Pulmonary and Critical Care Fellowship Curriculum

Cystic Fibrosis/Pulmonary Consult

This is a consult service for patients with cystic fibrosis and patients with pulmonary disease. Fellows will gain experience in the management of patients with cystic fibrosis exacerbations or complications of CF, including hemoptysis. Fellows will also see general pulmonary consultations for a wide spectrum of diseases, including interstitial lung disease, asthma and COPD.

Lung Transplant

The BSLMC Lung Transplant Program currently performs over 100 lung and heart-lung transplants per year. Fellows will be involved in evaluation of patients with end-stage lung disease prior to transplantation, immediate post-transplant management, inpatient management of transplant-related complications, and long-term outpatient care of transplant recipients. Fellows will have the opportunity to observe organ procurement and the transplant operation.

Medical Intensive Care Unit (MICU)

The BSMLC MICU service includes a multidisciplinary team led by a pulmonary/critical care or critical care faculty member. All patients housed in the MICU are managed by the MICU team. Fellows gain experience in the management of critically ill patients and also have the opportunity to gain procedural skills, including ultrasound skills and intubations.

Mobile Medical Intensive Care Unit (Mobile MICU)

The mobile MICU service assists with the management of unstable patients not located in the ICU (i.e. on the general floor or emergency room). Two fellows work on this service in a staggered shift model. Fellows will have the opportunity to gain procedural skills as well as have exposure to rapid response systems.

Coronary Care Unit (CCU)

Fellows will manage medical patients with cardiac disease, such as cardiogenic shock, myocardial ischemia, and other cardiac complications. Fellows will also spend time with echocardiography technicians to gain skills in cardiac ultrasound image acquisition and will also have formal training in echo interpretation. Additionally, fellows will gain exposure to mechanical circulatory support devices including IABP and Impella.

Cardiovascular Intensive Care Unit (CVICU)

Fellows will work with a multidisciplinary team led by a pulmonary/critical care or anesthesia critical care attending. The main focus will be care of the post-operative cardiovascular patient, particularly those who have undergone coronary artery bypass graft surgery and valve replacements. Fellows will also have exposure to patients undergoing minimally invasive surgery and endovascular interventional procedures and patients on ECMO. Fellows will also gain broader experience in ventilator management and liberation strategies.

LVAD and Transplant ICU

Fellows rotating on this service will gain experience caring for patients that have left ventricular assist devices (LVAD). They will become familiar with how the devices work and complications that may arise. Fellows will also care for patients that are immediately post heart, lung or heart-lung transplant. They will become familiar with early post-operative care of thoracic transplant recipients. Additionally, fellows will gain significant experience caring for patients on ECMO.

Pulmonary Consult

Fellows are responsible for all inpatient pulmonary consults and related procedures. A wide variety of disease processes are encountered such as asthma, COPD, interstitial lung disease, pulmonary vasculitis, HIV-related lung diseases, malignancies, tuberculosis and other infectious diseases. Fellows will gain extensive experience in bronchoscopy, EBUS, thoracentesis and chest tube insertion. Fellows are responsible for presenting relevant chest cases in a weekly thoracic multidisciplinary conference.

Pulmonary Consult Outpatient

Fellows will gain experience with outpatient pulmonary medicine care including biologics in asthma as well as interventional pulmonary. Procedure experience in this rotation includes all standard outpatient pulmonary procedures as well as complex airway disease and pleural disease. Fellows will also interpret pulmonary function tests and coordinate care for patients at the multidisciplinary thoracic tumor board.

Procedure

The Ben Taub procedure service fellow will be responsible for performing all daytime procedures for the MICU under the direct supervision of a faculty member. Procedures include bronchoscopy, central line placement, arterial line placement, pulmonary artery catheterization, chest tube insertion, thoracentesis, lumbar puncture, paracentesis and endotracheal intubation. 

Medical Intensive Care Unit (MICU)

The Ben Taub MICU is a 16-bed closed ICU. Two fellows rotate through the ICU each month in a staggered shift model. Fellows are responsible for overseeing the care of all ICU patients and providing guidance for a team of residents, interns, and students. Fellows will also perform and supervise procedures in the nighttime and on weekends, including bronchoscopy, central line placement, arterial line placement, and endotracheal intubations.

Neurosurgery 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. They will also assist with pulmonary procedures on neurosurgical patients, including bronchoscopy and thoracentesis.

Throughout the three years of fellowship, fellows will have general pulmonary continuity clinics, alternating locations between the Michael E. DeBakey VA Medical Center and Ben Taub Hospital. 

