Curriculum

The first year of PCCM fellowship training is dedicated to learning the fundamentals of complex pulmonary diseases, physiology (including exercise testing), sleep medicine, acquiring skills in various PCCM procedures, sonogram training, focusing on fundamentals of critical care medicine and bronchoscopy. Year 2 of fellowship training is focused on further developing advanced clinical and procedural skills in PCCM, while initiating research projects and developing leadership abilities.Towards the latter half of the 2nd year and going into the 3rd year, the fellows are allotted a protected block of research time to develop investigative skills, with training in research methodology and academic leadership training. This protected research time of around 48-52 weeks in entire fellowship is dedicated to scholarly activity in research projects involving medical education, quality improvement, clinical medicine/trials or basic or translational 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: 

  • Medical Knowledge
  • Patient Care
  • Practice Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism

PCCM CURRICULUM

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 “core faculty”, 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 a 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 but not limited to: 

  • 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 access to UpToDate.
  • Weekly PCCSM topics during core didactics, including monthly sessions in the sim lab and longitudinal sonogram skills training.
  • Board Review curriculum (including sleep medicine and pathology review).
  • A schedule of divisional and external weekly conferences emailed to all faculty and fellows.
  • Annual travel fund to attend professional society conferences for CME.

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 core faculty. 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. 

Our curriculum is a 36-month training program in pulmonary diseases and critical care medicine which includes 12 months of protected research time. Opportunities for rotating through other sites within the Mount Sinai Health System (MSHS) are also available. Didactics in core topics within pulmonary diseases and critical care medicine are supplemented by multiple educational conferences every day of the week.

We believe that our fellowship program provides a unique combination of a rigorous training lead by an outstanding group of faculty who at the same time create a supportive and open atmosphere for mentoring them into future leaders. While our fellows work hard, they also enjoy an exceptional work life balance. We prioritize their educational experience, while ensuring world class clinical and research training.

Our fellows have perfected the science of working hard and playing hard. Their social events besides holiday and graduation parties include travelling together for conferences and courses. They are an adventurous bunch and enjoy hiking and sailing adventures. The fellows celebrate each other’s birthdays and other important milestones together and have running, biking, and baking clubs.

Pulmonary Consult Rotation: The designated fellows along with the assigned pulmonary consult service faculty of the week provide inpatient pulmonary consultative services and procedures 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, lung cancer, interstitial lung diseases, pulmonary hypertension and sarcoidosis. 

Bronchoscopy Rotation: The designated fellow works closely with interventional pulmonology experts in learning the fundamentals of bronchoscopy and more advanced procedures including endobronchial ultrasound, balloon dilation, stent insertion and cryotherapy. In addition, pleural procedures such as biopsies, pleuroscopy, medical chest tubes and indwelling catheter placement 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 post-covid survivor care, difficult asthma, severe COPD, pulmonary nodules, lung cancer, pulmonary hypertension, sleep disordered breathing, bronchiectasis, lung nodule management, and interstitial lung diseases including sarcoidosis. 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 while being supervised by dedicated assigned precepting core faculty. 

Sarcoidosis Clinic: Through the outpatient Sarcoidosis clinic, senior fellows learn the art and science of diagnosis & management of complex manifestations of this pleomorphic disease. Physiology Rotation: Fellows learns the fundamentals of performing & interpreting pulmonary function tests, methacholine challenge tests and cardiopulmonary exercise testing under the direction of dedicated physiology faculty. 

Sleep Rotation: During physiology rotation several hours of the week are spent with the Sleep Medicine faculty learning the basic of sleep medicine, sleep disordered breathing, chr respiratory failure, reading sleep studies and attending out-patient sleep clinic.

Transplant Rotation: A designated fellow rotates with the Lung Transplant team, both in the in-patient and outpatient setting, including performing procedures and traveling for donor runs with the organ retrieval surgeon.

Critical Care Rotations

MICU Rotation: Two fellows supervise a team of medical residents, interns and APPs under the guidance of one MICU attending of the week to manage the care of 16 critically ill patients in the medical ICU (including ECMO). 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. 

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 post-op care (includes solid organ transplant recipients). 

Non-medical Intensive Care Unit Rotation: Every fellow gets an opportunity to rotate through other non-medical ICUs such as Neurosurgical ICU and cardio-thoracic ICU to gain exposure to neurosurgical and cardiothoracic surgical patients.

Multi-Disciplinary ILD Conference
Every Monday. 10-12 pre-determined ILD cases are discussed by having their clinical history presented in a multidisciplinary forum with chest radiologist, rheumatologist and lung pathologist to discuss the outpatient/inpatient ILD cases with clinical-radiologic-pathologic correlation.

Journal Club
Two Mondays a month. All available faculty and fellows attend Journal club (hybrid). Pre-assigned research faculty as preceptors facilitate the conversation focusing on methodology and basic statistics. A designated fellow meets with their preceptor in advance to review either a pulmonary or critical care or sleep medicine article (co-chosen by the fellow and mentor) prior to this discussion.

Case Conference
Two Mondays a month. Detailed 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 review.

Fellows Core Critical Care and Pulmonary Lecture Series
Every Tuesday. Lectures include core curriculum related pulmonary medicine, critical care medicine, QI and sleep medicine topics. This includes sessions in the Sim Lab and a longitudinal sonogram curriculum.

Thoracic Oncology Conference
Every Wednesday. The thoracic surgery fellow reviews all the recent surgical cases with a focus on interdisciplinary discussion regarding pulmonary tumors at “tumor board”.

Radiology Conference
Every Thursday. This conference is designed to review interesting CXRs, Chest CTs, and to discuss management of challenging cases on in-patient consult and MICU services. While it is expected that fellows on pulmonary consult service present cases, these may also come from bronchoscopy service, chest/sarcoidosis clinic, or ICU. Pulmonary and ICU faculty also sometimes bring cases to be presented.

Grand Rounds
Every Friday. Fellows, faculty members, visiting national and international guest speakers present various clinical and research topics.