Pulmonary/Critical Care Medicine Fellowship Program
Marvin Balaan, MD, FCCP
Length of Program: 3 years
Number of positions: 9
Accreditation Status: Full Accreditation - 5 years
The Pulmonary / Critical Care Medicine Fellowship Program is a fully accredited three-year program designed to prepare fellows for dual certification in the subspecialties of Pulmonary Diseases and Critical Care Medicine.
The Division of Pulmonary and Critical Care Medicine evaluates and manages patients with acute and chronic lung disease. The division includes a Bronchoscopy Laboratory, Pulmonary Function Laboratory, Sleep Disorders Center, Hyperbaric Oxygen Unit and Respiratory Therapy Department. The bronchoscopy laboratory performs a wide range of procedures ranging from routine diagnostic studies to advanced procedures such as endobronchial ultrasound and electronavigational bronchoscopy. The fellows typically log over 200 bronchoscopy procedures during their training. The Pulmonary Function Laboratory enables fellows to perform specialized physiologic studies, including exercise testing, arterial blood gas measurement, spirometry, lung volume measurement and diffusing capacity measurement. The Sleep Disorders Center enables fellows to gain experience in treating and managing those patients with a variety of sleep disorders. The Hyperbaric Unit provides experience in patients with carbon monoxide poisoning and diabetic/necrotic non-healing wounds.
The program is designed with a strong emphasis on clinical evaluation and management of patients with acute and chronic lung diseases as well as critical illnesses. During the three-year fellowship, fellows spend nine months on the consultation service, six months on the medical intensive care service. These experiences are enhanced by number of required and elective rotations that include Neurocritical Care, Coronary Care, Trauma, Anesthesia, Cardiothoracic ICU, Radiology Nutrition, and Infections Diseases. Fellows also spend dedicated time in the Pulmonary Diagnostic Laboratory and in Research
ICU rotations provide direct patient care and supervising experience in managing critically ill medical and surgical patients. Fellows in the MICU gain experience in managing critically ill patients with shock, respiratory failure, metabolic and toxic emergencies, and are given opportunities to master conventional and advanced modes of mechanical ventilation, hemodynamic monitoring, placement of arterial and venous lines, and ultrasound guided vascular and pleural procedures. The fellows work collaboratively with the respiratory therapists in the implementation of weaning protocols and ventilator modes.
The consultation service affords an opportunity for trainees to evaluate, and manage patients with a wide array of respiratory conditions in collaboration with referring services. Fellows are responsible for coordinating treatment plans, procedures and for the subsequent follow-up of these patients. Pulmonary fellows supervise and teach residents and medical students on all clinical rotations.
Division conferences include Journal club, Multidisciplinary Chest Conference, Lung Pathology, Research , Quality Improvement , M & M, Board Review, Pulmonary Physiology, X-ray conference and weekly faculty lecture series.
Ambulatory Care Facilities
Fellows gain considerable outpatient experience in a variety of settings, including the faculty offices, sleep disorders center and tuberculosis clinic. These half day sessions 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 will then formulate a differential diagnosis, diagnostic plan, and treatment plan in collaboration with a faculty preceptor. Graduated responsibility and autonomy is provided as the fellow develops and acquires competence.
Fellows work closely with other physicians in the surgical and medical subspecialties, specifically those in thoracic surgery, cardiology, infectious disease, general surgery and neurosurgery. The Division holds a popular weekly multidisciplinary conference that includes faculty and house staff in the Division of Pulmonary and Critical Care Medicine, Department of Cardiothoracic Surgery, Pathology, Radiology, and Oncology Fellows present current cases to the multidisciplinary faculty in order to optimize diagnostic and treatment plans as well as patient outcomes
Fellows are expected to participate in a variety of research projects in the division. The research experience includes attendance in formal lectures in research design and statistics. Fellows are then expected to participate in at least one project 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 national meetings and submit their work for publication in peer-reviewed journals.