Pulmonary and Critical Care Medicine Fellowship

About the program

Our fellowship is designed to prepare fellows to be board-eligible for the pulmonary board exam following the first two years and board-eligible for the critical care exam after completing the fellowship.

Areas of instruction include:

• Procedures
  • Flexible bronchoscopy
  • EBUS (endobronchial ultrasound)
  • Chest tube placement and management
  • Airway intubation skills
  • Thoracentesis
  • Percutaneous tracheostomy
  • Right heart catheterization
  • Advanced ventilator management skills
  • Advanced interventional pulmonology procedures
  • Rigid bronchoscopy
  • Thoracoscopy
• Required clinical rotations
• Elective clinical rotations
• Individual research blocks
• Supervised ambulatory continuity care clinics
• Simulation training
  • Bronchoscopy simulator
  • Advanced airway intubation skills
  • Vascular and thoracic ultrasound
• Didactic sessions, including conferences and rounds

Rotations

The ACGME requires at least six months of medical and three months of non-medical critical care experience. Schedules may be individualized to accommodate individual interests while ensuring that these requirements are met without exceeding the 15-month critical care limit.

Required rotations include:

• BSWH MICU
• VA MICU
• BSWH hospital service
• VA hospital service
• BSWH procedures
• Surgical ICU
• Neuro ICU
• Investigación
• Trasplante pulmonar
• Cirugía cardiotorácica
• Dormir
• Pulmonary function lab and rehabilitation

The ACGME also requires at least three months of non-medical ICU experience. This requirement is always achieved, with some individual choice, through the SICU rotation, the transplant rotation, the neurology ICU sections of the MICU at both Baylor Scott & White and the VA, and the PGY-5 and -6 consultative function in the cardiothoracic surgery ICU during MICU Fellow B rotations.

Elective rotations

Each fellow has two elective months in the second year, and four and a half months in the third year. Any or all of this time may be used in additional months of research.

Fellows have recently chosen two-to-four-week experiences in advanced sleep, interventional pulmonology, cardiothoracic surgery, allergy-immunology, tracheostomy care (ENT), pulmonary ambulatory care clinic, interventional radiology, pediatric ICU and burns.

Fellows may structure other electives, such as pulmonary hypertension, with the guidance and approval of the program director, associate program director and mentoring faculty.

Rotation schedule

PGY-4

• Two months BSWH MICU
• Two months VA MICU
• One month BSWH hospital inpatient/consult
• One month VA hospital consult and procedures
• One month BSWH procedures
• One month sleep
• One month PFT’s/pulmonary rehabilitation
• Three months research

PGY-5

• Two months BSWH MICU
• One month VA MICU
• One month BSWH hospital inpatient/consult
• One month VA hospital consult and procedures
• One month BSWH procedures
• One month SICU/Trauma
• One month transplant (offsite at UT-San Antonio)
• Two months research
• Two months elective

PGY-6

• Two months BSWH MICU
• One month BSWH hospital inpatient/consult
• One month VA hospital consult and procedures
• One month BSWH procedures
• One-half month cardiothoracic surgery
• Two months research
• Four and a half months elective

Conferences

There are at least three weekly division conferences, attended by faculty and fellows. On a monthly basis, averaged over a year, these include:

• One weekly curriculum conference (faculty and fellow shared responsibility)
• One to two weekly clinical case conferences
• One monthly evidenced-based medicine literature review
• One monthly clinical/pathology/radiology conference with staff pathologists and radiologists contributing to the presentation
• One monthly journal club conference
• One monthly division research conference
• One monthly ICU ethics conference

Additional conferences addressing medical humanities, faculty development, business practices and special invited speakers are included. Fellows are also expected to attend weekly internal medicine grand rounds.

Fellows are also required to present at current case conferences, journal clubs and evidenced-based medicine reviews.

Investigación

Each fellow has at least two months per year of research time. Three months are required in the first year, and elective time in years PGY-5 and PGY-6 mayo be added to the two required months in those years.

Interaction with faculty mentors must be demonstrated with progress towards a body of work that may be submitted for presentation at a national specialty meeting and/or publication. Completion of at least one project which is submitted for national presentation is required during the fellowship.