The first year of the fellowship is primarily a clinical year during which the fellows gain experience with a wide variety of patients in inpatient (both ICU and non-ICU) and outpatient settings, develop proficiency in the performance and appropriate utilization of various procedures, and develop proficiency in the utilization and interpretation of pulmonary function and exercise testing.
Throughout the year, emphasis is placed on developing: 1) an understanding of basic mechanisms and pathophysiology of respiratory disease and critical illness; 2) the ability to efficiently formulate clinical assessments and therapeutic plans; 3) the ability to critically analyze the relevant medical literature; and 4) skills in teaching medical students and house staff.
The first year fellow spends the year rotating among eight different services:
Pulmonary Consultation Service at University Hospital (10 weeks)
The consult fellow evaluates patients directly or supervises students and house staff in consultations throughout the University Hospital. After initial evaluation, all patients are discussed in detail with a member of the attending staff. Concurrent care is provided as required on all patients seen by the consultation service. The consultation service is also responsible for following all inpatients. Approximately 50-70 new consultations are performed per month.
Critical Care Medicine Unit (Medical ICU) at University Hospital (14 weeks)
This service is responsible for all patients under the care of the Department of Internal Medicine who require critical care and are not candidates for the Cardiovascular Intensive Care Unit. In this 20-bed unit, care is provided by two teams, each consisting of a divisional faculty member and fellow, four house officers and fourth year medical students. The attending physician leads both patient care rounds and didactic teaching rounds daily with house staff and fellows. In addition to his or her clinical supervisory role, the fellow is also responsible for performing and/or supervising invasive procedures in the Unit, including bronchoscopy, endotracheal intubation, thoracostomy placement, etc. The fellow will gain extensive experience with a variety of ventilators and monitoring techniques during this rotation. The fellow will actively collaborate with the nursing staff to ensure optimal and efficient patient care throughout, and will also have the opportunity to evaluate patients who might be candidates for various ongoing clinical studies. Fellows share call responsibilities during the day, providing pulmonary and critical care consultative services for acutely ill patients, and assisting house staff with the evaluations of newly admitted patients as well as those already on the CCMU service.
Lung Transplantation at University Hospital (2 weeks)
The fellow will explore all aspects of lung transplantation from outpatient evaluation and management, listing, in-patient care of pre- and post- transplanted patients.
Pulmonary Medical Procedures Unit at University Hospital (6 weeks)
This state-of-the-art facility is utilized for endoscopic procedures performed by the Pulmonary & Critical Care Medicine Division, as well as the Gastroenterology and Hepatology Division. The facility includes preoperative preparation, video endoscopy and fluoroscopy facilities, and recovery room facilities. Bronchoscopy with and including endobronchial ultrasound guided needle aspiration (EBUS), electromagnetic navigational bronchoscopy, transbronchial biopsy, other interventional bronchoscopic procedures (airway dilation, stent placement, endoscopic LVRS, etc), thoracentesis, and acute and chronic small and large bore chest tube placement are performed during the Procedure Service rotation.
Pulmonary Physiology - including Pulmonary Rehabilitation at University Hospital (2 weeks)
The fellow gains extensive experience with the indications, performance, and interpretation of clinical and physiologic studies. These include spirometry, flow volume loops, lung volumes (by plethysmography and nitrogen washout), airways resistance, lung compliance, diffusion capacity, arterial blood gas studies, respiratory muscle function studies, measurement of bronchial reactivity, and sophisticated cardiopulmonary exercise testing. Additionally, the fellow will participate in patient education and evaluation of patients in our Pulmonary Rehabilitation Program.
Pulmonary & Critical Care Medicine Services at the VA Medical Center (8 weeks)
Two fellows are assigned to the Ann Arbor VA Medical Center, one in the MICU/SICU and the other on the Pulmonary Medicine Consultation Service. Both fellows evaluate patients directly and/or supervise house staff and/or students on either clinical service. The MICU/SICU fellow participates in the management of critically ill medical and surgical patients with a dedicated ICU team (one medical and one surgical). The Pulmonary Medicine fellow participates in the inpatient evaluation of patients, outpatient evaluation of pulmonary hypertension and lung cancer patients, performs all bronchoscopies (including interventional bronchoscopic procedures) and tube thoracostomy placements, and reads pulmonary function tests. Approximately 150-200 bronchoscopies are performed annually.
Night Medicine at University Hospital (6 weeks)
This service is responsible for management of intensive care patients and pulmonary consultations (see description above) from 8:00 pm to 8:00 am.
Outpatient Pulmonary Clinic at University Hospital or VA Medical Center
First year fellows attend a general pulmonary outpatient clinic weekly, alternating between the VA and U-M Hospital. New patients are seen each week, and the fellow also obtains a longitudinal patient care experience by following his/her patients throughout the fellowship period. Fellows are supervised by attending physicians in the clinic.
The second year fellow spends half the year rotating among eight different services:
- Critical Care Medicine Unit (Medical ICU) at the University Hospital (6 weeks)
- Procedures Unit at the University Hospital including Pulmonary Function Laboratory (4 weeks)
- Pulmonary Service at the VA Medical Center (includes consults, medical ICU, and diagnostic services) (4 weeks)
- Surgical ICU at the University Hospital (2 weeks)
- Trauma-Burn ICU at the University Hospital (4 weeks)
- Neurological ICU at the University Hospital (2 weeks)
- Night Medicine at the University Hospital (4 weeks)
- The other half of the year is devoted to research (22 weeks). General pulmonary outpatient clinic is held weekly at the University Hospital
Although the primary focus of the third year is the development of skills and experience in research, senior fellows continue to participate in certain clinical activities. First, they maintain their longitudinal general outpatient clinic experience throughout this year. Additionally, they have a 6 month subspecialty clinic (one half day per week) split up as follows: 2 months in Pulmonary Hypertension, 2 months in Sleep, 2 months in an elective (Cancer, Allergy, etc.). Third year fellows rotate in the Cardiovascular ICU (4 weeks) and rotate in Night Medicine (2 weeks), the remaining time is spent in research (44 weeks).