Medical Intensive Care Unit (MICU) at Mount Sinai Morningside and Mount Sinai West
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 residents, critical care nurses, 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 attending, including intubations, percutaneous tracheostomies, chest tubes, bronchoscopy, and point-of-care ultrasonography. Fellows work closely with the palliative care team to address the needs of our patients and families.

Critical Care Consult Service at Mount Sinai Morningside and Mount Sinai West
Our team consists of a faculty member, fellow, and resident who respond to all patients requiring urgent critical care including rapid response teams, 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 provides consultative care for patients in cardiac and surgical ICUs.

Night Intensivist Experience at Mount Sinai Morningside and Mount Sinai West
Fellows participate in this non-continuous experience gaining autonomy in the management of critically ill patients at night. While still under faculty oversight, this experience mimics “real-life” practice and builds confidence in the independent management of the ICU, critical care consultations, and critical care procedures.

Trauma/Surgical Intensive Care Unit (SICU) Rotation at Mount Sinai Morningside
First-year fellows rotate for one month with the Trauma Service and Surgical ICU at Mount Sinai Morningside.

Neurology Intensive Care Unit at Mount Sinai West
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.

Pulmonary Consult Service at Mount Sinai Morningside and Mount Sinai West
Pulmonary fellows and attendings provide consultative care to a broad mix of patients with pulmonary diseases throughout the two 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, indwelling pleural catheter placement, pleural biopsy, pleuroscopy), bronchoscopy, and endobronchial ultrasound.

Physiology at Mount Sinai Morningside and Mount Sinai West
Under the supervision of our faculty physiology experts, fellows oversee and interpret a full array of pulmonary function testing including airway responsiveness testing (methacholine and histamine challenges) and cardiopulmonary exercise testing. Both campuses perform state-of-the-art outpatient physiology testing.

Procedures at Mount Sinai Morningside and Mount Sinai West
In addition to procedures incorporated into ICU and pulmonary rotations, fellows have additional time to develop mastery-level learning of pulmonary procedures and gain experience in advanced pulmonary procedures with our interventional pulmonologist, as well as perform right heart catheterizations with our pulmonary hypertension team.

Advanced Lung Disease/Lung Transplant Service at The Mount Sinai Hospital
Fellows are exposed to a wide variety of advanced lung diseases, pre-transplant evaluation, post-transplant management clinical and procedural management, and the management of post-transplant complications.

Sleep Medicine at Mount Sinai-Union Square
Working within the Mount Sinai Integrative Sleep Center, fellows are broadly exposed to the spectrum of sleep disorders (including excessive daytime somnolence, snoring, obstructive sleep apnea, insomnia, narcolepsy, restless legs syndrome, central sleep apnea, and REM behavior disorder) and receive intensive didactic training in sleep physiology and polysomnogram interpretation. The Sleep Center is also very active in pre-surgical and pre-bariatric evaluations.

Pulmonary Subspecialty Experiences at Mount Sinai West, Mount Sinai Morningside, and Mount Sinai-Union Square
Fellows have the opportunity to work in pulmonary subspecialty clinics during this rotation, with specialized experience in the following programs: Venous Thromboembolism Clinic, Severe Asthma Clinic, Smoking Cessation Clinic, Thoracic Surgery Program, Pulmonary Hypertension and Interventional Pulmonary Program.

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.

In addition to our core rotations, we offer the following electives:

• Thoracic Radiology
• Anesthesiology
• Thoracic Surgery
• Thoracic Oncology
• Coronary Care Unit
• Cardiothoracic Intensive Care Unit
• Advanced Heart Failure/Cardiac Device Management
• Medical Simulation
• Offsite electives (non-tuberculous mycobacteria service at the Mount Sinai – National Jewish Health Respiratory Institute, lung transplant, interventional pulmonology)

Simulation-Based Medical Education
The Center for Advanced Medical Simulation, based at Mount Sinai West, is the first New York City-based simulation program to receive accreditation from the Society for Simulation in Healthcare. Established in 2007, it is a system-wide center for the education of residents, fellows, nurses, respiratory therapists, and faculty across several departments.

Pulmonary and Critical Care Medicine fellows with a career interest in medical simulation have the opportunity to complete a 9-12 month fellowship within the three-year fellowship structure. Simulation fellows work closely with faculty members to conduct education research, quality improvement, and patient safety studies.

Fellows participate in longitudinal simulation training, 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 Center for Advanced Medical Simulation 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 audio-visual equipment providing simulation specialists with ongoing data. Educators use this information to provide learners with real-time feedback and education during debriefing sessions.

