ACGME Fellowship Program - Clinical Training
All fellows in the Pulmonary and Critical Care Fellowship Program complete 24 months of intensive clinical training done. Clinical training is primarily based at The University of Chicago Hospitals, a tertiary care referral hospital serving the south side of Chicago and northwestern Indiana, with the opportunity for further off-site clinical training by arrangement. Core rotations are provided in the following areas:
- Medical, Neurologic, and Surgical Intensive Care Units
- Pulmonary Consultation
- Pulmonary Procedures, including bronchoscopy
- Lung transplantation
- Pulmonary Function Testing
- Sleep Medicine
- Airway management
- Trauma Critical Care (at Advocate Christ Medical Center)
- Pulmonary rehabilitation (at the Schwab Rehabilitation Hospital)
In addition, a number of elective experiences are offered. These permit a fellow to tailor the training experience to meet anticipated future career plans.
Clinical training experiences are described below:
Intensive Care Units
The fellow supervises and directs the housestaff and medical students in the care of adult patients in the six Critical Care Units of The University of Chicago Hospitals (Medical, Coronary, Surgical, Cardiothoracic, Neurosurgical and Burn). The medical ICU is a 16 bed closed unit staffed by faculty from the section of Pulmonary and Critical Care Medicine. On these rotations, the fellow develops competence in the differential diagnosis and management of the critically ill, and learns to integrate these clinical skills with the biomedical instrumentation of bedside hemodynamic measurements, right heart catheterization, measurement and computation of gas exchange variables, cardiac output determination, and all aspects of mechanical ventilation and airway care. These principles, and those governing fluid therapy, nutritional support, and antimicrobial therapy in severely ill patients, are reviewed extensively through daily seminars covering the pathophysiology of critical illness. The fellow is also an important teaching resource for residents and students in an environment that fosters numerous opportunities for teaching.
Pulmonary Consultation Service
Fellows supervise and direct the residents and medical students on the Pulmonary Consult Service under the guidance of the attending physician. The fellow learns to assess all types of primary data that contribute to the accurate diagnosis of lung disease: pulmonary function tests, chest radiographs and computerized tomography, ventilation-perfusion lungs scans, pulmonary histopathology and cytology, and the bacteriology of respiratory pathogens. The consult service also attends a weekly conference in combination with the radiology department, in which instructive chest xrays and CAT scans are reviewed in a small group setting.
The Pulmonary and Critical Care fellows and faculty provide bronchoscopy services for the diagnosis of a wide variety of respiratory illnesses. Fellows perform bronchoscopy in a dedicated bronchoscopy suite using state of the art equipment and quickly become proficient at: airway inspection, bronchoalveolar lavage, endobronchial biopsy, transbronchial lung biopsy and transbronchial needle aspiration (TBNA). Approximately 600 bronschoscopies a year are performed in the endoscopy suite and in the intensive care units. Patients are referred for bronchoscopy from the outpatient pulmonary clinics, the inpatient consult service and from the oncology clinics. Biopsy of small peripheral lung nodules is performed using a CT-guided bronchoscopy system that is currently available at only a few institutions across the country.
In addition to performing bronchoscopy, fellows meet with faculty daily to interpret pulmonary function tests and learn airway mechanics. Fellows gain a thorough understanding of pulmonary function testing, including mechanics, cardiopulmonary exercise testing, and bronchoprovocation challenge testing.
The University of Chicago is home to one of the premier lung transplantation units in the Midwest. This popular rotation provides fellows with an intense introduction to the selection of transplant candidates and the management of these patients after transplantation. Fellows perform a number of bronchoscopies on lung transplant patients and work with a dedicated group of lunch transplant physicians.
Training in outpatient pulmonary medicine is a critical component of the fellowship experience at The University of Chicago. Pulmonary outpatient training is provided during the entire fellowship in a continuity clinic in the Center for Advanced Medicine on the main campus. The clinic has over 6,000 patient encounters per year. Two or three fellows see patients in collaboration with a dedicated attending physician. Ample time is provided to review findings and to discuss patient care issues. Additional time is used for directed teaching of topics important to outpatient pulmonary medicine. Fellows assume primary responsibility for managing their patients and have a dedicated panel of patients throughout their fellowship. The clinic is in close proximity to the pulmonary function laboratory and to the endoscopy suite.
Sleep Medicine Rotation
The rotation in sleep medicine allows fellows to learn basic principles of sleep-disordered breathing. Fellows will learn a multidisciplinary approach to sleep medicine under the direction of Dr. Babak Mokhlesi, Director of the Sleep Medicine Fellowship. Fellows spent time in the sleep disorders clinic and learning the basics of sleep physiology and polysomnogram interpretation.
A rotation in Trauma Critical Care at Advocate Christ Medical Center, a Level I trauma center, exposes fellows to the principles and management of trauma patients.
Pulmonary Rehabilitation Rotation
Fellows spend one month at the Schwab Rehabilitation Hospital. This rotation exposes fellows to issues in rehabilitation of patients with chronic pulmonary diseases as well as the use of non-invasive ventilation in patients with neuromuscular disease and respiratory muscle weakness.
Elective experiences in chest radiology and pulmonary pathology are provided by faculty in the Department of Radiology (Heber MacMahon, M.D.), and in the Department of Pathology (Aliya Husain, M.D.).
Teaching fellows is our highest priority: not just teaching pulmonary and critical care medicine, but teaching how to convey knowledge and an enthusiasm for learning to others. Two items that demonstrate our commitment: three different faculty within our Section have won the coveted McClintock Award for Teaching Excellence awarded by the fourth year medical students at The University of Chicago, and pulmonary / critical care faculty have won the award in 21 of the past 22 years. In the medical school graduation photograph, of the twenty faculty invited by the students to be in the photograph, the Department of Medicine generally places 10 faculty: 4 of these are from Pulmonary / Critical Care.
Fellows choosing to pursue a career as outstanding clinician-educators have opportunities to develop their teaching skills during their fellowship, and receive training in curriculum design and effective teaching methods.