Curriculum

The clinical training emphasizes the diagnosis and management of acute and chronic respiratory diseases, with emphasis on the practical application of pulmonary physiological and biologic principles to all aspects of critical care, consultative chest medicine, rehabilitation, pulmonary hypertension, lung cancer, and sleep medicine. During pulmonary blocks, fellows will evaluate and manage a breadth of common and rare pulmonary illnesses, learn pulmonary and sleep physiology and develop expertise in advanced pulmonary procedures. During critical care blocks, fellows will manage our intensive care units gaining experience in all aspects of critical care management, end of life care, ultrasound and procedures.

Year 1: The first year is dedicated to developing the foundations of clinical training in pulmonary and critical care medicine and subspecialty critical care medicine. This includes training in the management of patients in surgical intensive care/trauma, neuro-critical care, cardiac critical care and palliative care medicine.

Year 2: During the second year of fellowship, fellows further their clinical expertise in pulmonary medicine with rotations on pulmonary subspecialty services, including cystic fibrosis, pulmonary physiology and sleep medicine. Fellows in their second year also focus on scholarly activities and work closely with mentors to develop an individualized pathway to meet their career goals.

Year 3: The goal of the third year is to develop clinical expertise in a specific area of a fellow’s choosing, complete scholarly activity and build on educational and leadership skills.

An equally important aspect of our program is training fellows to independently and expertly perform a vast array of pulmonary and critical care procedures. Our training program includes in-depth preparation in:

  • Intubation with video and direct laryngoscopy
  • Management of the difficult airway
  • Flexible bronchoscopy
  • Endobronchial ultrasound (EBUS)
  • Short and long-term chest thoracostomy tube insertion and maintenance
  • Pleurodesis and pleural biopsy
  • Critical Care Ultrasonography/Point-of-care ultrasonography
  • Interpretation of pulmonary function tests, airway responsiveness testing and cardiopulmonary exercise testing
  • Pulmonary rehabilitation
  • Treatment of primary and secondary pulmonary hypertension
  • Percutaneous Tracheostomies

A unique aspect of our program is the pairing of a comprehensive foundation of clinical training with an individualized pathway for career development. Fellows are deeply engaged in learning research, quality improvement, teaching and leadership skills. We have an expectation that our fellows participate in scholarly projects; fellows routinely present their research at national meetings and publish in peer-reviewed journals. Our goal is to help our fellows succeed and become leaders in Pulmonary and Critical Care Medicine. Many of our graduates have gone on to become innovative clinician-educators and leaders in medical education and hospital administration.

