Curriculum

More specifically, the first year of fellowship training is dedicated to learning the fundamentals of pulmonary diseases, physiology, procedures, critical care medicine and bronchoscopy. Year 2 of fellowship training is focused on further improving upon clinical skills in PCCM, initiating research projects and developing leadership abilities. Towards the later half of the 2nd year into the 3rd year, the fellows are allotted research time to develop skills in academic leadership.  The fellows are provided dedicated research time with the expectation of scholarly activity in projects involving medical education, quality improvement, clinical medicine or basic sciences with the benchmark of a presentation at national conferences and/or manuscript publications.

Core Competencies: Throughout the 36 months fellows are trained and evaluated on the ACGME milestones in Core Competencies including:

  1. Medical Knowledge
  2. Patient Care
  3. Practice Based Learning and Improvement
  4. Interpersonal and Communication Skills
  5. Professionalism
  6. Systems Based Practice

Increasing Levels of Responsibility and Supervision: Throughout the fellowship, the fellows are supervised in the care of their patients by PCCM faculty. Each rotation has a dedicated  “key clinical faculty” (KCF), an attending who has direct supervision of the fellow. With each year of additional training, the fellow acquires graduated levels of responsibility for each rotation. Fellows begin by learning the fundamentals of PCCM and then progress through their 2nd and 3rd year with respect to their management skills, procedural skills, level of responsibility in leading the team and educating members of the team. Ultimately, at the end of the 36 months of training, fellows are expected to have gained enough experience and knowledge to independently practice PCCM.

Educational Resources: There are a variety of educational resources that are available to the fellow. These include:

  1. The Levy Library with online access to standard pulmonary and critical care textbooks as well as relevant publications in pulmonary and critical care journals including UpToDate.
  2. Pulmonary and Critical Care reading lists (updated annually by the PD and associate PD).
  3. Board Review curriculum (available as a hard-copy or from the internal pulmonary fellowship website).
  4. A schedule of divisional and external weekly conferences emailed to all faculty and fellows including combined teleconferences within the Mount Sinai Health System and with National Jewish Hospital in Denver.

Clinical Competency Committee: The new accreditation system (NAS) has set up a practice whereby fellows need to meet certain milestones within the three years of training. These milestones correspond to six core competencies. A fellow’s performance is evaluated by a Clinical Competency Committee (CCC) made up of key clinical faculty (KCF): Drs Dua, Poor, Acquah, Harkin, Braman, Rogers, DiFabrizio, Mathur, Powell. They meet on a semi-annual basis to review each fellow’s progress and then determine if there are any deficiencies in meeting milestones. If a fellow is found to be deficient in any milestone, they meet with the PD to discuss strategies on improvement. Fellows meet with the PD on a semi-annual basis to review their six monthly performance. 

Pulmonary Medicine Rotations

  • Pulmonary Consult Rotation: The “consult” fellow along with the pulmonary consult service attending of the week provides inpatient pulmonary consultative services for a variety of medical & surgical services in the hospital. In addition to bread and butter pulmonary diseases such as asthma and COPD, the fellow gains the experience of managing complex lung diseases such as immunosuppressed patients, bronchiectasis, interstitial lung diseases, pulmonary hypertension and sarcoidosis.
  • Bronchoscopy Rotation: The “bronch” fellow works closely with Dr. Timothy Harkin in learning the fundamentals of bronchoscopy and more advanced procedures including endobronchial ultrasound, balloon dilation and cryotherapy. In addition, other types of interventional procedures including pleural biopsies and medical chest tubes during this dedicated procedures-based rotation are performed.
  • Outpatient Continuity Clinic: Each fellow has a continuity clinic over the three years where a patient panel drawing from the East Harlem population is built. The breadth of pulmonary diseases includes difficult asthma, COPD, pulmonary nodules, lung cancer, and interstitial lung diseases. The fellow through this experience gains an expertise in the outpatient management of a wide array of pulmonary diseases and in performing the pre-op chest exam. 
  • Sarcoidosis Clinic: Through the outpatient Sarcoidosis clinic, fellows learn the diagnosis & management of complex manifestations of the disease.
  • Physiology Rotation: The “Physiology” fellow learns the fundamentals of performing  & interpreting pulmonary function tests, methacholine challenge tests and cardiopulmonary exercise testing.
  • Sleep Rotation: During physiology rotation several hours of the week are spent with the Sleep medicine attending learning the basic of sleep medicine, reading sleep studies and attending sleep clinic.
  • Respiratory Institute Rotation: The “RIF” or Respiratory Institute fellow assists the faculty in their respective subspecialty fields (such as asthma, COPD, ILD, Pulmonary Hypertension, lung cancer) by attending office-based practice of programmatic faculty.

