The curriculum has been shaped over the years to fit the growing needs of the specialties and the dynamic changes in the healthcare sector. Besides the traditional essential service lines of pulmonary consult service, critical care consult service and ICU service, our fellows rotate through many specialties as a part of their curriculum.
ORIENTATION
All rotations in the first two months for first year fellows are with a senior fellows and while on call, they will have a backup senior fellow available to call or come in to help. This is on top of an attending in house 24 hours a day throughout the year.
The first two-month didactic schedule is catered for the first year fellows to help them build a basic fund of knowledge as they start their fellowship and this includes the core pulmonary and critical care topics that they would be seeing frequently during their training.
Our core rotations include
- Pulmonary Consult:
The pulmonary consult rotation is a dedicated rotation with a fellow and an attending along with rotating residents and medical students as well. The fellows see inpatient pulmonary consults and provide longitudinal care throughout the patient’s hospital course. The fellows also become proficient in routine pulmonary procedure including but not limited to thoracentesis, pigtail and PleurX catheter placement, surgical chest tube placement and bronchoscopies including interventional procedures as well. Fellows gain competency in clinical knowledge, management skills, and procedural skills through the course of the three years. They form plans of care, manage the patients on a daily basis under the supervision of faculty and also ensure communication of goals and plans with the primary team as well.
- Medical ICU:
The fellows perform a supervisory role with the rotating residents in the ICU and round with the team along with faculty and ensures the smooth running of the ICU. The daily rounds and subsequent admitting of new patients through the course of the day ensures an adequate supervised training encompassing a wide variety of critical care medicine pathologies including but not limited to shock, respiratory failure, ARDS, PE, upper and lower GI bleeds, liver failure, hematological/oncological emergencies, toxic and metabolic disorders, and renal disorders. Throughout the months in the ICU, they become more competent and confident in their critical care management skills including procedures as well. The fellows are also given adequate autonomy to be competent in handling a full-fledged ICU, not only with regards to the medical aspect of it but also about the logistics and administrative side of running an ICU.
Other ICUs that the fellows rotate in include
- Cardiothoracic ICU
Fellows rotate with the cardiothoracic surgery team and take part in daily activities and are able to be an integral part of the post-operative management team and follow the patients to discharge.
- Surgical ICU
The surgical ICU receives patients from general surgery, trauma service and other surgical services including GI surgery and neurosurgery.
- Critical Care Consult:
The fellow rotates closely with a dedicated critical care faculty and are seen as the ‘first responders’, be it on the floor or the emergency room, when a critical care consult is called. The fellow forms the initial impression of the patient and triages the patient with respect to their disposition and continues to provide advanced critical care services to ensure patient stability and communicates the plan with the consulting team. The fellow also learns prioritization of his/her caseload of consults and effectively learning one of the key components of being an intensivist. This rotation also aims to develop critical care thinking and skills and build a confident physician who will be able to manage and face any challenges put across their way.
Other rotations include
- PFT laboratory
- Anesthesia
- Radiology and interventional radiology
- Sleep medicine
- Trauma
- Pulmonary Rehabilitation
