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Curriculum

Rotation Schedule Pulmonary Critical Care

Rotation PGY4 PGY5 PGY6
Pulmonary Consult 4 3 1
Medical Intensive Care 3 2 1
Cardiovascular/Thoracic ICU 2
Trauma ICU 1
Neurosurgical ICU 2
Burn/ECHO 1
Lab 1 2 1
Research 2 3
Sleep 2
Radiology 1
Anesthesiology 1
Pulm HTN/Thoracic 2 wks
Pulm Amb./Allergy-Immunology/Pulm Rehab 1 2 wks
Orientation 1

Orientation

Each first year fellow will have the opportunity to rotate on the MICU service for 2 weeks, the Pulmonary Consult service for 2 weeks, and spend time in clinics.  Each fellow will - Gain knowledge of the indications/complications and develop competence in the performance of basic ICU procedures and develop skills in performing as a consultant – Assessing reason for consult; develop a differential diagnosis; recommend a treatment plan.

Each first year fellow will also participate in the STAR Center Skills Lab Simulation – This is a one day course covering:  Central and arterial lines: Indications, contraindications, preparation, technique, complications and their management.  Bronchoscopy: Integrating fundamental bronchoscopic techniques, gaining cognitive knowledge and clinical decision making skills.  Airway management: Provide practical, effective skills and strategies for intubation.

All fellows participate in a Cadaver Lab in July:

The human cadaver lab in collaboration with our Anesthesia Residency Program augments their procedural experience in direct laryngoscopy, bronchoscopy, chest tube placement, pigtails, perc trach and crics ensuring optimal hands-on training while providing confidence and ensuring patient safety.  The lab also enhances the fellows understanding of the gross human anatomy.

Pulmonary Consults

The pulmonary consult rotation is a dedicated teaching service with 2 fellows per month, rotating residents, medical students, and teaching attending.  During this rotation the fellows gain competency in clinical knowledge, management skills, and procedural skills in all aspects of pulmonary medicine, including but not limited to the following:  Asthma, COPD, bronchiectasis, infections, interstitial and inflammatory lung diseases, pleural disease, sleep disorders, vascular and neoplasms.  Fellows are responsible for coordinating treatment plans, procedures and for the subsequent follow up of these patients.  The most senior fellow on rotation will serve as a “junior attending” and lead the team of residents and medical students.   9 months of consults will be required over the 36 months of training. 

Lab Rotation

The lab rotation is dedicated to learning and gaining competency in all aspects of bronchoscopy, including diagnostic, therapeutic, endobronchial ultrasonography, and navigational bronchoscopy.  The lab fellow will also gain competency in pulmonary function testing, exercise stress testing, and methacholine challenge testing.  Fellows generally log greater than 200 bronchoscopies over their 36 months of training.

ICU Rotations

Our fellows generally have 6-7 months of Medical ICU training, which encompass all aspects of critical care, including ARDS, PE, shock, respiratory failure, upper and lower GI bleeds, liver failure, hematological/oncological emergencies, toxic and metabolic disorders, and renal disorders.  During these months, fellows will learn conventional and unconventional modes of mechanical ventilation including, Bilevel, APRV, and PAV.  As the fellow progresses their role will become more of a Junior attending leading MICU team rounds and reviewing action plans with the attending physician.  This graduated responsibility provides the fellow more autonomous growth and confidence in handling an ICU upon graduation.

Fellows rotating through our Trauma Unit will obtain ATLS certification, learn primary and secondary surveys, may participate in trauma codes, and help run the Trauma ICU.

Cardiovascular/thoracic ICU rotation - The fellow will gain experience with flow directed pulmonary artery catheters, post-operative care of cardiothoracic patients, and manage the care of those patients admitted to the intensive care unit following coronary artery bypass graft surgery, valvular heart surgery, and thoracic surgery.  The fellow will also gain experience in ECMO, VAD and transplants.

Neurosurgical ICU - 6 of our current faculty members are also boarded in Neurocritical Care.  This rotation provides the fellow with instruction and experience in the diagnosis and management of those diseases in the neurosurgical intensive care setting including:  a variety of neurological illnesses (e.g. prolonged mechanical ventilation, increased intracranial pressure, anemia, hypotension, low cardiac index, sepsis, and coagulopathies).