Each fellow will have a panel of patients that they will follow for three years. Fellows gain experience with outpatient management of patients with COPD, asthma, lung cancer, interstitial lung disease, pulmonary hypertension, lung nodules/masses, bronchiectasis and pulmonary infections such as tuberculosis.

Pulmonary Consult

Fellows on the pulmonary consult service are responsible for pulmonary inpatient and urgent outpatient consults. Fellows will be exposed to a variety of pulmonary disease, including COPD, interstitial lung disease, pleural disease, and lung cancer. Fellows will gain skills in procedures such as bronchoscopy, tube thoracotomy, and insertion of indwelling pleural catheters. Fellows are also responsible for presenting relevant chest cases in a weekly thoracic multidisciplinary conference.

Interventional Pulmonary

Fellows will evaluate and treat patients with complex pleural and airway disease under the supervision of interventional pulmonology trained faculty. Fellows function as the sole trainee on the service, gaining extensive hands-on experience with advanced diagnostic and therapeutic bronchoscopy, EBUS, and pleural procedures including thoracentesis, chest tube placement, pleuroscopy and tunnelled indwelling pleural catheters.

Pulmonary Function Test (PFT)

Fellows will be responsible for interpreting all pulmonary function tests and cardiopulmonary exercise tests performed at the MEDVAMC. Fellows may also spend time on this rotation on research projects.

Sleep Medicine

Fellows rotating on this service will be responsible for the inpatient and outpatient evaluation of patients with sleep disorders. Fellows will also gain experience in interpreting sleep studies.

Medical Intensive Care Unit (MICU)

The MEDVAMC MICU is a 16-bed closed unit (sharing beds with the Coronary Care Unit). Two fellows rotate through the ICU each month in a staggered shift model. Fellows are responsible for overseeing care of all ICU patients and providing guidance for a team of residents, interns and students. Fellows will also perform and supervise procedures including bronchoscopy, central line placement, arterial line placement, and endotracheal intubations.

Anesthesia

Fellows on the anesthesia rotation will practice airway management in the operating room under the supervision of anesthesiologists. Fellows may also spend time on this rotation on research and scholarly projects.

Ambulatory Rotation

This rotation will be focused on outpatient pulmonary experience. Fellows will rotate through multiple specialized outpatient pulmonary clinics, including tele-pulmonary rehab, pulmonary hypertension clinic, pulmonary nodule clinic, and neuromuscular disease clinic. Fellows will also have time to work on research projects.

Faculty from the Section as well as guest faculty from BCM present on core topics in pulmonary and critical care. Lecture topics generally follow the blueprint for pulmonary and critical care boards.

Fellows learn to formulate a differential diagnosis and approach to common and uncommon manifestations of pulmonary disease. Fellows collect and present a variety of pulmonary and critical care cases with interesting radiographic findings. Faculty give a brief discussion on important clinical and radiographic points for each case. 

Fellows critically review research articles from major pulmonary, critical care, sleep journals, and key general medicine journals. Fellows learn principles of evidence-based medicine, statistical analysis, and critical appraisal of the literature with the guidance of a faculty member.

Held monthly, fellows present cases from the individual training sites that resulted in morbidity or mortality. Using quality improvement tools such as fishbone diagrams, fellows will identify errors and deficiencies.

A fellow-led and faculty-supervised conference that assists incoming PCCM fellows in learning the basics of commonly encountered pulmonary concerns - both inpatient and outpatient. This series is geared specifically for first-year PCCM fellows at the beginning of their fellowship training.

Faculty lead this conference series for both critical care medicine and pulmonary medicine to review various topics using board style questions to frame the talks.  

This combined day-long boot camp is organized by MD Anderson Cancer Center, UT Health Science Center at Houston, and Baylor College of Medicine. Fellows who attend join from Baylor, UT Houston, UT Galveston, and Tulane participate annually. The workshop combines online didactic lectures and hands-on workshops teaching bronchoscopy with biopsy, thoracentesis, indwelling pleural catheter placement, chest tube insertion, percutaneous tracheostomy, and central line placement.

The course is taught by pulmonary and critical care and anesthesia faculty. The approach to difficult airway management is introduced using simulated clinical scenarios and hands-on stations.

The mechanical ventilation course combines didactics with case-based, small group sessions. Attendees learn about new and advanced modes of mechanical ventilation and how to troubleshoot common problems encountered in patients on mechanical ventilation.

The Pulmonary and Critical Care Fellowship offers a formal ultrasound curriculum to teach fellows how to perform point-of-care ultrasound and how to interpret ultrasound images. This curriculum includes a series of lectures given by ultrasound-trained faculty; online resources including articles, books, and images/videos; and one-on-one training with faculty. Fellows will also gain experience with performing echocardiograms and echo interpretation during their CCU rotation.