Curriculum

The core faculty in the Division of Pulmonary, Critical Care and Sleep medicine includes 11 full-time, internationally-recognized faculty who possess a broad array of clinical and research interests covering the major fields of pulmonary and critical care medicine. The Program Director is Dr. Paru Patrawalla, an accomplished teacher and widely invited lecturer with an extensive background in using Medical Simulation Training techniques as well as a national expert in the growing field of Critical Care Ultrasonography. Fellows interact with core faculty on a daily basis through bedside rounds, daily clinical conferences, journal clubs, and didactic sessions. Formal didactic sessions are built around a core lecture series given year-round by our faculty and include respiratory physiology, hemodynamic monitoring, mechanical ventilation, and respiratory infections.

The Mount Sinai Beth Israel Pulmonary and Critical Care Medicine Fellowship Program is a 3 year combined program committed to providing outstanding clinical training in all aspects of pulmonary and critical care medicine. The first-year is dedicated to developing the foundations of clinical training in pulmonary and critical care medicine, as well as giving fellows the building blocks to subspecialty critical care medicine. This includes training in the management of patients in trauma, surgical intensive care, neuro critical care, cardiac critical care and palliative care medicine. The second year of fellowship is designed to further build clinical expertise in pulmonary with rotations on pulmonary subspecialty services, including pulmonary vascular disease, cystic fibrosis and sleep. Fellows in their second year also focus on scholarly activities and an individualized pathway to meet their career goals. The goal of their third year fellowship is to develop clinical expertise in a specific area of their choosing, complete scholarly activity and build on their educational and leadership skills.

Mount Sinai Beth Israel is a 600 bed tertiary care referral center that serves the lower east side of Manhattan and the surrounding boroughs and is the Lower Manhattan campus for the Icahn School of Medicine at Mount Sinai. Mount Sinai Beth Israel’s unique combination of referral and primary care patient populations provides a well-balanced mix for the training and clinical research programs of the Pulmonary and critical care medicine Fellowship Program.

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 and all aspects of critical care, consultative chest medicine, rehabilitation, pulmonary hypertension, lung cancer, and sleep medicine. An equally important aspect of our program is training in a vast array of pulmonary and critical care procedures. Our training program includes in-depth preparation in:

  • Critical Care Ultrasonography/Point-of-care ultrasonography
  • Percutaneous Tracheostomies
  • 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
  • Treatment of primary and secondary pulmonary hypertension
  • Interpretation of pulmonary function tests, airway responsiveness testing and cardiopulmonary exercise testing
  • Pulmonary rehabilitation

A unique aspect of this program is that we are able to pair a robust and 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 will participate in scholarly projects and 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.

The Alice and Richard Netter Simulation Center: Mount Sinai Beth Israel boasts a state-of-the-art simulation center directed by Dr. Paru Patrawalla. The center utilizes the most modern, life-sized, computerized patient simulator (SimMan™ 3G) to emulate a vast array of clinical scenarios to facilitate critical skills acquisition in areas such as basic and advanced airway management, resuscitation from cardiac arrest & shock, medical crisis leadership tactics and task based procedures such as insertion of central lines under ultrasound guidance. Dr. Patrawalla trains both residents and fellows in simulation training skills in order to serve as simulation center faculty and to promote and practice these skills during their careers.

Critical Care Ultrasonography/Point-of-care Ultrasonography: The Division has become a national leader in this relatively young field, having applied the use of ultrasonography to the care of ICU patients since the early 1990’s. 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 3 day regional introductory course during their 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. 

MICU: Our 16-bed medical intensive care unit specializes in the care of medical critical illness. Led by Samuel Acquah, MD, the MICU features a team comprised of an array of health professionals committed to delivery of cutting-edge critical care. Our team consists of critical care faculty, critical care fellows, medicine and emergency medicine residents and interns, critical care nursing staff, physical therapists, respiratory therapists, nutritionists, and social workers. Critical care attendings provide in-house nighttime coverage of the MICU. 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.

Critical Care Consults: A senior pulmonary/critical care fellow provides support to the junior MICU fellow. This fellow is also responsible for critical care consults in the Neurosurgical ICU, Coronary Care Unit, Surgical ICU, Emergency room and floors under the supervision of a critical care attending. 

RCU/RRT/Airway: Our 12 bed respiratory care and medical step-down unit is primarily dedicated to the care of patients with respiratory diseases and slowly resolving critical illnesses who require extended periods of mechanical ventilation for acute and chronic respiratory failure. With a dedicated staff of respiratory therapists, nutritionists, physical therapists and pulmonologists, we offer high success rates in liberating patients from mechanical ventilation. Fellows are responsible for supervision of the medical residents under the supervision of a pulmonary attending. Additionally, the fellows perform their own intubations and airway management during rapid response team activations, including difficult airways.

