The Pulmonary and Critical Care Medicine Fellowship Program at the University of Maryland is a three year combined pulmonary and critical care medicine training program. The fellowship is structured to provide broad clinical training in pulmonary and critical care medicine as well as related clinical and basic research. Successful completion of the fellowship leads to board eligibility in Pulmonary Medicine and Critical Care Medicine.
The outline below gives a summary of our major clinical rotations. Additionally, our current rotation schedule and overview of our three year curriculum can be seen by clicking on the following link: Representative Three Year Rotation Schedule.
The UMMC MICU is a 29 bed state-of-the-art facility. Fellows are responsible for the care of all patients admitted to the MICU, including performing procedures appropriate in critically ill patients (endotracheal intubation, bronchoscopy, right heart catheterization). Fellows are responsible for supervision of medical housestaff and medical students. In the MICU, fellows learn the physiology, pathophysiology, diagnosis and therapy of critical illness and multi-system disease.
On the UMMC Pulmonary Consult Service, fellows perform pulmonary consultations on patients with a variety of pulmonary diseases, and perform bronchoscopy on inpatients and outpatients. Each fellow can expect to perform between 150 and 200 bronchoscopy procedures over the entire three year fellowship period. Detailed understanding and accurate interpretation of pulmonary function tests (PFTs) is an integral part of this rotation. Fellows are also responsible for the supervision of medical housestaff and medical students, and for preparation of conferences.
On the combined VA MICU and consult service rotation, fellows are responsible for the care of all patients admitted to the MICU, and responsible for performing procedures appropriate in critically ill patients (endotracheal intubation, bronchoscopy, right heart catheterization). On the consult portion of this rotation, fellows perform pulmonary consultations on patients admitted to the general medical wards of the VA. Bronchoscopy and interpretation of pulmonary function tests are key components of this rotation. As with the other services, supervision of residents/students and preparation for conferences is required.
On the UMMC Lung Transplant rotation, fellows participate in all aspects of care related to lung transplantation. Fellows assist with the care of inpatients who are post-lung transplant, and participate in the evaluation and management of outpatients who are being actively evaluated for lung transplantation. Bronchoscopy on post-lung transplant patients is an integral part of this rotation. A core curriculum of reading materials has been developed to ensure the fellows learns the core components of the care of pre- and post lung transplant patients.
For the past three years, this one month Trauma Anesthesia rotation has become standard in our Fellowship Program at the beginning of the first year. During this month, the fellow learns basic and advanced airway management skills under the direct supervision of a Trauma Anesthesiologist. Most of our fellows who have participated in this rotation have performed 50-60 intubations in this one month time frame either in the operating room or in the Trauma Resuscitation Unit. This rotation creates a foundation of airway management skills which the fellow can build upon during the remainder of their fellowship.
In addition to the core clinical rotations above, numerous pulmonary medicine electives are available for the fellows, and include rotations in thoracic radiology, pulmonary physiology, pulmonary rehabilitation, pulmonary pathology, interventional bronchoscopy, thoracic surgery, sleep medicine, pulmonary hypertension, and pediatric pulmonary medicine. The fellows generally have two elective months in the first year, and need 2-3 in the third year to fulfill the ACGME program requirements.
In addition to caring for patients in standard medical intensive care units (MICUs), the ACGME requires that fellows complete three one-month rotations in non-medical critical care units. At the University of Maryland, we are fortunate to have the the Maryland Shock Trauma Center, which is the prototype trauma hospital in the United States. Critical care rotations other than the MICU include the Cardiothoracic ICU (CT-ICU), the general surgical ICU (SICU), and three critical care units at Shock Trauma (the Neuro-Trauma Unit, the Multi-Trauma Unit, and the Select Trauma Unit). These non-medical ICU rotations expose the fellows to a wide array of critical illnesses which are often not seen in the MICU, and provide the fellows a milieu to learn the principles of critical care within the respective disciplines.
The ambulatory experience in our Fellowship Program 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. The ambulatory experience within our program is comprehensive. Fellows see new and established patients in continuity clinics at our Faculty Practice at UMMC and at the Baltimore VA, and see patients in subspecialty clinics (Cough/Dyspnea, COPD/Asthma, ILD, Transplant, Lung Mass) as well.
Again, our current rotation schedule and overview of our three year curriculum can be seen by clicking on the following link: Representative Three Year Rotation Schedule.
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 first year fellow covers all of the clinical services along with two faculty members. Weekend call by first-year fellows is presently every fourth or fifth weekend, and holiday coverage is shared equitably.
In-house overnight call at present is infrequent in our program. The one month Trauma Anesthesia rotation at the beginning of the fellowship uses a shift-work model, with shifts being from 7 a.m.- 7 p.m. or 7 p.m.- 7a.m. Our fellows typically work 15-16 shifts during this month, with about one-half of these shifts being 7 p.m.- 7a.m. On the two or three one-month non-medical ICU rotations which are required in the third year of fellowship, in-house call is required with a frequency of every fourth or fifth night depending on the rotation. The UMMC MICU is staffed by 24 hour faculty coverage, and fellows are not required to take overnight in-house call. The remainder of call responsibilities in our program is home call.