As a fellow, you will engage in a rigorous three-year program that combines experiential learning in a university hospital setting and outpatient clinic with teaching and research. You will serve rotations on the pulmonary consult service, the Medical Intensive Care Unit (MICU), the Cardiac Intensive Care Unit (CICU), the Trauma/Surgical Intensive Care Unit (SICU), the renal service, in the ambulatory/rehabilitation clinic, on research or elective service in the allergy and sleep clinics.

The pulmonary and critical care fellowship program meets the requirements for residency education in pulmonary disease and critical care medicine established by the Accreditation Council for Graduate Medical Education (ACGME). Click here to apply for the fellowship program.

For more information about working as a resident of Pitt County Memorial Hospital, visit the Graduate Medical Education website.

Inpatient and emergent consultation for pulmonary diseases and related problems is a major portion of clinical pulmonary medicine, as is management of patients with medical illness requiring admission to the MICU, CICU, and SICU. Ambulatory clinic experience provides fellows with exposure to a variety of pulmonary disorders encountered in that setting and the opportunity to gain experience in long-term patient management.

Fellows conduct daily rounds with the attending on the consult service and the MICU, CICU, and SICU services. Fellows work with an attending in the pulmonary clinic one afternoon per week and in four other clinics during the ambulatory rotation.

CONSULT: Fellows on the consult rotation work under the supervision of the pulmonary consult attending. The fellow provides consultation on all inpatient services upon request. The fellow has the opportunity to be the first person to see pulmonary consultations. Fellows have the option of supervising the medical resident or student while on the consult rotation. After performing a complete history and physical exam, he does a pertinent write-up and presents the patient to the attending physician for discussion, interpretation of pertinent data, and formulation of differential diagnosis and management plans. Recommendations are communicated to the primary service.

MICU: Under the supervision of the medical critical care attending, the fellow is part of a team providing assessment, management, and follow-up of critically ill medical patients. As members of the MICU team, fellows work in a collaborative manner with interns, residents and medical attendings. The team works in a coordinated fashion with all consulting physicians/services, nutritional support services, physical therapy, occupational therapy, radiology, laboratory, and chaplain and patient representative services.

CICU: The fellow on CICU rotation works under the supervision of the cardiology attending. The fellow will be part of a team providing assessment, management, and follow-up of critically ill cardiac patients.  As a member of the CICU team, the fellow will work in a collaborative manner with cardiology interns, residents, cardiology attendings, nursing, pharmacy, respiratory therapy, and the nutritional services. The fellow will do this rotation during the third year of the pulmonary and critical care training program.  He or she will have 2 years of experience including rotations in the medical intensive care unit and pulmonary consult service.

SICU: While on SICU rotation, the fellow works under the supervision of the surgical/trauma critical care attending. The fellow will be part of a team providing assessment, management, and follow-up of critically ill trauma surgery patients.  As a member of the SICU team, the fellow works in a collaborative manner with surgical interns, residents, surgical attendings, nursing, pharmacy, respiratory therapy, and the nutritional services. The fellow will do this rotation during the third year of the pulmonary and critical care training program.  He or she will have 2 years of experience including rotations in the medical intensive care unit and pulmonary consult service.

CLINIC:  Fellows attend a continuity clinic a half day each week throughout the year. Patients may be seen for an acute consult as well as for long-term management. The clinic also provides an opportunity to follow up patients seen in the hospital.  Additional ambulatory experience takes place during the ambulatory rotations. During this month the fellow spends two to three half days in the sleep clinic, attends photodynamic therapy clinic, thoracic oncology clinic, allergy clinic, and is available to see patients in the pulmonary clinic. For more information on our outpatient clinic, click here.

PROCEDURES: All procedures are done under the direct supervision of the attending unless he or she has been certified to perform the procedure without supervision. The key procedures for pulmonary fellows are:

• Oral/nasal intubation
• Thoracentesis and pleural biopsy
• Central venous line placement
• Placement of arterial and pulmonary artery catheter
• Progressive exercise testing
• Fiberoptic bronchoscopy and accompanying procedure
• Insertion and management of chest tubes
• Ventilatory support, weaning, and respiratory care techniques
• Hemodynamic monitoring techniques
• Vasopressor and inotropic support management
• Basic and advanced cardiopulmonary resuscitatio
• Transvenous pacemaker insertion and management

The pulmonary and critical care division holds weekly conferences, which both the fellows and supervising faculty attend. Fellows present at two journal clubs a year, present two to three grand rounds a year, give monthly lectures to third-year medical students rotating on the internal medicine service, and present at four to five multidisciplinary conferences during the year. During the second year of training, they prepare at least one research conference presentation.

The pulmonary and critical care program also provides a lecture series in important topics in pulmonary and critical care to internal medicine residents rotating through both the MICU and pulmonary services, as well as give medical grand rounds and housestaff noon conference, and attend morning report.

PULMONARY/CRITICAL CARE CONFERENCES AND LECTURES

• Case Conference: Case-based topic and review of pertinent literature presented by a pulmonary/critical care faculty member or fellow. The second half of the conference is devoted to presenting interesting cases or difficult issues in diagnosing or managing current patients.
• Thoracic Oncology Conference: Patients with thoracic malignancy are presented, pathology is reviewed and further diagnostic evaluation and management are discussed.
• Journal Club: Recent journal article is chosen by the presenting fellow or attending and critically reviewed.
• Research-in-Progress Conference: Pulmonary/Critical Care faculty and fellows present research proposals and data from ongoing projects at a monthly research conference. Faculty with related interests from outside the section are invited to present as well.
• Rad-Path Case Conference: Monthly conference in coordination with Radiologists to discuss cases.
• Pulmonary Grand Rounds: Pulmonary/critical care faculty, private pulmonary doctors, and outside speakers cover topics that include asthma, pneumonia, respiratory failure, ventilator management, hemodynamics, pulmonary hypertension, nutrition, nosocomial ICU infections, pulmonary embolism, dialysis, electrolyte disorders, and acid-base abnormalities.
• Family Medicine Lecture Series: Fellows will attend research lectures given throughout the year by the Family Medicine faculty.

Participation in research projects improves the fellow's knowledge of study design and interpreting scientific data. This also allows the fellow to focus and become more expert in a particular area of interest. After this rotation, the fellow will be able to critically review scientific literature, develop a hypothesis-driven research project, and interpret and report scientific results.

To accomplish this, the fellow identifies a faculty mentor who works with him on a research project of his own design. The fellow devotes a six-month period of time to this research and completes the project during the second year of the training program. Fellows will also attend the Department of Internal Medicine monthly conference on designing clinical research.

The fellow presents his findings at section conference and submits an abstract to the Department of Research Medicine. Submission of abstracts to national meetings is encouraged.