Pulmonary and Critical Care Medicine Fellowship Program

Fellowship: Division of Pulmonary and Critical Care Medicine

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. Click for information about living in Maryland.

Introduction

Our Division provides a comprehensive 3-year Fellowship Program in Pulmonary and Critical Care Medicine. The fellowship program takes advantage of the growing resources of the University of Maryland Medical System, as well as the resources of other local institutions including the Armed Forces Institute of Pathology and the National Institutes of Health. The program is designed to provide the highest quality training in clinical pulmonary and critical care medicine, and to provide experience in the fundamentals of clinical and basic science research.

Clinical Training Program

The clinical training program is a busy program. Our fellows develop personally and professionally by acquiring expertise in the diagnostic evaluation and therapeutic intervention of a wide range of pulmonary and critical care diseases. There are more than sufficient numbers of pulmonary and critical care patients and pulmonary and critical care procedures. The major inpatient rotations at the University of Maryland Medical System and the Baltimore VA Medical Center include the medical intensive care units (MICUs), the pulmonary medicine consult service, and the pulmonary medicine transplant service. In the MICUs, fellows learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system disease. On the pulmonary consultative services, the fellows learn to provide expert pulmonary consultation in the diagnosis and treatment of a wide variety of respiratory conditions, and to learn the appropriate indications and contra-indications of the pulmonary specialty procedures, particularly bronchoscopy. Detailed understanding and accurate interpretation of pulmonary function tests (PFTs) is an integral part of this rotation. On the pulmonary medicine transplant service, the fellow learns appropriate indications and contraindications for lung transplantation, acquires knowledge into the pathophysiology of transplantation and its complications, and learns the appropriate use of specialty procedures in the evaluation and management of transplant patients.

The ambulatory experience within our program is comprehensive. The ambulatory experience is designed to instruct fellows in the approach to the pulmonary outpatient, including the integration of the history, physical examination, imaging, laboratory and pulmonary function data, and the subsequent synthesis of a coherent plan. The focus of patient care is on both the careful and complete evaluation of new respiratory complaints as well as appropriate and efficient follow-up of chronic conditions. Fellows care for pulmonary outpatients in a continuity clinic seeing both new and established patients, in subspecialty pulmonary clinics such as transplant medicine, and in a continuity clinic for uninsured patients. At the Baltimore VA Medical Center, fellows participate in the general pulmonary clinic, as well as an outpatient Lung Mass clinic. This clinic gives the fellow substantial experience in the diagnostic evaluation, including bronchoscopy, of patients with suspected intrathoracic malignancy.

Fellows have the opportunity to participate in the care of patients within two other specialized areas within the Division, Sleep Medicine and Pulmonary Rehabilitation. Sleep Medicine is led by a full time faculty member within our Division who is the Director of the Sleep Disorders Center of the University of Maryland. Fellows may elect to participate in the care of patients in the Sleep Clinic at the University Health Center, a multidisciplinary sleep disorders clinic which evaluates patients with a variety of respiratory and non-respiratory sleep disorders. A second specialized rotation within our program is Pulmonary Rehabilitation, which occurs on-site at the University of Maryland Specialty Hospital. Fellows develop an understanding of how combining exercise training and behavioral and educational programs helps patients with pulmonary diseases control symptoms and improve day-to-day activities. They gain experience in the use of a team approach, working with physicians, nurses, respiratory therapists and physical therapists, psychologists, and dietitians.

In addition to the core inpatient and outpatient rotations, fellows have the opportunity to participate in numerous electives within the program, some of which are required for successful completion of the program. A Trauma Anesthesia rotation has recently become a standard one month rotation for our first year fellows in order to gain training and expertise in airway management. Rotations through intensive care units other than the MICU include the Coronary Care Unit (CCU), the Cardiothoracic ICU, the General Surgical ICU, the Maryland Shock Trauma Center, and the Neurological ICU. These non-medical ICU rotations expose the fellows to a wide array of critical illnesses which are often not seen within the MICU, and provide the fellows a milieu to learn the principles of critical care within the respective disciplines. Radiology and Pathology rotations are available for the fellows to gain further expertise in these areas.

