The Fellowship in Pulmonary and Critical Care at the University of Maryland School of Medicine is designed to provide broad training in both clinical pulmonology and critical care and related clinical and basic research.
The fellowship is a 3-year program. The fellowship emphasizes advanced clinical skills, clinical research, and laboratory research. The fellowship leads to board eligibility in Pulmonary medicine and added certification in the area of Critical Care medicine.
The program is designed to prepare fellows for a career in academic medicine or clinical practice.
University MICU Service
The MICU receives patients primarily from the medical wards, emergency room and transfers from community hospitals. The main goal of this rotation is to provide a milieu for the fellow to learn the principles of critical care medicine. Fellows will have the opportunity to learn the physiology, pathophysiology, diagnosis and therapy of disorders of the cardiovascular, respiratory, renal, gastrointestinal, genitourinary, neurologic, endocrine, hematologic, musculoskeletal, and immune systems as well as of infectious diseases.
The medical team consists of the fellow, two R-2 or R-3 residents, four medical interns, and one medical student. Fellows care for critically ill patients with a broad variety of medical illnesses under the guidance of a full-time faculty member from the Division of Pulmonary and Critical Care Medicine. Fellows learn the basic and advanced clinical skills (Swan-Ganz monitoring, intubation and Chest tube insertions) 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. The critical care fellow has primary care responsibility for all patients admitted to the MICU, including complete history and physical examination. Fellows must insure documentation of all procedures, and teach residents, interns and students.
University Consult Service
The consultation service provides assistance in the diagnosis and treatment of a wide variety of respiratory conditions to all services at University Hospital. The goal of this rotation is to provide the fellow with the opportunity to learn the principles of consultative medicine. Fellows have the opportunity to learn the physiology, pathophysiology, diagnosis and treatment of disorders of the respiratory system.
The fellow is expected to perform an initial consultation on in-patients at the request of a referring service, present the case to the attending physician for discussion, and develop a plan. Fellows will also perform any diagnostic procedures such as bronchoscopy, pleural biopsy, and chest tube insertion and management. Fellows also interpret pulmonary function and exercise tests and review these with the attending physician.
The inpatient consultation service evaluates 45-50 patients per month. The consultation service performs 450 bronchoscopies and interprets 1500 pulmonary function studies and 150 cardiopulmonary exercise tests per year.
VA MICU/Consult Service
The Baltimore VA Medical Center (BVAMC) is a 324-bed acute care hospital that serves the immediate Baltimore metropolitan area as well as the regional area (Greater Chesapeake region) of the Veterans Administration Hospital System. There are two aspects to this rotation including the inpatient MICU service and the inpatient pulmonary consultation service. Both services are staffed by the same fellow and attending simultaneously.
The 10 patient MICU receives patients primarily from the medical wards, emergency care services and transfers from regional Veterans Administration hospitals. Here the fellows are exposed to the principles of critical care medicine. The MICU team consists of the attending (a full-time faculty member from the Division of Pulmonary and Critical Care Medicine), pulmonary and critical care fellow, an upper level resident (R2 or R3), two medical interns, and one or two senior medical students. Fellows learn the basic and advanced clinical skills (Swan-Ganz monitoring, intubation and Chest tube insertions) required for intensive care medicine. Emphasis is placed on invasive and non-invasive diagnostic/monitoring procedures, pathophysiology, continuity of care and medical ethics.
The inpatient consultation service evaluates 20-30 patients per month. Emphasis is placed on the clinical, functional and radiographic assessment of patients with lung disease. Critical care consultation is provided for patients in the Surgical and Coronary intensive care units. The consultation service performs 150-200 bronchoscopies and interprets 1000-1200 pulmonary function studies per year.
The fellow is expected to assist the attending in supervising the MICU team members, managing the clinical care of the patients, and educating the housestaff. The pulmonary fellow has primary care responsibility for all patients admitted to the MICU, including complete history and physical examination, daily progress notes, documentation of all procedures, and teaching of residents, interns and students. In addition, the pulmonary fellow is responsible for conducting all consultations requested of the pulmonary division, performing all bronchoscopies and interpreting all pulmonary function tests. The fellow is expected to be present at all cardiopulmonary exercise tests.
Pulmonary Clinics
The University Clinic functions as an outpatient setting for the evaluation of patients referred for short and long-term management of respiratory diseases. The main goal of the rotation is to provide the fellows with experience in the outpatient management of respiratory diseases, including continuity care in the ambulatory setting. Fellows care for patients with a wide variety of respiratory illnesses under the guidance of a full-time faculty member from the Division of Pulmonary and Critical Care medicine. Emphasis is placed on providing optimal medical care in the ambulatory setting in a cost-efficient manner.
The fellow has primary care responsibility for their clinic patients, and is expected to review all cases with the clinic attending. The Baltimore VA Pulmonary Clinic is conducted every Thursday from 12:00 to 4:00 PM. Two faculty members attend clinic each week. 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; thus fellows will follow the same patients for up to three years. Each week approximately 32-34 established and 8-10 new patients are seen in the Pulmonary Clinic.
Residents 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. Additionally, most research residents accompany an attending to their faculty practice clinic one-half day each week during the research years. Other short-term ambulatory experiences are gained when residents rotate through sleep and pulmonary rehabilitation services, and in the VA Lung Mass clinic. Electively, fellows may choose to attend clinic with a faculty member in the Faculty Practice Office during the second and third years.
Night Call
The Division provides 24 hour per day service throughout the year. On weekdays, the Pulmonary fellow on each clinical service takes calls regarding management of patients for that service. On weekends one fellow on call will cover all three clinical services. Fellows do not remain in the hospital while on call. Attending rounds are conducted at both MICUs Saturday and Sunday.
Consult patients are seen on weekends on an as-needed basis. A faculty attending is always assigned as back up for the fellow and is available for consultation. All procedures at night or on weekends are supervised directly by the attending physician.
Evaluation
At the beginning of each clinical month, faculty will review the expectations for that particular clinical service with the fellow. Attendings provide written evaluations of the fellows and verbal feedback at the end of each month for fellows on their rotation. Evaluations are made based on the six areas of core competency identified by the ACGME. At least twice each year, Dr. Amelung and Dr. Hasday meet with the fellows to review their overall performance. Likewise, fellows are encouraged to provide feedback, and are provided with the opportunity to anonymously evaluate the attending physician at the close of each clinical rotation.
Additionally, fellows’ input concerning the entire teaching and didactic program is solicited. Fellows are assigned faculty mentors for research projects and conferences. The fellow has ample opportunity for discussion with the program director throughout the training period and is encouraged to seek the program director, division head or any faculty member to discuss issue relating to the program or the fellows career goals at any time.
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