expand the care it provides to include rehabilitation services that are specific to patients with respiratory failure and to provide pulmonary rehabilitation to patients with COPD, both on and off the ventilator.
University Specialty Hospital provides a multi-disciplinary approach to therapy, providing a team of physical, occupational and speech therapists that evaluates and cares for each patient as well as a pulmonologist dedicated addressing the specific needs of patients with respiratory failure and COPD.
First year fellows have outpatient continuity clinic experience at the VA Medical Center on a weekly basis. The fellow is expected to serve as the outpatient pulmonary consultant for newly referred patients and as a primary care/pulmonary physician for patients with predominantly pulmonary diseases. Each physician follows his own patient population for 3 years.
Each week approximately 32-34 established and 8-10 new patients are seen in the VA Pulmonary Clinic. All new patients and difficult established patients are discussed with the attending physician during the Clinic. This clinic is continued on a biweekly basis in the second and third years of fellowship. This gives fellows the opportunity to follow established patients with chronic pulmonary diseases, including asthma, chronic obstructive pulmonary disease, interstitial diseases, pulmonary vascular disease, sleep apnea, and restrictive diseases of musculoskeletal origin. Supervision of the fellows is provided by two faculty members present in the clinic each week.
In addition to biweekly VA clinic, third year fellows have fellow’s clinic every third week at UMMS in the faculty’s practice office. The University Clinic functions as an outpatient setting for the evaluation of patients referred for short and long-term management of respiratory diseases. Fellows care for patients with a wide variety of respiratory illnesses, under the guidance of full-time faculty members from the Division of Pulmonary and Critical Care medicine.
Fellows learn the approaches to outpatient diagnosis and management of chronic respiratory diseases, including infectious, inflammatory and neoplastic diseases. Emphasis is placed on providing optimal medical care in the ambulatory setting in a cost-efficient manner. The clinic is located in the Faculty Practice Office building, across the street from University Hospital.
Second and third year fellows attend VA Lung Mass Clinic, designed for the work-up and diagnosis of newly discovered lung masses. Upper level fellows may also choose other clinic experiences, such as faculty practice office with a faculty member, or clinics associated with sleep, lung mass evaluation, lung transplantation, asthma, COPD, or interstitial lung disease.
Both University of Maryland Hospital and the Baltimore VAMC have 10 bed MICUs; University has an additional six-bed intermediate care unit. In May, 2006, we moved in to a new, expanded 29 bed MICU/intermediate care unit located in the newly completed Weinberg building. The move to this larger state-of-the art MICU will allow us to expand our opportunities for training and for translational and outcomes research.
Fellows learn the basic and advanced clinical skills (Swan-Ganz monitoring, intubation and management of mechanical ventilation) required for the intensive care medicine. Emphasis is placed on invasive and non-invasive diagnostic/monitoring procedures, physiology, cost containment, and medical ethics. The fellow is expected to assist the attending in supervising the team members, managing the clinical care of the patients, and educating the housestaff.
As the regional referral center for critical care and with a large, active cancer center and transplant programs, patients with a wide range of common and rare diseases are seen in our critical care units. The medical, surgical, and pediatric critical care programs share a monthly interdisciplinary critical care conference and a translational research conference, clinical and outcomes research programs, and a critical care visiting professor program. These resources provide outstanding opportunities for clinical training, exposure to other critical care disciplines, and clinical, outcomes, and translational research in diseases of the critically ill.
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