Pulmonary and Critical Care Fellowship Curriculum
Fellows rotate through a variety of clinical settings including private (St. Luke’s Episcopal Hospital (SLEH) and the Methodist Hospital (TMH) and public (Ben Taub Hospital (BTH) and Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) hospitals.
One to two fellows rotate on pulmonary inpatient services at each of the hospitals.
General Pulmonary Consult Service:
BTH: Fellows are responsible for all pulmonary consults and related procedures. They are also responsible for direction and interpretation of pulmonary function tests including cardiopulmonary exercise tests. A wide variety of disease processes are encountered such as HIV-related diseases, malignancies, tuberculosis, and other infectious diseases. Fellows are responsible for presenting relevant chest cases in a bi-monthly thoracic multidisciplinary conference.
MEDVAMC: Fellows are responsible for inpatient and urgent outpatient consults. Numerous procedures are performed daily, especially diagnostic bronchoscopy utilizing TBNA and EBUS. Fellows are responsible for presenting relevant chest cases in a weekly thoracic multidisciplinary conference.
Cystic Fibrosis: The Adult Cystic Fibrosis Center at TMH is a tertiary referral center serving a large portion of southeast Texas. Fellows rotating on this service will evaluate and treat patients with cystic fibrosis and bronchiectasis, both in an outpatient and inpatient setting.
Pulmonary Hypertension: Fellows rotating on the pulmonary hypertension service will gain experience in diagnosing and treating patients with primary and secondary pulmonary hypertension. Fellows will have the opportunity to perform diagnostic right heart catheterizations and become familiar with novel therapies for this disease.
Lung Transplant: Fellows will be involved in transplant evaluation, inpatient management of transplant-related complications, immediate post-transplant management, and long-term outpatient care of transplant recipients. Fellows will have the opportunity to observe organ harvest and transplant in the operative suite.
Interventional Pulmonary: On this service, fellows will evaluate and treat patients with pleural and complex airway disease. They will be trained in diagnostic chest ultrasound. In addition, they will become familiar with various procedures such as thoracentesis, percutaneous tracheotomy, chest tube placement, and management of tunneled pleural catheters. In addition, the fellows will obtain experience with rigid bronchoscopy and VATS.
Critical Care Rotations
Medical Intensive Care Unit (MICU): Fellows will rotate through the MICU at both the BTGH and MEDVAMC. The BTGH MICU is a 24-bed closed unit, and the MEDVAMC MICU is a 16-bed closed unit (both units share beds with the Coronary Care Unit). Fellows are responsible for overseeing care of the ICU patients and providing guidance for a team of residents, interns, and students. Fellows will also perform and supervise procedures, including bronchosopy, central line and arterial line placement, Swan-Ganz catheterization, and endotracheal intubations.
St. Luke’s Episcopal Hospital Pulmonary and Critical Care Consults: On this rotation, fellows will work with a busy group of six pulmonary and critical care consultants. The main focus will be care of the post-operative patient, particularly those who have undergone coronary artery bypass graft surgery and valve replacements. Fellows will also gain broader experience in ventilator management and weaning.
Neurosurgical Intensive Care Unit (NICU): Fellows will round with the neurosurgical team in the Ben Taub NICU. They will learn about common neurosurgical injuries, such as intracranial hemorrhages, masses, and infections. Fellows will gain experience with intracranial pressure monitoring and ventilator management of the neurosurgical patient.
Kindred Hospital: Kindred Hospital is a 110-bed long-term acute care facility. The main focus of this rotation will be management and weaning of the patient on prolonged mechanical ventilation. Fellows will also learn about pulmonary rehabilitation and PICC line placement.
In the first year, pulmonary and critical care fellows will rotate in two-month blocks through a variety of clinics, including: asthma, sleep disorders, occupational health, tuberculosis, and general pulmonary clinics. In addition, fellows on rotations such as lung transplantation, cystic fibrosis, and pulmonary hypertension will also attend these specialty clinics at least once a week. In the last two years, fellows will have a general pulmonary continuity clinic located at either the VA or BTGH, where they will see their own panel of patients.
All fellows are required to participate in a research project. They may spend two years dedicated to research through the institutional T-32 training grant (tracks) or spend part of their third year conducting research. A wide range of research opportunities are available both within the Department of Pulmonary and Critical Care and in other departments at BCM.
In addition, all fellows are encouraged to maintain proficiency by keeping abreast of current pulmonary, critical care, and sleep medicine literature. A list of recommended articles is published by the American Thoracic Society.