Core Rotations

  • Medical Intensive Care Unit (MSSL, MSW, MSBI) - The MICU service features an array of health professionals committed to the delivery of cutting-edge critical care. Our team consists of critical care faculty, critical care fellows, medicine and emergency medicine housestaff, critical care nursing, physical therapists, respiratory therapists, nutritionists, pharmacists and social workers. Critical care attendings and fellows provide in-house nighttime coverage. The pulmonary/critical care fellow supervises the MICU residents and performs necessary procedures under the supervision of the MICU attending, including intubations, percutaneous tracheostomies, chest tubes, bronchoscopy and point-of-care ultrasound. Fellows work closely with the palliative care team in the MICU to address the needs of our patients and families.
  • Pulmonary Consult Service (MSSL, MSW, MSBI) - Pulmonary fellows and attendings provide consultative care to a broad mix of patients with pulmonary diseases throughout the three hospitals. They are responsible for supervising elective residents and students. Fellows develop expertise in chest radiology interpretation and have the opportunity to perform thoracentesis, advanced pleural procedures (small and large bore chest tubes, pleurX catheter placement, pleural biopsy), bronchoscopy and EBUS.
  • Critical Care Consult Service/Pulmonary Stepdown Unit (MSSL, MSW, MSBI) - Our team consists of a faculty member, fellow and resident who respond to all patients requiring urgent critical care including RRTs, codes and critical care consultations. Fellows perform their own intubations and airway management - including difficult airways - under the guidance of a pulmonary/critical care or anesthesia attending. The team also cares for chronically critically ill patients who require extended periods of mechanical ventilation for acute and chronic respiratory failure.
  • Physiology/Procedures (MSSL, MSW) - All three campuses boast state of the art physiology testing. Under the supervision of our faculty physiology experts, fellows oversee and interpret a full array of pulmonary function testing including airway responsiveness testing (methacholine & histamine challenges) and cardiopulmonary exercise testing. On this rotation, fellows also dedicate time to mastery-level learning of pulmonary procedures.
  • Cystic Fibrosis Service/Sleep Medicine (MSBI) - During this combined second-year rotation, fellows rotate with Drs. Patricia Walker and Maria Berdella, co-directors of the Cystic Fibrosis Center at MSBI. They evaluate and manage inpatients and outpatients with cystic fibrosis. Through experiences in the MSBI Sleep Center and the MSW Sleep Disorders and CPAP Clinic, fellows are broadly exposed to the spectrum of sleep disorders (including excessive daytime somnolence, snoring, obstructive sleep apnea (OSA), insomnia, narcolepsy, restless legs syndrome, central sleep apnea, and REM behavior disorder) and receive intensive didactic training in sleep physiology and polysomnogram interpretation. The MSBI Sleep Center is also very active in pre-surgical and pre-bariatric evaluations.
  • Night Intensivist Experience-Second- and third-year fellows participate in this non-continuous experience gaining autonomy in the management of critically ill patients at night. While still under faculty oversight, this rotation mimics ‘real-life’ practice and builds confidence in the independent management of the ICU, critical care consultations and critical care procedures.
  • Trauma/SICU Rotation (MSSL) - First-year fellows rotate for one month with the Trauma service and Surgical ICU at Mount Sinai St. Luke’s.
  • Neurology ICU (MSW) - First-year fellows rotate for one month in the neurocritical care unit at Mount Sinai West. Pulmonary and critical care fellows are integrated into the multidisciplinary team and are trained in the direct management of subarachnoid hemorrhage, acute subdural hematoma, large ischemic stroke, and intracerebral hemorrhage. Fellows also provide care for patients with neuromuscular conditions requiring ventilator support, status epilepticus, complicated postoperative neurosurgical needs, meningitis, and patients with encephalitis.
  • Chest Clinic - Fellows conduct a weekly continuity clinic throughout the three-year fellowship. Fellows serve as the primary pulmonologist for patients with common and complex disorders of the respiratory system, including asthma, chronic cough, chronic obstructive pulmonary disease, interstitial lung diseases, sarcoidosis, and lung cancer.
  • Ambulatory Subspecialty Experiences - In addition to Cystic Fibrosis and Sleep Medicine, fellows have several opportunities to work in pulmonary subspecialty clinics throughout their training and may elect to rotate through the following programs: Venous Thromboembolism Clinic, Lung Cancer Screening Program, Asthma Clinic, Smoking Cessation Clinic, Thoracic Surgery Program, Pulmonary Rehabilitation Program, Thoracic Oncology Program, Cough Clinic (NY Eye and Ear Infirmary at Mount Sinai).


Elective Opportunities

  • Thoracic Radiology
  • Anesthesiology
  • Thoracic Surgery
  • Thoracic Oncology
  • Coronary Care Unit
  • Cardiothoracic Intensive Care Unit
  • Medical simulation
  • Point-of-care ultrasound
  • Pulmonary Rehabiliation
  • Pulmonary Hyptertension
  • Offsite electives (non-tuberculous mycobacteria service at National Jewish, lung transplant, interventional pulmonology)

 

 

Our fellows are deeply engaged in a curriculum that incorporates innovative educational techniques, including multidisciplinary learning, simulation and hands-on training. During your training, you will participate in a wide range of on-site, system-wide and national conferences. Sessions are televised between campuses.

On-site

  • Introductory summer core curriculum in basic principles of pulmonary and critical care medicine
  • Monthly ‘flipped classroom’ discussion of advanced pulmonary and critical care medicine topics
  • Weekly core lectures in pulmonary and critical care medicine
  • Weekly Pulmonary and Critical Care Medicine Grand Rounds
  • Weekly Chest Radiology Conference
  • Monthly Point-of-care Ultrasound case conference
  • Weekly Multidisciplinary Thoracic Tumor Board
  • Monthly Physiology Conference
  • Monthly Morbidity and Mortality Conference
  • Multidisciplinary ICU Quality Improvement conference
  • Pulmonary and Critical Care Medicine Journal Club
  • Pro-Con Debates in controversial areas of Pulmonary and Critical Care
  • Pathology conference
  • ID – Pulmonary Joint case conference
  • Research-in-progress conference
  • Simulation workshops on airways, code/RRT training, vascular access, bronchoscopy and advanced pulmonary and critical care scenarios

Mount Sinai/National Jewish/Respiratory Institute system-wide conferences

  • ILD conference
  • Airways Disease conference
  • Critical Care Grand Rounds
  • Tumor Board