Critical Care Medicine Rotations

  • MICU Rotation: The “MICU” fellow supervises a team of medical residents & interns under the guidance of one MICU attending of the week to manage the care of 14 critically ill patients in the medical ICU. This rotation provides a wealth of experience in acquiring procedural and ultrasound skills as well as the fundamentals of mechanical ventilation & the care of the critically ill.
  • Night Float Rotation: Two fellows share a two-week block of night float when they are responsible for managing the MICU between 6 PM- 7 AM. This rotation provides the fellow with further autonomy and experience in managing critically ill patients with supervision from an off site attending.
  • Critical Care Consultative Service (CCCS): The “medical acute response” or “MARS” fellow along with a supervising attending provides triage and resuscitative services for critically ill patients on the floors.
  • SICU rotation: This rotation involves joining other fellows from the Critical Care Fellowship training programs in managing post-operative patients with a specific focus on the care of patients post solid organ transplantation.
  • “Other” Intensive Care Unit Rotation: Every fellow gets an opportunity to rotate through other non-medical ICUs such as Neuro-ICU and cardio-thoracic ICU to gain exposure to neurosurgical and cardiothoracic surgical patients.

  • Journal Club
    Three Mondays a month 12 PM
    Facilitator: Dr. Wisnivesky, Dr Mathews, Dr Shah and Dr. Lee
    All available faculty and fellows attend Journal club. Dr. Wisnivesky, Mathews, Shah or Lee facilitate the conversation focusing on methodology and basic statistics. A designated fellow meets with one of the above attendings in advance to review either a pulmonary or critical care article (chosen by the fellow or mentor) prior to this discussion.
  • Multi-Disciplinary ILD Conference
    Mondays 1 PM
    Facilitator: Dr Padilla
    Three to four pre-determined ILD cases are discussed by having their clinical history presented in a multidisciplinary forum with chest radiologist (Dr Salvatore) and lung pathologist (Dr Beasley) to discuss the week’s ILD cases with clinical-radiologic-pathologic correlation. Once a month this is held inter-institutionally by video conferencing in the other MSHS sites and NJH, Denver.
  • Radiology Conference
    Thursdays 4 PM
    Facilitator: Dr. Mendelson or Salvatore or Eber
    This conference is designed to review interesting CXRs, Chest CTs, and to discuss management of challenging cases on in-patient consult service. While it is expected that the fellow on pulmonary consult service present cases, these may also come from bronchoscopy service, chest/sarcoidosis clinic, or ICU. Other pulmonary and Thoracic Surgery attending also sometimes bring cases to be presented.
  • Fellows Core Critical Care and Pulmonary Lecture Series
    Tuesdays 4-6 PM
    Facilitator: Program Directors
    Lectures include core curriculum related pulmonary, critical care and sleep medicine topics.
  • Thoracic Oncology Conference
    Wednesdays 7:30 AM
    Facilitator: Thoracic Surgery Fellow
    The thoracic surgery fellow reviews all the recent surgical cases with a focus on interdisciplinary discussion regarding pulmonary tumors.
  • Pathology Conference
    Alternate Mondays 4 PM
    Facilitator: Dr Beasley
    An assigned fellow presents 4-5 interesting cases with available radiology and a confirmed pathological diagnosis. A radiologist is in attendance to review the imaging followed by a review of the relevant histology by the pathologist.
  • Case Conference
    Alternate Mondays 4 PM
    Facilitator: Dr Poor
    Two cases are presented by assigned fellows with a short evidence based discussion on a relevant topic pertaining to the case (diagnostic work up, management). The aim is to answer a specific question using literature-based evidence.
  • Grand Rounds
    Fridays 12:30 PM
    Facilitator: Dr. Allison Lee
    Fellows, faculty members, and guest speakers present various clinical and research topics.

Year 1

Rotation

Number of Weeks

Pulmonary Consults

6

Bronchoscopy

6-8

Physiology/Sleep

6-8

MICU

6-8

SICU/Non-Medical ICU

2

Night Float

8

CCCS

4-6

Airway

2

Research

0

Elective

2

Vacation

4

Resp Institute

2-4


Year 2

Rotation

Number of Weeks

Pulmonary Consults

2-4

Bronchoscopy

2-4

Physiology/Sleep

2

MICU

2-4

SICU/Non-Medical ICU

2

Night Float

6-8

CCCS

2-4

Airway

2

Research

24

Elective

0

Vacation

4

Resp Institute

0


Year 3

Rotation

Number of Weeks

Pulmonary Consults

2

Bronchoscopy

2

Physiology/Sleep

2

MICU

2

SICU/Non-Medical ICU

2

Night Float

8

CCCS

4

Airway

2

Research

24-26

Elective

0

Vacation

4

Resp Institute

0