Sleep

Pulmonary and Critical Care Fellows rotate through the Sleep Disorders Center at AGH for two months during their second year.  This is a multidisciplinary program that evaluates, diagnoses and treats all sleep disorders, including sleep disordered breathing, narcolepsy, insomnia, and restless limb syndrome, among other entities. The center is staffed by board certified sleep medicine physicians, and is directed by one of our faculty members who is board certified in pulmonary, critical care, and sleep medicine.  During this rotation fellows will be exposed to many different sleep disorders, and will interact with many medical discipline including Sleep Dentistry, OMFS, and ENT ensuring the most proper care for their patients.  Fellows will also be asked to spend time in the Sleep Laboratory to observe basic PSG set up and interpretation, as well as OCST (Out of Center Sleep Testing).  The Sleep Disorders Center also works closely with the Neurology residency program, as well as with Psychiatry and Cardiology, to provide a multifaceted learning experience.

Radiology

Working with AGH Thoracic Imaging Radiologists the Fellows will obtain instruction and knowledge in the indications, interpretation, and differential diagnosis of the key chest imaging procedures including chest radiographs, chest CT scan, MRI, and ventilation-perfusion lung scan.

Anesthesiology

This one month rotation provides the fellow with instruction and experience in the placement of endotracheal tubes and airway management in patients preparing for surgery.

Pulmonary Hypertension

This one month rotation provides clinical principles in the care of patients with pulmonary hypertension.  The fellow will become familiar and technically competent in the placement of pulmonary artery or right heart catheters.  They will become familiar with and competent in the interpretation of waveforms as well as directly measure and calculated hemodynamic variables used in the diagnosis and therapy of patients with pulmonary hypertension.

Research

Dr. Tariq Cheema, Assoc. Program Director and Director of Research is highly dedicated to the division’s clinical research.  We have projects underway with different industry partners in innovative devices and medications.  We have several clinical projects underway encompassing asthma, COPD, population health, pulmonary/vascular diseases, IPF etc.  The research experience includes lectures in research design and statistics.  Fellows are then expected to participate in variety of research projects during their training period where they will be involved in the formulation of hypotheses and research questions, research design, submission of research proposals to the IRB, implementation and actual conduct of the research and analyses of results.  Fellows are guided throughout the research process as well as in the presentation and writing aspects.  Fellows are expected to present abstracts at our national meetings (ACCP, SCCM, ATS). The fellows are given 5 months of dedicated research time to prepare their work for submission to a peer reviewed journal.

Ambulatory Care

Faculty Offices

Fellows are assigned to a “clinic attending” for 36 months of their training.  Through these half day sessions, the fellow will develop graduated responsibility and autonomy as competency is acquired.  The faculty offices at AGH allow the fellow to gain knowledge in the diagnosis, management and longitudinal follow up of patients with various types of lung diseases.  Each patient is seen initially by the fellow who then formulates a differential diagnosis, a diagnostic as well as treatment plan in collaboration with a faculty preceptor.

Breathing Disorders Center

Fellows will have the opportunity during their ambulatory care experience to rotate through the Breathing Disorders Center at our Health Wellness Pavilion, which is a full service pulmonary practice with a strong focus on the management of chronic respiratory disorders through evidence based protocols.  The high touch, high impact care pathways provide the fellow with the experience of chronic disease management.

Tuberculosis Clinic

Fellows are also provided experience at the Allegheny County Health Department Tuberculosis Clinic, under the direction of Dr. Eric Bihler, Assoc. Program Director. This is a rather unique opportunity to care for local and international patients who have latent and active disease.

Didactics Include

Weekly:

  • Faculty Lectures
  • X-ray Conference
  • Thoracic Oncology Case Conf. - Multidisciplinary

Monthly:

  • Journal Club
  • Pulmonary Case Conference
  • Critical Care Case Conference
  • Board Review
  • M&M case review and RCA conference
  • Interstitial Lung Disease Case Review – Multidisciplinary

Quarterly:

  • Research Conference

The Division has three multidisciplinary conferences that include faculty and house staff from the Department of Cardiothoracic Surgery, Pathology, Radiology, Oncology, Nephrology, Infectious Disease and Rheumatology.   Fellows present current cases to the multidisciplinary faculty in order to optimize diagnostic and treatment plans as well as patient outcomes.