Our Facilities

The University of Maryland Medical Center (UMMC) is the principle hospital for the fellowship training program and for our Division. UMMC is a large tertiary care medical center, with 650 total licensed beds and approximately 200 licensed critical care beds. UMMC offers a complete range of technologically advanced and cutting edge clinical services for adults and children. Additionally, it serves as a regional referral center for the most serious and complicated health problems in Maryland and the Mid-Atlantic region. The Medical Center is composed of University Hospital and the Maryland Shock Trauma Center, the prototype trauma hospital in the United States. All UMMC physicians are faculty of the University of Maryland School of Medicine.

The Program benefits from the presence and location of the Baltimore VA Medical Center, a key component of both the clinical and research training programs. The VA Medical Center allows the fellows to care for numerous pulmonary and critical care patients, and have the opportunity to perform pulmonary and critical care procedures in a patient population different from that which is seen at UMMC. The VA medical center is on campus and directly connects to UMMC via a walking indoor bridge. This allows the Division to cover both hospitals with a single, fully integrated faculty and to have a single didactic conference series.

Didactic Conferences

Our fellowship program and Division has a comprehensive didactic conference series. The fellows are required to attend four weekly conferences: a) two Pulmonary and Critical Care Core Lecture Conferences, into which Journal Club is incorporated, b) a Pulmonary and Critical Care Evidence Based Medicine Conference, during which topics in pulmonary and critical care diseases are presented in an evidence based manner, and c) an Interdisciplinary Chest Conference, a clinical patient-based conference, in which fellows are expected to present clinical cases that includes a discussion of the relevant radiologic and pathologic materials, and a short literature review of the illnesses that are highlighted in these cases. Once monthly, this conference is a combined critical care conference with surgical and pediatric critical care specialists. Throughout the year, fellows have responsibilities for preparing and presenting at each of these conferences. As an academic institution, there are many additional conferences and lectures that the fellows are encouraged to attend as their schedules allow. These include the Interdisciplinary Thoracic Oncology Conference, Thoracic Tumor Board, Interdisciplinary Critical Care Conference, Translational Research Conference, Inflammation Research Group Conference, and many other clinical and basic science special lectures that occur on campus intermittently throughout the year.

Research

Research and scholarly work is a major priority of our program. The research opportunities at the University of Maryland are numerous, and all faculty in our Division are involved in some manner with either basic science or clinical research efforts. Fellows are expected to spend 10-14 months during the second and third years of fellowship participating in either basic science or clinical research projects under the guidance of the Division Faculty. The goal of the research rotation is to provide fellows experience in the fundamentals of basic science and clinical research within critical care units, inpatient services, the pulmonary function laboratory, or the basic science laboratory. Clinical and/or laboratory research projects are complemented by didactic coursework, including a one-week course in clinical research offered by the Department of Epidemiology, and a two week course introducing the trainee to basic laboratory techniques. Fellows are expected to produce scholarly work as a result of their research efforts for publication in peer reviewed journals or for presentation at national meetings.

For those fellows interested in pursuing an academic career, our fellowship program provides didactic training and expertise to help support their research projects, as well as improving their competitiveness for career development grants. The Department of Epidemiology has established a K30-funded clinical research training program that offers didactic courses toward a Masters in Clinical Research. The Epidemiology Department also now offers a Masters in Public Health. The University of Maryland has access to several valuable resources to support a transition to a faculty position, including K30 and K12 NIH awards, the VA career development award, a wealth of potential mentors to support individual K23 and K08 awards, and a General Clinical Research Center. The program and faculty fully support any fellow desiring an additional year of fellowship training in order to meet their academic goals.

Overall Goals

The overall goals of our fellowship program are to provide comprehensive clinical training experiences and a broad range of research opportunities in order to create a strong foundation for a subsequent career in Pulmonary and Critical Care Medicine. The Division Chief and Fellowship Program Director are committed to achieving these goals. Both meet with each fellow regularly to discuss their current fellowship training experience and their career plans for the future. For those fellows who elect to pursue a career in clinical practice, this fellowship training program provides immense clinical experience along with exposure to clinical or basic science research. For those fellows who elect to pursue a career in academic medicine, this training will provide a springboard for transition to the next step in their academic career development.

This page was last updated on: November 13, 2008.

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