Distinctive local conferences

  • Mount Sinai Health System simulation day for 1st-year fellows - focused training on bronchoscopy, airway training with direct and video laryngoscopy, thoracentesis and pigtail chest tube placement
  • Regional 3-day Critical Care Ultrasound Course for 1st-year fellows - focused training on echocardiography, lung and pleural ultrasound, abdominal ultrasound, DVT studies and ultrasound for vascular access
  • New York State Thoracic Society Annual Meeting
  • Annual Inter-city Fellows’ Symposium
  • Quarterly New York City Resuscitation Ultrasound Rounds

Fellows are encouraged to attend national meetings during all three years of their training to present their research

  • American Thoracic Society (ATS)
  • American College of Chest Physicians (ACCP)
  • Society of Critical Care Medicine (SCCM)

 

 

 

 

Simulation-Based Medical Education

Based at Mount Sinai West, the Center for Advanced Medical Simulation (CAMS) is the first NYC-based simulation program to receive accreditation from the Society for Simulation in Healthcare. Established in 2007, it is now a system-wide center for the education of residents, fellows, nurses, respiratory therapists and faculty from several departments including Pulmonary & Critical Care, Anesthesia, Internal Medicine, Emergency Medicine, General Surgery Critical Care Nursing and Respiratory Therapy.

Training is provided in a variety of clinical domains such as cardiac arrest, rapid response scenarios, airway management, emergency and elective invasive procedures, teamwork, leadership and communication skills, bronchoscopy, and rare events.

The simulation center has several training labs supported by high-tech audiovisual equipment that capture detailed images of training events. Sophisticated, computerized, high fidelity manikins are linked to the AV equipment providing Simulation Specialists with ongoing data. Educators use this information to provide learners with real-time feedback and education during debriefing sessions.

The CAMS interdisciplinary structure promotes collaborative learning among members of the Pulmonary & Critical Care Division and other departments. In 2014, we hosted the first annual Joint Simulation Orientation for all new Pulmonary & Critical Care Fellows in the Mount Sinai Health System. This one-day intensive course focuses on basic and advanced airway management, introductory bronchoscopy training, and ultrasound-guided thoracentesis/pigtail catheter placement.

A one-year Fellowship in Simulation was created in 2010 as a joint collaboration with the Department of Emergency Medicine. In addition, Pulmonary & Critical Care Fellows with a career interest in medical simulation have the opportunity to complete a 6-month ‘mini’-Simulation Fellowship within the 3-year fellowship structure. Simulation fellows work closely with faculty members to conduct education research, quality improvement and patient safety studies.

Critical Care Ultrasonography/Point-of-care Ultrasonography

Several program faculty are recognized as national leaders in this relatively young field, having applied the use of ultrasonography to the care of ICU patients since the early 1990s. Critically ill patients are routinely scanned using this safe, non-invasive imaging modality to determine the causes of shock, respiratory failure, intravascular volume status and procedural guidance.

Dr. Patrawalla has achieved national recognition as a leader of critical care ultrasound training with a focus on competency-based educational methods. She serves as co-chair of one of the largest national courses for critical care ultrasound and reviewer for the only national assessment-based certificate for critical care ultrasound.

Fellows receive extensive training in point-of-care ultrasound, beginning with a three-day regional introductory course during the 1st month of fellowship. This is followed by an intensive, mastery-learning approach to training using a web-based image archiving application to deliver immediate and instructive feedback to fellows. Train-the-trainer sessions are used to enhance the teaching skills of fellows, many of whom have become faculty at the national level. Training in advanced echo and transesophageal echocardiography is also available. 

 

An ongoing philanthropic donation was gifted to Mount Sinai St. Luke's and Mount Sinai West to establish a ‘lung center of excellence’ under the leadership of Dr. Turino. The mission of the Mara Lung Center is to develop programs that optimize patient care, education, teaching, and research and to enhance the lives of patients disabled by chronic lung disorders. The center provides support for several programs that enhance fellows’ training and research opportunities:

  • Active research program with recent efforts focused on elastin degradation as a biomarker in COPD and hyaluronon as a novel therapy in COPD
  • Active grants awarded for the study of early detection of lung disease, smoking cessation, alpha-1 antitrypsin deficiency
  • Pulmonary rehabilitation - The James P. Mara Center for Lung Disease is one of only two certified pulmonary rehabilitation centers in NYC. Fellows assess and evaluate the progress of their patients, and participate in cardiopulmonary exercise testing.
  • Community outreach programs include early detection of lung disease, asthma screenings, The Great American Smokeout, Asthma Day and COPD Day
  • Patient-run support groups (COPD, alpha-1 antitrypsin deficiency and pulmonary hypertension)
  • Local and national involvement in advocacy programs