The fellowship program consists of 18 months of clinical exposure, the majority of which occurs during the first year. We have a large and diverse patient population and currently have 5 “core” clinical rotations per month.  In addition to these rotations, F2’s rotate for one month in the surgical critical care unit and F3’s rotate for one month on cardiothoracic/thoracic surgical critical care units.  We have a full array of sub-subspecialty programs (both patient care and research components) including:  allergy, asthma, COPD, cystic fibrosis, interstitial lung disease, interventional pulmonology, lung cancer, pulmonary hypertension, pulmonary transplantation, sarcoidosis and sleep medicine.

First Year

The clinical, or 1st year, fellow is exposed to the entire spectrum of pulmonary and critical care illnesses through time spent at OSU University Hospital on the Medical Intensive Care Unit (MICU) service; at University Hospital, James Cancer Hospital and Ross Heart Hospital on the Pulmonary Consult services; and at OSU East Hospital on the pulmonary consult service. The fellow will rotate among the “core” service rotations in an ordered fashion and each fellow will spend approximately the same amount of time on the various rotations. First year fellows also do one month of a combination of various sub-subspecialty clinics, which is a no call month. 
A unique feature of our fellowship is that we have a month long orientation program in July of F1 year developed by our Program Director, which we call "Pulmonary Medical School." No first year fellow takes any call in July and they are not formally assigned to a service. First year fellows spend July reviewing the basics of pulmonary physiology, learning basics of pulmonary/critical care medicine, spending time in our simulator lab with interactive sessions aimed at mastering the basics of bronchoscopy, airway management, chest tubes, and other essential procedures. When not in class or in the simulator lab (1/2 day per most days), F1’s spend time on all of the core rotations learning the specific requirements of each rotation and fully participating in the care of the patients. The goal of this month is to allow the first year fellows to review the basics of pulmonary/critical care physiology and clinical medicine, begin to learn the essential procedural skills required of a pulmonologist, and get acclimated to the hospital/program before being placed on service or on call.

Critical Care Training

Our program offers the unique ability for the fellows to experience caring for critically ill patients within various models of ICU structure.  We have two  12 bed MICUs on the 11th floor of University Hospital which are staffed in the traditional academic model with a faculty, fellow, two residents and two interns, and the occasional fourth year medical student.  The 12 bed MICU on the 8th floor of University Hospital utilizes a staffing model of a faculty, a fellow and three nurse practioners.  There are no housestaff on this rotation.  The 18 bed mixed ICU (medical, cardiac, surgical)  at OSU East is primarily staffed by hospitalists with one pulmonary/critical care faculty and fellow consulting on all MICU and CCU patients.  The fellow thus gets to experience a wide range of critical care models which require different levels of involvement and team dynamics.  Responsibilities of the fellow on all the ICU rotations generally include overseeing the execution of the ICU patient care management plan, guiding ventilator management, performing and/or supervising critical care procedures, such as intubation, bronchoscopy, venous central line placement, arterial line placement, pulmonary artery catheter placement and interpretation, tube thoracostomy and chest tube management.  We also have monthly critical care ultrasound sessions in the ICU staffed by ER and Pulmonary/Critical Care faculty which are intended to allow interested fellows to become proficient in all aspects of critical care ultrasound.

Non medical ICU training occurs primarily via four venues.  F2s spend one month as part of the SICU CC team, caring for all surgical patients including trauma patients.  F3s spend one month split between caring for all post-operative cardiac patients in the ICU and post-operative thoracic surgical patients in the ICU.  Fellows also see surgical critical care patients in a consultative manner when on consult rotations at University Hospital and OSU East Hospital.  The Surgical CC fellows also rotate in the 11th floor MICU as part of our cross-disciplinary training in critical care.

Pulmonary Medicine Training 

Training in pulmonary medicine occurs via several venues.  The inpatient pulmonary consult services see approximately 800-900 consults per year and includes all aspects of pulmonary consultative medicine. There are two consult teams each with a faculty, fellow and 0-2 residents/students.  One team is based in the James Cancer Hospital and the other team is based in the Ross Heart Hospital. The two teams alternate days of accepting new admissions from the University Hospital. The majority of the patients are pulmonary in nature, but there are critical care consults for and ventilator management for patients requiring mechanical ventilation on cardiology services in the Ross Heart Hospital, in the James Bone Marrow Transplant Unit and in the University Hospital Surgical Intensive Care Unit; we only provide consultative service for these ICUs and are not responsible for the primary care of these patients.   Through these experiences the fellow will be exposed to the entire spectrum of pulmonary procedures including chest tube placement and management, pleural catheter placement, pleurodesis and bronchoscopic procedures, such as bronchoalveolar lavage, transbronchial and needle biopsies, cryotherapy, stent placement and brachytherapy. 

The pulmonary/cc consult service at OSU East provides exposure to a wide spectrum of pulmonary patients.  OSU East is a secondary hospital with a combination of private practice services and traditional academic services, this experience exposes the fellow to a different patient population and health care system than OSU University Hospital. 

Additionally, the consult fellow is responsible for interpreting inpatient and outpatient pulmonary function tests, bronchoprovocation studies and pulmonary exercise tests performed during the consult months.

Training in outpatient pulmonary medicine occurs via fellow clinics which are located in the Martha Morehouse Medical Plaza.  Fellows maintain a outpatient clinic one half day per week throughout their fellowship.  Clinics are only cancelled during the non-medical ICU rotations in SICU, Cardiac and Thoracic surgery.  Fellows will have a continuity clinic in general pulmonary medicine for 24 months. The final 12 months of clinic will be done in six month blocks in a variety of the sub-subspecialty clinics. Fellows will choose which 3 sub-subspecialty clinics they wish to rotate through from programs in pulmonary hypertension, pulmonary transplantation, cystic fibrosis, TB, ILD, lung cancer, COPD, asthma, sarcoid, interventional pulmonary and others that can be modified to the fellow’s interest.

Procedures

 Over the last several years, graduating fellows have performed approximately 250-300 bronchoscopic procedures including transbronchial biopsies, transbronchial needle aspirations, bronchoalveolar lavage; 10-20 chest tubes; 50+ intubations including use of glidescope and intubating bronchoscope; as well as thoracentesis and central venous catheters (both with and without ultrasound guidance).  

We also have a growing Interventional Pulmonology program and fellows can achieve competency in performance of endobronchial ultrasound guided TBNA, argon plasma coagulation (APC), cryotherapy, flexible stent placement, medical thoracoscopy, rigid bronchoscopy, and indwelling pleural catheter placement.

Fellows assist and have the opportunity to become proficient in placement of percutaneous tracheotomies in the MICU.  Fellows have the opportunity to achieve competency in critical care ultrasound imaging.

Second and Third Years

During the second and third years, the primary focus of training is on research projects and fellows also complete the remaining seven months of their 18 month clinical requirement. This will include core rotations as described above, as well as rotations in surgical critical care, cardiothoracic and thoracic critical care.  All F2’s also participate and obtain certification in ATLS, funded by the division.