Pulmonary Disease & Critical Care Fellowship: Curriculum

---

Rotation Synopses

MICU
The MICU at Houston Methodist Hospital is a 23-bed unit staffed at all time by Critical Care and Pulmonary/Critical Care faculty and nurse practitioners. Fellows are assigned to this rotation for 2 months in each year of training and can choose additional elective time. Internal Medicine and Neurology residents and medical students rotate through the unit in addition to fellows. Patients present with a wide variety of conditions including sepsis, respiratory failure, pre- and post- lung transplant illness, acute and chronic renal failure, neuromuscular disease, hyperglycemic crises, malignancies and others. Fellows are responsible for direct patient care as well as supervision of residents and medical students. Procedures include intubation, central venous lines (including hemodialysis catheters), arterial lines, bronchoscopy, paracentesis, and others. Multidisciplinary rounds are held each morning with a team that includes pharmacists, respiratory therapists, chaplains, dieticians, nurses and bioethics representatives.

SICU
Fellows are assigned to this rotation for 1 block in the first year and can choose additional elective time. The SICU is a 28 bed unit staffed by Critical Care faculty from the Department of Surgery and nurse practitioners. The SICU serves a diverse group of patients including critically ill general, vascular, oncologic, transplant, orthopedic, plastic, urologic, and head and neck surgical patients. The rotation includes significant exposure to patients with decompensated liver disease as well as pre- and post- liver transplant patients.

NICU
Fellows are assigned to this rotation for 1 block in the first year and can choose additional elective time. The NICU is a 20 bed unit staffed by Critical Care faculty from the Department of Anesthesiology. The NICU serves patients with diseases and conditions of the brain, spinal cord, and nerves. Fellows have significant exposure to neurosurgical procedures, neuromonitoring, acute stroke, intracranial hemorrhage, innovative interventional neuroradiology procedures, brain death and organ donation.

CVICU
Fellows are assigned to this rotation for 1 block in the second year of training and can choose additional elective time. The CVICU is a 40-bed unit staffed at all time by Critical Care faculty from the Department of Anesthesiology. This rotation provides exposure to the evaluation and management of a variety of patients with cardiovascular surgery, heart and lung transplant, mechanical assist devices, and other critical illnesses.  In addition, the fellow will gain significant experience with ECMO and innovative cardiovascular surgical procedures.  Fellows are involved in presenting at Journal Club and case presentations in addition to didactic lectures based on ICU topics.

Academic Consults
Fellows are assigned to this rotation for 4 blocks during the 3 years of training and can choose additional elective time. On this rotation, fellows act as a consultant under the supervision of the Pulmonary faculty from the Department of Medicine for hospitalized patients with a variety of acute and chronic pulmonary conditions. Consults include patients on the general floor and ICUs. Fellows perform pulmonary procedures when indicated on their patients.

Private Consults
Fellows are assigned to this rotation for 4 blocks during the 3 years of training and can choose additional elective time. On this rotation, fellows act as a consultant under the supervision of faculty from the private physicians of Pulmonary Critical Care and Sleep Medicine Consultants for hospitalized patients with a variety of acute and chronic pulmonary conditions. Consults include patients on the general floor and ICUs. Fellows will perform routine as well as specialized pulmonary procedures when indicated on their patients.

Pulmonary Function
Fellows are assigned to this rotation for 1 block in the first year of training and can choose additional elective time. Fellows supervise and interpret pulmonary function tests, arterial blood gases, and cardiopulmonary exercise testing for hospitalized patients and outpatients.

Transplant
Fellows are assigned to this rotation for 2 blocks during the first and second year of training and can choose additional elective time depending on career goals. Fellows participate in the evaluation and care of pre- and post- lung transplant patients as inpatients and outpatients. They participate in a very active outpatient transplant clinic and perform bronchoscopies and other indicated procedures. Fellows are supervised by the Pulmonary Transplant faculty and participate in a multidisciplinary team that includes nurse practitioners, pharmacists, and social workers.

Sleep
Fellows are assigned to this rotation for 1 block in the first year of training and can choose additional elective time if desired. Fellows are supervised by Sleep Medicine faculty during outpatient and inpatient evaluations of a variety of sleep disorders. Polysomnograms are reviewed by the fellow with the attending. They are responsible for recommendations for appropriate interventions and medications.

Interventional Pulmonology
Fellows are assigned to this rotation for 1 block in their second year of training and can choose additional elective time. Fellows participate in evaluation of patients and performance of routine and advanced pulmonary techniques under the supervision of an interventional pulmonologist or advanced bronchoscopist. Advanced procedures include endobronchial ultrasound, insertion of tunneled pleural catheters, rigid bronchoscopy, argon plasma coagulation, cryotherapy, stent placement, brachytherapy, electromagnetic navigational bronchoscopy, bronchial thermoplasty, endobronchial coils/valves, percutaneous dilatational tracheostomy, and others.

LTAC
Fellows are assigned to this rotation at Kindred Hospital for 1 block in their first year of training and can consider additional elective time. Fellows evaluate and manage a variety of inpatients with chronic pulmonary diseases and chronic critical illness who require aggressive pulmonary rehabilitation, physical rehabilitation and weaning from mechanical ventilation. They are supervised by the Pulmonary faculty from the Department of Medicine.

Research
Fellows are assigned to this rotation for a minimum of 4 blocks during the 3 year training program but may elect to take an additional 2 blocks. An experience in research is mandatory for every fellow. During this rotation, the fellow gains an understanding of critical thinking, scientific methodology and basic statistical methods. The fellow develops a research question, submits an IRB proposal and carries out the protocol with the expectation of peer-reviewed publication or presentation of results at a national meeting. Mentors are selected based on the research direction of the fellow. Basic science and clinical support are available and the Houston Methodist Research Institute offers collaboration with renowned researchers.

Palliative Medicine
Fellows are assigned to this rotation for 1 block in the second year of training and can choose additional elective time. Fellows function as part of a Palliative Care team that includes physicians, nurse practitioners and social workers. They will evaluate and manage patients with a variety palliative care needs including pain and symptom control, end-of-life care, support of family members, and setting goals of care under the supervision of the Palliative Care attending faculty. Fellows gain extensive experience with family meetings and hospice utilization.

Pathology/Radiology
Fellows are assigned to this rotation for 1 block in the second year of training. Fellows work directly with pathologists, pathology fellows, and radiologists to acquire expertise in lung and critical care imaging and interpretation of lung pathology specimens. Fellows review pathology samples and imaging studies from inpatients and outpatients at Houston Methodist Hospital and its affiliated facilities.