Pulmonary and critical care fellows will rotate through various pulmonary, critical care, and combined pulmonary/critical care rotations. They will spend approximately equal time at three different training sites, including Ben Taub Hospital, the Michael E. DeBakey VA Medical Center, and CHI Baylor St. Luke's Medical Center.
Baylor St. Luke's Medical Center
Cystic Fibrosis/Pulmonary Consult Service
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 Service
The BSLMC Lung Transplant Program currently performs 35-40 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.
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.
Ben Taub Hospital
Pulmonary Consult Service
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.
Procedure Service
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, and endotracheal intubation. The procedure fellow will also interpret all pulmonary function tests and cardiopulmonary exercise tests performed at Ben Taub.
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.
Continuity Clinic
Throughout the three years of fellowship, fellows will have general pulmonary continuity clinics, alternating locations between the Michael E. DeBakey VA Medical Center and Harris Health System, Smith Clinic.
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, interstitial lung disease, pulmonary hypertension, lung nodules/masses, and pulmonary infections such as tuberculosis.
Michael E. DeBakey VA Medical Center
Pulmonary Consult Service
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 and thoracentesis. Fellows are also responsible for presenting relevant chest cases in a weekly thoracic multidisciplinary conference.
Interventional Pulmonary Service
Fellows will evaluate and treat patients with pleural and complex airway disease under the supervision of interventional pulmonology-trained faculty. They will be trained in diagnostic chest ultrasound and advanced bronchoscopy. In addition, they will gain extensive experience with procedures such as thoracentesis, percutaneous tracheostomy, chest tube placement, and management pleural catheters. Fellows will also gain considerable experience with EBUS-guided transbronchial needle aspiration.
Pulmonary Function Test (PFT) Service/Research
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 Service
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/Research
Fellows on the anesthesia rotation will practice airway management in the operating room under the supervision of anesthesiologists. Fellows on the research rotation will work on research 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, and neuromuscular disease clinic. Fellows will also have time to work on research projects.
