PULMONARY, CRITICAL CARE AND SLEEP MEDICINE FELLOWSHIP PROGRAM

 PROGRAM NARRATIVE DESCRIPTION

 The Pulmonary and Critical Care Medicine Fellowship Program at Creighton University Medical Center is a three-year training program accredited by the Accreditation Council for Graduate Medical Education (ACGME) leading to board certification in pulmonary medicine and critical care medicine by the American Board of Internal Medicine.  Applicants are required to have completed three years of internal medicine residency in an ACGME-accredited program and must pass the 3-part United States Medical Licensing Exam (USMLE).  Eligible applicants are interviewed and matched in the program through the National Residency Match Program (one new fellow per academic year; two new fellows every three years).  The fellowship is designed to educate fellows in a scholarly academic environment in all aspects of pulmonary disease processes and procedures, as well as critical care medicine, as specified in the Program Requirements of the ACGME.  Fellows will receive instruction in the basic sciences with particular emphasis on molecular biology, pulmonary physiology, and pulmonary immunology and they will obtain competencies in patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.  Fellows will rotate between Creighton University Medical Center, The Veterans Administration Medical Center, and Bergan Mercy Hospital under the supervision of Creighton University affiliated faculty members.

Pulmonary Inpatient

Fellows will rotate on the inpatient services of Creighton University Medical Center, The Veterans Administration Medical Center, and Bergan Mercy Hospital as pulmonary consultants under the direct supervision of an attending physician for a minimum of 6 months.  Fellows will acquire knowledge of and have clinical experience with a broad spectrum of pulmonary diseases including obstructive lung diseases, pulmonary malignancies, pulmonary infections, interstitial lung disease, pulmonary vascular disease, occupational and environmental lung diseases, iatrogenic respiratory diseases, acute lung injury, pulmonary manifestations of systemic diseases, respiratory failure, disorders of the pleura and the mediastinum, genetic and developmental disorders of the respiratory system, and sleep disorders.  Fellows will develop skills in providing consultation services communicating with referring physicians and other members of the healthcare team, and ensuring support for continuous care by the patient’s primary physician.  Fellows will observe and perform diagnostic and therapeutic procedures including thoracentesis, pleural biopsy, flexible fiberoptic bronchoscopy, and other related procedures.  In addition, fellows will supervise residents and students rotating on the service and will lead daily teaching rounds under the supervision of an attending physician.  Attending physicians will conduct didactic teaching sessions throughout the rotation.

Intensive Care Unit

Fellows will rotate in the Intensive Care Unit for at least 12 months where they will manage adult patients with a wide variety of serious illnesses and injuries.  Fellows will acquire knowledge of and competence in establishment and maintenance of open airway in nonintubated, unconscious, paralyzed patients; pressure-cycled, volume-cycled, time-cycle, and flow-cycled mechanical ventilation; use of reservoir masks and continuous positive airway pressure masks for delivery of supplemental oxygen, humidifiers, nebulizers, and incentive spirometry; weaning and respiratory care techniques; management of pneumothorax (needle insertion and drainage systems); maintenance of circulation (arterial puncture and blood sampling; insertion of central venous, arterial, and pulmonary artery balloon flotation catheters; basic and advanced cardiopulmonary resuscitation; cardioversion); pulmonary function tests to assess respiratory mechanics, gas exchange, and respiratory drive, including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis, and exercise studies; diagnostic and therapeutic procedures, including thoracentesis, pleural biopsy, flexible fiberoptic bronchoscopy, and related procedures; calibration and operation of hemodynamic recording systems; ventilator support, weaning, and respiratory care techniques; examination and interpretation of sputum, bronchopulmonary secretions, pleural fluid/tissue, and lung tissue for infectious agents, cytology, and histopathology.  Fellows will also gain knowledge of the ethical, economic, psychosocial, and legal aspects of critical illnesses. Fellows will develop skills in rounding and communicating with a multidisciplinary team of physicians, other members of the healthcare team, and patient family members, under the supervision of an attending physician.

Continuity Clinic

Fellows will see outpatients at either the Creighton University Medical Center Pulmonary Outpatient Clinic or Veterans Administration Medical Center Pulmonary Clinic one-half day per week under the supervision of a faculty member for at least 30 months during the 3-year fellowship.  Fellows will develop skills in providing consultation services communicating with referring physicians and other members of the healthcare team, and ensuring support for continuous care by the patient’s primary physician.

Electives

Fellows will rotate for one month in the Pulmonary Function Lab/Respiratory, Radiology, Pathology, Allergy and Immunology, and Sleep Medicine under the direct supervision of an attending physician.

During the Pulmonary Function Lab/Respiratory rotation, fellows will learn to assess respiratory mechanics, gas exchange, and respiratory drive, including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis, inhalational studies, and exercise studies.

During the Radiology rotation fellows will acquire knowledge and ability to interpret imaging procedures such as chest roentgenograms, computed axial tomograms, radionuclide scans, pulmonary angiograms, and other radiologic procedures.

During the Pathology rotation fellows will acquire knowledge and ability to examine and interpret sputum, bronchopulmonary secretions, pleural fluid/tissue, and lung tissue for infectious agents; cytology; and histopathology.

During the Allergy and Immunology rotation fellows will become more familiar with the clinical and diagnostic aspects of asthma and allergic lung disorders.  Fellows will participate in clinics, conferences, and journal clubs.

During the Sleep Medicine rotation fellows will acquire knowledge and skills in the diagnostic testing and treatment of sleep disorders including insomnia, sleep apnea, restless legs syndrome, snoring, and narcolepsy.

Research and Scholarly Activities

Fellows will choose a mentor to provide a meaningful, supervised research experience with appropriate protected time to learn the design and interpretation of research studies, responsible use of informed consent, and research methodology and interpretation of data.  Fellows will actively participate in publication of peer-reviewed articles resulting from their research.  Fellows will be encouraged to submit abstracts for presentation at national meetings.  Fellows will attend research design and statistics course.

Conferences

Clinical Case Conference

Fellows will attend and give presentations at clinical case conference twice a month at Creighton University Medical Center.

Journal Club

Fellows will attend and give journal club twice a month; one at Creighton University Medical Center and one at Bergan Mercy Hospital.

Core Curriculum Conference

Fellows will attend and give presentations at core curriculum conference once a month.

Research Conference

Fellows will attend monthly Department of Medicine research conference.

Ethics Conference

Fellows will attend monthly Department of Medicine ethics conference.

Evaluations

Fellows will receive verbal and/or written feedback from attending physicians during each rotation.  Fellows will meet with the program director and division chief twice a year.  Fellows will evaluate attendings and rotations anonymously at the end of each rotation.

Applications for Fellowship

Applications for Pulmonary and Critical Care Fellowship are accepted through the online ERAS program at: http://www.aamc.org/audienceeras.htm. For more information or questions, please contact Margie Galkowski via e-mail (margie@creighton.edu) or by phone at (402) 449-4487.

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Updated Jan 2005