Leadership

The Pulmonary Critical Care Fellow will begin their three year Leadership journey which will provide the opportunity to grapple with leadership issues including: characteristics of great leaders, emotional intelligence in medicine, values and the impact to leadership skills, team dynamics, identifying and cultivating talent, thinking as a system and the art of execution.  Program entails a project-based experience resulting in a leadership development plan.

Critical Care Track for Nephrology - Infectious Disease

In an effort to allow collaboration and pursuit of a multidisciplinary program, our 2 critical care track positions provide Nephrology and Infectious Disease fellows with a unique training experience.  Fellows will be accepted into the combined track, with some critical care training integrated into their first two years of their respective subspecialty.  By the time they are in their PGY-6 year, there will be a heavy focus on pure critical care training encompassing all aspects of intensive care medicine.  Please see our proposed curriculum.

Rotation Schedule Infectious Disease/Nephrology Critical Care Track

Orientation

Each fellow will participate in:

STAR Center Skills Lab Simulation - This is a one day course covering:  Central and arterial lines: Indications, contraindications, preparation, technique, complications and their management.  Bronchoscopy: Integrating fundamental bronchoscopic techniques, gaining cognitive knowledge and clinical decision making skills.  Airway management: Provide practical, effective skills and strategies for intubation.

Cadaver Lab – The human cadaver lab in collaboration with our Anesthesia Residency Program augments their procedural experience in direct laryngoscopy, bronchoscopy, chest tube placement, pigtails, perc trach and crics ensuring optimal hands-on training while providing confidence and ensuring patient safety.  The lab also enhances the fellows understanding of the gross human anatomy.

In addition the Critical Care Track Fellows will be required to attend key lectures, MICU orientation, ventilator training and buddy calls during their PGY 4-5 years.

ICU Rotations

Each fellow is required to have 6 months of Medical ICU training, which encompass all aspects of critical care, including ARDS, PE, shock, respiratory failure, upper and lower GI bleeds, liver failure, hematological/oncological emergencies, toxic and metabolic disorders, and renal disorders.  During these months, fellows will learn conventional and unconventional modes of mechanical ventilation including, Bilevel, APRV, and PAV.  Critical Care track fellows will begin their MICU training during their PGY 4 year.  As the fellow progresses their role will become more of a Junior attending leading MICU team rounds and reviewing action plans with the attending physician.  This graduated responsibility provides the fellow more autonomous growth and confidence in handling an ICU upon graduation.

Fellows rotating through our Trauma Unit will obtain ATLS certification, learn primary and secondary surveys, may participate in trauma codes, and help run the Trauma ICU.

Cardiovascular/Thoracic ICU rotation - The fellow will gain experience with flow directed pulmonary artery catheters, post-operative care of cardiothoracic patients, and manage the care of those patients admitted to the intensive care unit following coronary artery bypass graft surgery, valvular heart surgery, and thoracic surgery.  The fellow will also gain experience in ECMO, VAD and transplants.

Neurosurgical ICU - 6 of our current faculty members are also boarded in Neurocritical Care.  This 2 month rotation provides the fellow with instruction and experience in the diagnosis and management of those diseases in the neurosurgical intensive care setting including:  a variety of neurological illnesses (e.g. prolonged mechanical ventilation, increased intracranial pressure, anemia, hypotension, low cardiac index, sepsis, and coagulopathies).

Anesthesiology

This one month rotation provides the fellow with instruction and experience in the placement of endotracheal tubes and airway management in patients preparing for surgery.

Didactics Include:

Weekly:

  • Faculty Lectures

Monthly:

  • Journal Club
  • Critical Care Case Conference
  • Board Review
  • M&M case review and RCA conference                                                                               

Quarterly:

  • Research Conference

Leadership

The Critical Care Fellow will participate in the PCCM leadership curriculum during their PGY 6 year. This training will provide the opportunity to grapple with leadership issues including: characteristics of great leaders, emotional intelligence in medicine, values and the impact to leadership skills, team dynamics, identifying and cultivating talent, thinking as a system and the art of execution.  This program entails a project-based experience resulting in a leadership development plan.