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Curriculum

Orientation

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Each first year fellow will have the opportunity to rotate on the MICU and Pulmonary Consult service.  During this orientation month, the first year fellow will become competent in basic ICU procedures, including central lines, arterial lines, and chest tubes and gain an understanding of the indications and complications of these procedures.  The fellow will work alongside a senior fellow and attending during this time while in the ICU and on the pulmonary consult service.  

Each first year fellow will also participate in:

  • STAR Center Skills Simulation Lab – 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: Provides practical, effective skills and strategies for intubation.
  • Cadaver Lab- The human cadaver lab in collaboration with our Anesthesia Residency Program augments the fellows procedural experience in direct laryngoscopy, bronchoscopy, chest tube placement, pigtails and IO’s ensuring optimal hands-on training while providing confidence and ensuring patient safety.
  • Ultrasound Course - Utilizing standardized patients the fellow will perform critical care ultrasonography for Vascular - access and anatomy; Thoracic – pleural, lung and pneumothorax; Abdominal - ascites, bowel and bladder, renal; and Cardiac - image acquisition and interpretation.  SonoSim equipment and modules is also available for portable, online ultrasound training.  In addition, throughout the year ultrasound training sessions conducted in the MICU will provide the fellow with competency in the performance of critical care ultrasonography. 

Pulmonary consults

The pulmonary consult rotation is a dedicated teaching service with 2 fellows per month, rotating residents, medical students, and a 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.  A cap has been created to ensure the educational experience is of the upmost importance.

Lab rotation

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The lab rotation is dedicated to learning and gaining competency in all aspects of bronchoscopy, including diagnostic, therapeutic, endobronchial ultrasonography, and navigational bronchoscopy under the direction of our interventional pulmonary team. The fellow will perform bedside tracheostomies and PleurX catheter placement.  The lab fellow will also gain competency in pulmonary function testing, exercise stress testing, methacholine challenge testing and cardiopulmonary stress testing.  There are weekly one on one sessions with an attending with special interest in pulmonary physiology.

ICU rotations

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Medical ICU - Our fellows generally have 6-7 months of MICU 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 that of a Junior Attending leading MICU team rounds, rounding
with a physician extender, and reviewing plans with the attending physician.
This graduated responsibility provides the fellow more autonomous growth and
confidence in handling an ICU upon graduation.

Trauma - Fellows will rotate through our Trauma Unit which is a Level One Trauma Center. Fellows will learn primary and secondary surveys, respond to trauma codes with the trauma team, participate and lead trauma rounds, and perform critical care procedures.

Cardiovascular/thoracic ICU rotation - The fellow will gain experience with VA and VV ECMO, pulmonary artery catheters, mechanical devices, post-operative
care of cardiothoracic patients, and the management of those patients admitted to the intensive care unit following coronary artery bypass graft surgery, valvular heart surgery, thoracic surgery, and solid organ transplant.

Neurosurgical ICU – AGH is a comprehensive stroke center and has a
robust neurosurgical service.  6 of our current faculty members are also boarded in Neuro-critical Care. The fellow will rotate daily with the neurosurgical and neurology team.

Sleep

Pulmonary Critical Care Fellows rotate through the Sleep Disorders Center at AGH 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 fellow will interact with many medical discipline including Sleep Dentistry, OMFS, ENT, and sleep psychiatry. Fellows will also be asked to spend time in the Sleep Laboratory to observe basic PSG set up and interpretation. 

Radiology

Working with AGH Thoracic Imaging Radiologists, 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 rotation allows the fellow to gain airway skills in the non-emergent
setting.  Skills include bag mask ventilation, LMA insertion, and endotracheal intubation with direct laryngoscopy and glidescope.

Research

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Fellows participate in research with the attending physicians in the PCCM division who have a strong interest in clinical research. Fellows are encouraged to select research projects based on their interests and partake in industry research studies, quality improvement projects, abstracts, manuscripts, and oral presentations.  The Medicine Institute provides research coordinators and statisticians.  Fellows are required to present research at national meetings.

Ambulatory care

Faculty Offices

Fellows are assigned to a “clinic attending” for 36 months of their training. Through these half or whole day sessions, the fellow will develop graduated responsibility and autonomy as competency is acquired. The faculty offices 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 and discussed with the faculty preceptor.  The tests ordered by the fellow will be sent to their results section of their EPIC inbox for review and
to provide longitudinal care

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 TB.

Interventional Pulmonary Clinic

While fellows are on their lab rotation, they will attend IP clinic.  Procedures performed include thoracentesis, lymph node aspiration, and pleurX management. In IP clinic, the fellow will also evaluate nodules and evaluate airway disease for stent placement. 

Conferences

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Our comprehensive conference schedule enhances to the fellows clinical training. Conference schedule includes:

  • X-ray Conference 
  • Thoracic Oncology Case Conf. - Multidisciplinary 
  • Journal Club – Pulmonary and Critical Care 
  • Case Conferences -- Pulmonary and Critical Care 
  • Core curriculum didactic lectures 
  • Board Review 
  • M&M case review and RCA conference 
  • Physiology review 
  • Pulmonary Topic Review - one on one, fellow-driven review session with attending 
  • Interactive Clinical Case Series
  • Interstitial Lung Disease Case Review – Multidisciplinary 
  • Research/Quality Improvement Conference
  • Ventilator Rounds
  • 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.