Goals of the Program:
- To train fellows for independent clinical practice in the specialty of pulmonary medicine.
- To train fellows for independent clinical practice in the specialty of critical care medicine.
- To prepare fellows for the practice of sleep disorders medicine as practiced by pulmonologists in a multi-disciplinary environment and to prepare them for further formal training in sleep disorders medicine if desired.
- To expose fellows to research endeavors in basic science and translational medicine.
- To prepare fellows for a lifetime of continuing education, leadership, teamwork and professional development by imparting to the fellows the skills, attitudes and ethical principles necessary to keep up with scientific, clinical, administrative and ethical developments in the fields of pulmonary, critical care and sleep medicine.
Progressive Responsibilities
Clinical:
By their nature, core responsibilities during clinical rotations do not change from month to month. However, attending faculty generally grant more autonomy and responsibility to fellows as they progress through their fellowship.
- During the first year, fellows concentrate on consultation, differential diagnosis, interpretation of diagnostic tests and development treatment plans.
- In the second and third years, more emphasis is placed on implementation of plans in a complex environment and on higher level communication skills.
There are a few areas where there are progressive clinical responsibilities granted only to fellows according to year.
Interpretations of exercise studies generally are done by a second-year fellow while on research time.
- Interventional bronchoscopy procedures, such as laser and placement of endobronchial stents, generally are “weighted” toward senior fellows.
Academic:
The following duties are apportioned according to year of training:
- Research: Fellows have protected research time in their second year. Prior to the start of those rotations, usually during the first year, a research project is identified. All fellows present a seminar and research proposal prior to beginning their research rotation, ideally toward the end of their first year A research update is expected during their research time, and either an abstract at a national conference or a published paper is expected at some point during their third year.
- Physiology Course: The physiology course is presented by the fellows with faculty mentors for each topic. Topics are assigned to first-, second- and third-year fellows, according to complexity. For example, basic topics, such as pulmonary gas exchange, are generally assigned to first-year fellows. More complex, integrative topics, such as heart-lung hemodynamic interactions, are presented by a third-year fellow. In addition, second- and third-year fellows each present a seminar on a physiology topic of their choosing.
Administrative:
- Third-year fellows are given responsibilities for the administration of the fellowship. These include generating the fellows’ call schedule and a schedule for presentations at the weekly case conference.
Pulmonary Diseases
Fellows at Robert Wood Johnson University Hospital (RWJUH) will assume primary responsibility for consultations referred to the division, as well as provide direct care to patients admitted to the pulmonary service, including those in the respiratory care unit at RWJUH. Fellows play a pivotal role in the teaching of medicine housestaff (RWJMS) assigned to the consult service. Daily responsibilities include rounding with the supervising attending, reading pulmonary function studies and supervising (from time to time) cardiopulmonary exercise studies. Fellows perform bronchoscopies under direct supervision of the attending physician. Fellows will share responsibility for organizing the weekly clinical conference at RWJUH and participate in case presentations. They will attend all relevant conferences at the institution to which they are assigned, as well as weekly journal clubs/research conferences at RWJUH. Attendance at the weekly physiology conference is also mandatory. Each fellow will have a longitudinal clinic at RWJUH that will meet one half-day per week.
Sleep Disorders
Site: Comprehensive Sleep Disorders Center at Rutgers Robert Wood Johnson Medical School
Duration of Rotation: One Month
The fellow assigned to the VAHCS rotation will participate in the outpatient activities of the Comprehensive Sleep Disorders Center on Wednesday mornings. This sleep clinic is multidisciplinary, incorporating sleep-boarded pulmonology, sleep-boarded neurology, an ear, nose and throat specialist, and a dentist. In addition, certain clinics will also incorporate a pediatric pulmonologist specializing in sleep medicine and a psychiatry rotating resident. In addition, fellows receive didactics by the sleep faculty.
Medical Critical Care
Site: Robert Wood Johnson University Hospital
Duration of Rotation: One Month
One month the fellow will function as an intensivist and will have the responsibility of supervising the housestaff under the direction of the attending physician. The fellow will be involved in the management of all aspects of patient care. She/he will interact with the nursing and other personnel in ensuring the efficient functioning of the unit for the purpose of optimal patient care. Daytime fellows will triage patients into the ICU and sign out to their colleagues on night rotations. The night time fellows will supervise the housestaff at night and continue patient care.
Ambulatory Care
Sites: Clinical Academic Building at Rutgers Robert Wood Johnson Medical School; the VA New Jersey Health Care System (VANJHCS) at Lyons and East Orange, NJ; Jersey Shore University Medical Center (JSUMC), Neptune, NJ; and Deborah Heart & Lung Center, Browns Mills, NJ.
Fellows attend weekly the weekly outpatient clinic in the Clinical Academic Building except when on vacation or rotation at Deborah Heart & Lung Center or JSUMC. Weekly clinics are conducted under the direct supervision of faculty members. Additional outpatient experiences are also provided at the VANJHCS under the supervision of the site director and in the sleep clinics at the Clinical Academic Building.
Non-Medical Critical Care/Trauma
Sites:Deborah Heart & Lung Center and Robert Wood Johnson University Hospital
These rotations focus on intensive management in the hours immediately following surgery, management of common postoperative problems, and management of resources within the intensive care unit. The fellow functions as primary caregiver in the surgical intensive care unit, to which patients are admitted directly from the operating room. The fellow interacts closely with intensivists, anesthesiologists, surgeons and other members of the SICU team in a multidisciplinary environment. Patients are followed until they leave the unit and fellows are encouraged to obtain follow-up on their patients that leave the unit.