Pulmonary Inpatient Consultative Service
Fellows rotate on the Inpatient Pulmonary Consultation Service as part of their Pulmonary Medicine experience required by the Pulmonary and Critical Care Residency Review Committee. Fellows assigned to this clinical service are responsible for providing comprehensive primary care of pulmonary inpatients, for pulmonary and sleep medicine consultation, and learning competency in the relevant pulmonary medicine clinical procedures with attending supervision. Fellows assigned to this clinical service have responsibilities for teaching and supervision of residents and medical students assigned to the service.
Pulmonary Outpatient Subspecialty Rotations
Fellows rotate on the Pulmonary Subspecialty Service as part of their first fellowship year. Chest Medicine Associates is the principal training site for this rotation. Fellows assigned to this clinical service are responsible for providing consultative care of outpatients with a variety of subspecialty pulmonary disorders requiring expertise for diagnosis and management. The rotation comprises the following Pulmonary Subspecialty Programs: Pulmonary Hypertension, Cystic Fibrosis, Mycobacterial Lung Diseases and Interstitial Lung Diseases
Sleep Disorders
This rotation includes experience in the evaluation and management of patients referred for a wide variety of sleep disorders. Fellow responsibilities include developing expertise in overnight polysomnography and multiple sleep latency testing, interpretation of study results, completion of study reports, and communication with referring physicians. Fellows develop familiarity with the various technical components of Sleep Medicine including nasal CPAP, BiPAP, oral devices, and other therapeutic equipment. Clinical problems and literature review will be presented at the Sleep Physiology Conference. Fellows participate in Advanced Clinical Sleep clinic during this rotation with board certified sleep physicians.
Outpatient Pulmonary Rehabilitation
Fellows rotate on the outpatient Pulmonary Rehabilitation Service during their third fellowship year. The principal training site for this rotation is the New England Rehabilitation Hospital at the Brighton Medical Campus of MMC. Fellows assigned to this clinical service will be active participants in the Outpatient Pulmonary Rehabilitation Program, responsible for learning competency in pulmonary rehabilitation principles and practice.
Pulmonary Function Laboratory
This rotation is designed for the fellow to learn the physiologic basis for pulmonary function and cardiopulmonary exercise testing (CPET) and develop a technical proficiency in conducting the studies. This rotation includes clinical experience and performance of spirometry, static lung volume determinations, measurements of gas diffusion, bronchoprovocation studies, impedance plethysmography, and CPET. The technical aspects of fiberoptic bronchoscopy are also a part of this curriculum. The fellow is expected to gain a practical exposure to pulmonary function and exercise testing, obtain clinical correlations, interpret studies, review studies with the responsible attending physician and dictate the necessary reports.
Pulmonary Medicine Elective/Research
This time is devoted to the fellow's programmatic needs not included in the general curriculum. Possibilities include, but are not limited to, exposure to the related clinical disciplines of pulmonary medicine (e.g., chest radiology, allergy/immunology, pathology, interventional pulmonology, etc.) and research activities. Elective rotations are proposed by the fellow in writing, with a teaching attending of record identified and approved in advance by the program director.
Critical Care Inpatient Service
Fellows rotate in the Intensive Unit on the Critical Care Medicine Service to fulfill part of their 12 month Critical Care experience required by the ACGME. Fellows assigned to this clinical service are responsible for providing comprehensive primary care of the critically ill patient, and for critical care medicine consultation, while learning competency in the relevant critical care medicine clinical procedures. Fellows assigned to this clinical service are responsible for the teaching and supervision of residents and medical students assigned to the service.
Critical Care Clinical Services/Anesthesia
This rotation is designed specifically for an in-depth exposure to the technology of critical care medicine. The fellow is expected to establish an up-to-date knowledge base and practical experience with mechanical ventilation, oxygen delivery systems, arterial blood gas analysis, carbon dioxide monitoring, metabolic analysis, respiratory care procedures, nutritional support, hemodynamic monitoring, and airway management. Each fellow works directly with the respiratory therapists, hemodynamic technicians, clinical engineers and nutritionists within the Critical Care Unit. The critical care clinical services month is scheduled during the first fellowship year and is coordinated with the Anesthesiology teaching service to provide an opportunity for instruction and experience in the performance of endotracheal intubation (ETI), right heart catheterization (RHC), arterial cannulation (ATC) and central venous catheterization (CVC).
Neurocritical Care
Fellows rotate on the Neurocritical Care service to fulfill part of their 12 month Critical Care experience required by ACGME. Fellows assigned to this clinical service will obtain clinical experience with the neurocritically ill, including patients with stroke, neurotrauma, brain infections, hypoxic-ischemic brain injury, status epilepticus, and neuromuscular respiratory failure. Fellows will gain experience in relevant neurocritical care clinical procedures. Fellows assigned to this clinical service should participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.
Trauma - Surgical Critical Care
Fellows rotate on the Trauma Critical Care Surgical Service to fulfill part of their 12 month critical care experience required by ACGME. Fellows assigned to this clinical service obtain clinical experience with critically ill surgical, shock/trauma, and burn unit patients, while learning competency in the relevant trauma critical care clinical procedures. Fellows assigned to this clinical service should participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.
Thoracic Surgery Critical Care
Fellows rotate on the Cardiothracic Surgery Critical Care Service to fulfill part of their 12 month critical care experience required by the ACGME to obtain clinical experience with the pre– intra- and post-operative management of thoracic surgical patients, learning competency in the relevant thoracic surgery critical care clinical procedures. Time is spent in the operating room assisting the attending surgeon of record on thoracic surgical procedures. Fellows assigned to this clinical service should participate in the teaching and supervision of residents and medical students assigned to the service as appropriate.
Critical Care Electives
This time is devoted to the individual's programmatic needs not included in the general curriculum. Possibilities include, but are not limited to, patient care rotations in related disciplines of critical care medicine (e.g., cardiothoracic surgery, nutritional support services, or critical care pharmacology). Elective rotations are proposed by the fellow in writing, with a teaching attendings of record identified and approved in advance by the program director.
Each fellow is assigned three to four half-days per month to the ambulatory pulmonary medicine facility at Chest Medicine Associates for outpatient consultations and patient follow-up. Clinical rotation and research responsibilities are suspended during this assigned time. This provides the opportunity for the fellow to assess and manage, with progressive autonomy and responsibility, a wide variety of patients from the spectrum of pulmonary, sleep and critical care medicine. Continuity clinics allow the fellow to learn the natural history of pulmonary and sleep disorders, as well as the effectiveness of therapeutic interventions. Discussion time is provided with the teaching attending linked to the fellow’s clinic for review of patient management. First year fellows are paired with one supervising clinic attending during their first year of fellowship. Senior fellows participate in Senior Fellows clinic which is staffed by a rotating attending each month.