Critical Care Ultrasonography/Point-of-Care Ultrasonography Education
Several Icahn Mount Sinai faculty members are recognized as national leaders in the growing field of critical care ultrasonography. Critically ill patients are routinely scanned using this safe, non-invasive imaging modality to determine the cause of shock, respiratory failure, intravascular volume status, and procedural guidance. Fellowship Director, Paru Patrawalla, MD (link to: https://profiles.mountsinai.org/paru-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 ultrasonography.

Fellows receive extensive training in point-of-care ultrasonography, beginning with a three-day regional introductory course during the first 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. We also train in advanced echocardiography and transesophageal echocardiography.

Clinician Educator Track
The fellowship program offers a specialized Clinician Educator Track to provide foundational education in the method and practices of teaching health care providers. The backbone of the Clinician Educator Track is the Teaching Scholars Curriculum, a one-year medical educator curriculum delivered in a hybrid model to accommodate the busy schedules of subspecialty fellows. In parallel and with close mentorship, scholars design, implement, and disseminate a medical education capstone project.

Additionally, Clinician Educator Track scholars:

• Utilize core Teaching Scholars Curriculum elements to conduct medical education scholarship
• Engage widely with members of the Mount Sinai Health System medical educator community
• Develop mentorship relationships with seasoned clinician educators
• Participate in focused teaching experiences
• Formulate an Educator Portfolio
• Obtain desired academic medicine position post-fellowship

Candidates for the Clinician Educator Track apply during their first or second year of fellowship. We encourage fellows to express interest for this track during the application process.

The Divisions of Pulmonary, Critical Care, and Sleep Medicine at Mount Sinai Morningside and Mount Sinai West provide ample opportunities for clinical, epidemiological, quality improvement, medical simulation, medical education, and basic science research. Our faculty and fellows are engaged in a broad range of investigations, with opportunities to collaborate with investigators throughout the Mount Sinai Health System.

During the first year of training, fellows meet with the Program Director to identify research and career interests and to establish a research mentor. Research projects are then integrated over three years with up to six months in dedicated research time during the third year. All fellows complete our quality improvement curriculum. This program provides a foundation in the science of quality improvement and the application of principles to improve quality, patient safety, and value in health care. Fellows develop and lead individual and group quality improvement projects in pulmonary or critical care.

Resources for research include institutional review board guidance and availability of statistical support, system-wide research symposia, and system-wide research education seminars. Fellows are encouraged to attend national meetings during all three years of their training and present their research at the American Thoracic Society, American College of Chest Physicians, and Society of Critical Care Medicine conferences.

During your training, you will participate in a wide range of on-site, system-wide, and national conferences. Academic half-day sessions provide a strong backbone to our conference structure and enables fellows to be protected from clinical responsibilities and focus on learning.

On-Site Conferences

• Introductory core lectures in basic principles of pulmonary and critical care medicine
• Academic half-day:
  • “Flipped classroom” discussion of advanced pulmonary and critical care medicine topics
  • Point-of-care ultrasound case conference
  • Physiology Conference
  • Pulmonary function testing/cardiopulmonary exercise testing review
  • Morbidity and Mortality Conference
  • Case-based clinical and procedural training in the Center for Advanced Medical Simulation
  • Longitudinal research methods and quality improvement curriculum
  • Longitudinal Humanism in Medicine curriculum
  • Leadership, communication, teaching skills, and health care finance workshops

• Tele-conferences
  • Pulmonary and Critical Care Medicine Grand Rounds
  • Chest Radiology Conference
  • Journal Club/Literature Review
  • Clinical-Radiologic-Pathology Conference
  • Research-in-Progress Conference

• Multidisciplinary ICU Quality Improvement conference
• Longitudinal Simulation workshops
  • Airways, code/rapid response team training, vascular access, bronchoscopy, and advanced pulmonary and critical care scenarios

System-wide Mount Sinai conferences

• Interstitial Lung Disease Conference
• Airways Disease Conference
• Critical Care Grand Rounds
• Multidisciplinary Thoracic Tumor Board

Local Conferences

• Mount Sinai Health System Simulation Day
  • First-year fellows receive focused training on bronchoscopy, airway training with direct and video laryngoscopy, thoracentesis, and pigtail chest tube placement.
• Regional Two-day Critical Care Ultrasound Course
  • First-year fellows receive focused training on echocardiography, lung and pleural ultrasound, abdominal ultrasound, deep vein thrombosis studies, and ultrasound for vascular access.
• New York State Thoracic Society Annual Meeting