Pulmonary consult service: A team of two pulmonary/critical care fellows work with a Pulmonary attending to evaluate and provide consultative care to a broad mix of patients with pulmonary diseases throughout the hospital. They are responsible for supervising elective residents and students. Fellows have the opportunity to perform thoracentesis, advanced pleural procedures including small and large bore chest tubes and pleurX catheter placement, bronchoscopy and EBUS.

Palliative Care: We are lucky to work closely with our palliative care team from the Hertzberg Palliative Care Institute. Fellows work closely with the palliative care team in the MICU to address the needs of our patients and families. First-year fellows also rotate with the Palliative Care Consult team to gain a stronger foundation in the principles and practices of Palliative Care medicine.

PFT Lab/Pulmonary physiology: The Beth Israel Pulmonary Function Laboratory is located on the 3rd floor of PACC. This state of the art facility is directed by a world leader and pioneer in lung function and cardiopulmonary exercise testing, Dr. Albert Miller. The lab offers a full-array of pulmonary function testing including airway responsiveness testing (methacholine & histamine challenges) and cardiopulmonary exercise testing. Fellows work closely with Dr. Miller and pulmonary attendings on dedicated PFT rotations to learn the principles of pulmonary physiology. They also participate in the care of patients enrolled in pulmonary rehabilitation, a specialized program that is geared toward improving the quality of life in patients with pulmonary disease by increasing exercise tolerance and reducing symptoms of dyspnea.

Pulmonary Hypertension Service: The Pulmonary hypertension program at Mount Sinai Beth Israel is among the largest in the United States. The Director, Dr. Roxana Sulica, is a national expert in the diagnosis and treatment of pulmonary vascular diseases and participates in many national, multi-center studies of new therapies for pulmonary hypertension. Second year fellows on this rotation evaluate and manage inpatients and outpatients with pulmonary vascular disease and perform right heart catheterizations under Dr. Sulica’s supervision.

Cystic Fibrosis Service: Fellows rotate with Drs. Patricia Walker and Maria Berdella, co-directors of the Cystic Fibrosis Center at Mount Sinai Beth Israel, in their second year. They evaluate and manage inpatients and outpatients with cystic fibrosis.

Sleep Rotation: Dr. Alfredo Astua is the Director of the Mount Sinai Beth Israel Sleep Center. The center offers comprehensive diagnostic and treatment services for all types of sleep disorders, including excessive daytime somnolence, snoring, obstructive sleep apnea (OSA), insomnia, narcolepsy, restless legs syndrome, central sleep apnea, and REM behavior disorder. The center is also very active in pre-surgical as well as pre-bariatric (weight loss) evaluation that patients need to undergo in order to have a safe and successful surgical experience. Fellows rotate with Dr. Astua during their second year and evaluate a wide range of patients with sleep disorders, get intensive didactic training in sleep physiology and learn how to interpret sleep studies.

Trauma/SICU Rotation: First-year fellows rotate for one month with the Trauma service and Surgical ICU at Mount Sinai St. Luke’s.

Neurology ICU:  First-year fellows rotate for one month with the Neuro critical care unit at Mount Sinai Hospital. Pulmonary/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 and ENT patients, meningitis, and patients with encephalitis.

Pulmonary Medicine Continuity Clinic: Located in the Phillips Ambulatory Care Center (PACC), outpatient consultation and care of the entire spectrum of pulmonary disease and sleep disorders is offered by a team of pulmonologists. Fellows have a weekly clinic where they see 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 experience: Fellows have several opportunities to work in pulmonary subspecialty clinics throughout their training. In addition to their required rotations in pulmonary vascular disease, cystic fibrosis and sleep, they also have the opportunity to see patients in our Venous Thromboembolism clinic, Lung Cancer Screening program, Thoracic Oncology program, and Cough clinic at NY Eye and Ear Infirmary at Mount Sinai.

Elective experiences: Fellows can do electives in point-of-care ultrasound, thoracic oncology, thoracic surgery, thoracic radiology, ENT, and smoking cessation.

Away elective experiences: Fellows can choose to complete an elective rotation on the non-tuberculous mycobacteria service at National Jewish. Fellows have also done away rotations for lung transplant and interventional pulmonary. 

Our fellows are deeply engaged in didactic learning that incorporates innovative educational techniques, including multidisciplinary learning, simulation and hands-on training. During your training, you will participate in a wide range of local, system-wide and national conferences:

On-site:

  • Introductory summer core curriculum in basic principles of pulmonary and critical care medicine
  • Weekly core lectures in pulmonary and critical care medicine
  • Weekly Pulmonary and Critical Care Medicine Grand Rounds
  • Weekly Chest Radiology 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
  • Pathology conference
  • ID – Pulmonary Joint case conference
  • Fellow quality improvement project in-progress conference
  • Research-in-progress conference
  • Point-of-care Ultrasound case conference
  • Simulation workshops on airways, code/RRT training and vascular access training

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: focused training on echocardiography, lung and pleural ultrasound, abdominal ultrasound, DVT studies and ultrasound for vascular access
  • New York State Thoracic Society Annual Meeting
  • Inter-city Fellows’ Symposium

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)