Division of Pulmonary & Critical Care
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Life at Jeff
Combined MS with Fellowship
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Alumni of our Fellowship
Fellows are trained in the following procedural skills: fiberoptic bronchoscopy and related procedures including bronchial and transbronchial biopsy, transbronchial needle biopsy and aspiration, and bronchoalveolar lavage; thoracentesis and pleural biopsy; additional training in trans-thoracic needle biopsy is obtained during a chest radiology elective.
Fellows rotate through a procedure service. During this time, fellows work closely with an interventional bronchoscopist and have the opportunity to observe and to participate in advanced bronchoscopic procedures such as endoscopic ultrasound guided needle aspirations and biopsies, electrocautery and laser treatment of endobronchial lesions, endoluminal stent placement, insertion and management of chest thoracostomy and pleural catheters.
Moreover, fellows are trained in the technical aspects and interpretation of pulmonary function testing and other specialized tests including exercise stress tests. One objective of this training is to provide a firm understanding of the physiologic basis of pulmonary function testing as well as experience in the operational management of a pulmonary laboratory. A 5,000 sq. ft. laboratory with facilities for routine clinical testing, exercise testing, pulmonary mechanics measurements, and bronchial provocation testing is the focus of this training.
We enjoy a close working and academic relationship with the thoracic surgeons, thoracic radiologists, and thoracic oncologists. Fellows are expected to complete rotations in the cardiothoracic surgical unit. Fellows also spend devoted time to a sleep rotation where they evaluate sleep disorders in the office, perform polysomnography in the sleep lab, and interpret sleep studies.
As part of their clinical training in pulmonary diseases, fellows assume a one-half day per week commitment to outpatient pulmonary medicine where they have a one-on-one interaction with an attending during a continuity clinic. As a tertiary care center, Thomas Jefferson University Hospital has a broad base of patient referrals with a wide variety of usual and unusual pulmonary disorders.
Critical Care Medicine
The mission of the division of Pulmonary and Critical Care Division is to achieve excellence in patient care, teaching and research. Critical care medicine training at Jefferson is designed to satisfy all requirements for certification in critical care. While the critical care curriculum is organized independently, it is fully integrated with the pulmonary medicine training program. We run two independent critical care services: the medical respiratory intensive care unit (MRICU) which is run by our division, and a Surgical/Medical Coronary Care Service. The MRICU is a 17-bed facility that serves the needs of all non-coronary critically ill patients in the department of medicine. Fellows supervise the house staff in their initial patient evaluations and, with division faculty, guide diagnostic and therapeutic management. Two medical residents and four medical interns are assigned to the MRICU and provide in-hospital nighttime coverage. All invasive procedures performed in the MRICU are supervised by faculty and fellows, ensuring an opportunity for proficiency in pulmonary artery catheter insertion, arterial cannulation, central venous catheter placement and bronchoscopy. A diverse patient population offers a wide array of critical care problems, with extensive exposure to patients with shock, pulmonary edema, acute respiratory failure, acute renal failure, coma, metabolic and endocrine problems, infectious disease, hematological problems, disorders of the gastrointestinal system and others. The MRICU fellow and attending also provide medical critical care consultation to the bone marrow transplant unit.
The MRICU is equipped with state-of-the-art monitoring and support capabilities, including traditional and advanced volume and pressure control modes of ventilation; extensive use of non-invasive oximetry and capnometry; and continuous fiberoptic mixed venous oximetry; and bedside ultrasonography. A team of specially trained respiratory therapists (under the direction of the Division of Pulmonary Medicine) provides extensive physiologic monitoring and recording services. Personnel from pharmacy, nutrition, nursing and other areas are also involved in a multi-disciplinary approach to critical care.
The Surgical/Medical Critical Care service is comprised of a separate fellow and medical critical care attending. On this service we co-attend patients admitted to the cardiothoracic unit along with the surgeons. The fellow, along with the surgical housestaff, is part of a team responsible for the day-to management of these patients that include periop heart, general thoracic, and heart transplant patients. We also provide critical care services to the adjacent Medical Coronary Care Unit as well as the other non-medical intensive care units in the hospital (Surgical Intensive Care, Neuro Intensive Care, and Obstetrics). During the fellowship, two to three months are also spent in the intensive care unit at Lankenau Hospital, a major participating affiliate located five miles from Center City. In addition to general intensive care, the Lankenau is a major heart center for the Jefferson Main Line Health system and fellows will gain additional exposure to acute medical and surgical coronary care. An additional focused rotation is required in anesthesia to complete the training requirements for critical care. Our fellows have the opportunity to do electives in echocardiography, neurosurgery, transplant surgery, general, and trauma surgery. Our fellows actively participate in clinical research having the opportunity to present their results at National and International meetings.
834 Walnut Street, #650 Philadelphia, PA 19107 (215) 955-5161
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Fellowship Programs Contact:
1015 Chestnut Street
Philadelphia, PA 19107