Pulmonary Disease and Critical Care Medicine Fellowship (ACGME)
All fellows in the Pulmonary and Critical Care Fellowship Program complete 24 months of clinical training. Clinical training is primarily based at The University of Chicago Medicine, a tertiary care referral medical center serving Chicago’s south side, the surrounding Chicagoland communities, northwestern Indiana, and western Michigan. There are opportunities for off-site clinical training by arrangement. Core rotations are provided in the following areas:
- Medical Intensive Care Unit
- Cardiac/Cardiothoracic Intensive Care Units
- Trauma Intensive Care Unit
- Neurologic Intensive Care Unit
- Pulmonary Inpatient Consultation
- Bronchoscopy and Interventional Pulmonology
- Advanced Lung Diseases (ambulatory)
- Pulmonary Function Testing
- Lung Transplantation
- Sleep Medicine
- Airway Management
- Pulmonary Rehabilitation (at the Schwab Rehabilitation Hospital)
In addition, a number of elective experiences are offered. These permit a fellow to customize the training experience to meet anticipated future career plans.
Clinical training experiences are described below:
Intensive Care Units
The fellow supervises and directs residents and medical students in the care of adult patients in Critical Care Units of the University of Chicago Medicine (Medical, Cardiac, Cardiothoracic, and Neurologic), with the Medical ICU being the core critical care rotation for the fellowship. 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 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 ultrasound and biopsy, transbronchial lung biopsy and transbronchial needle aspiration (TBNA). Approximately 800 bronschoscopies are performed annually in our bronchoscopy 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 CT-guided and robotic bronchoscopy systems that are available at only a few institutions across the country.
Advanced Lung Disease/PFT
Fellows on this rotation will meet daily with faculty 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.
Additionally, fellows on this core rotation will participate in specialized pulmonary clinics that care for patients with advanced obstructive disease (asthma and COPD), interstitial lung disease, neuromuscular disease, and lung transplantation.
The University of Chicago is home to a dedicated lung transplantation program. Fellows have the opportunity to work with transplant faculty as part of the Advanced Lung Disease and Bronchoscopy rotations, but also have the opportunity to round on the inpatient lung transplant service and attend pre- and post-transplant clinic to become familiar with the inpatient and outpatient management of lung transplantation.
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. Alejandra Lastra, Director of the Sleep Medicine Fellowship. Fellows spend time in the sleep disorders clinic and learning the basics of sleep physiology and polysomnogram interpretation.
A rotation in our Level I trauma center exposes fellows to the principles and management of initial assessment, operative management, and critical care management of trauma patients.
Pulmonary Rehabilitation Rotation
Fellows spend one month between the Schwab Rehabilitation Hospital and the University of Chicago outpatient cardiopulmonary rehabilitation program. 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.
Critical Care Ultrasound
First-year fellows attend the Midwest Fellows Critical Care Ultrasound Symposium at the beginning of fellowship, a two-day didactic and hands-on course that provides intensive education and training in critical care ultrasonography. The course draws on expert faculty from across Midwestern institutions, including our own, to provide foundational knowledge. Fellows will continue to build their ultrasound expertise during fellowship, especially during their ICU rotations, with feedback from faculty. We are introducing a longitudinal critical care ultrasonography curriculum in the form of an ultrasound interest group, which will meet in regular intervals with dedicated teaching and image review.
Teaching is our highest priority: not just pulmonary and critical care medicine, but teaching our fellows how to convey knowledge and an enthusiasm for learning to others. The preclinical teaching award at the University of Chicago Pritzker School of Medicine is named for the founder of our section, the prior Dean of the Medical School was a member of our section, multiple of our faculty have been awarded the coveted McClintock Award for Teaching Excellence awarded by the fourth year medical students, five of our faculty are members of the Academy of Distinguished Medical Educators, and our faculty routinely populate the “favorite faculty” who join our students on the graduation photo composite.
We are most proud, however, that it is considered an upset when a Pulmonary and Critical Care Fellow DOES NOT win the “Favorite Fellow” award from the internal medicine residency program.