Multidiscplinary Training Opportunities
Fellows are trained in the following procedural skills:
Fiberoptic bronchoscopy and related procedures including bronchial and transbronchial biopsy
Transbronchial needle biopsy and aspiration
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 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 interpreting 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.
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 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 Hospitals has a broad base of patient referrals with a wide variety of usual and unusual pulmonary disorders.
Critical Care Medicine Training
We run two independent critical care services: the Medical Respiratory Intensive Care Unit (MICU) which is run by our division, and a Surgical/Medical Coronary Care Service. The MICU 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 MICU and provide in-hospital nighttime coverage. All invasive procedures performed in the MICU 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 MICU fellow and attending also provide medical critical care consultation to the bone marrow transplant unit.
The MICU 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
Continuous fiberoptic mixed venous oximetry
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 house staff, is part of a team responsible for the day-to-day 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). 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.
The goal of research training in pulmonary medicine and critical care is to provide fellows with experience in the design, performance and analysis of original work in order to develop clinicians and scientists of the highest caliber. It is our belief that the ability to critically evaluate experimental and clinical data is an important skill for all physicians. The ability to effectively communicate such information to others is also a highly regarded skill, and instruction is offered to fellows to hone these skills.
The clinical and basic science departments of the Sidney Kimmel Medical College and Thomas Jefferson University Hospital are all located within a single campus in downtown Philadelphia.
Fellows have access to multidisciplinary projects which opens up a large canvas to explore. Research opportunities include:
Data from the medical intensive care unit
A completely equipped pulmonary function laboratory including facilities for exercise and bronchial challenge testing
A bronchoscopy suite including a video bronchoscopy unit
A state-of-the-art university run animal facility with core services to support generation of transgenic mice
A morphology core facility which includes a transmission electron microscope, microscopes equipped for regular, phase and fluorescent microscopy, and a quantitative morphometry laboratory
Laboratories equipped for research using the techniques of physiology, cell biology, biochemistry, immunology and molecular biology
Fellows have the opportunity to participate in a wide variety of basic and clinical research projects. While most research activity occurs in the second and third years of fellowship training, fellows are encouraged to become involved in these activities during their first year, to the extent that time allows. Independent clinical research projects with faculty mentorship are strongly encouraged. Fellows are expected to actively participate in ongoing research and present their data at national meetings such as the ATS, ACCP or the critical care meetings and ultimately generate an original manuscript with the help of their faculty mentor.
The newest change to the program is an opportunity to participate in the University’s Masters Program in Population Health. The Masters in Clinical Research assists fellows and junior faculty in obtaining the essential skills necessary to conduct human research. Fellows are able to complete a Masters program while doing their fellowship in Pulmonary and Critical Care Medicine. The research for the fellowship often is presented as a Master’s Thesis. This program is optional, but has been an excellent resource to strengthen one’s interest in clinical research.