Curriculum
Invasive Pulmonary Procedures
Procedures taught include:
- Bronchoscopy with bronchoalveolar lavage (BAL) and endobronchial biopsy
- Bronchoscopy with transbronchial biopsy
- Transbronchial needle aspiration
- Endobronchial ultrasound (EBUS) bronchoscopy
- Percutaneous tracheostomy
- Indwelling pleural catheter placement
- Pigtail catheter placement
- Medical thoracoscopy
- Ultrasound-guided procedures
Rotation Schedule
The primary teaching site for the program is NewYork-Presbyterian Brooklyn Methodist Hospital (NYPBMH) in Brooklyn, New York. Our site is a well-equipped, modern facility with in-patient and ambulatory care facilities, laboratories for pulmonary function testing, and exfoliated cytology laboratories and extensive pathology services. There are dedicated modern bronchoscopy/procedure suites and facilities for microbiology procedures. NewYork-Presbyterian Brooklyn Methodist Hospital's Center for Sleep Disorders, a fully accredited eight-bed sleep center, is an integral part of the Pulmonary, Critical Care and Sleep Medicine Program. We also have a brand new, state of the art Center for Community Health located across the street from our main hospital, with outpatient offices serving multiple different specialties, which is now the location of our pulmonary fellows clinic.
Mandatory Rotations
Mandatory rotations at NYP BMH take place in the medical intensive care unit, pulmonary consultation service, the respiratory care unit/step down unit, night float service, and interventional pulmonary (interventional pulmonary starting second year).
Medical Intensive Care
Every admission to the intensive care unit is evaluated and managed by a fellow. The fellow also manages a team of medical residents from both internal medicine and emergency medicine. Our ICU has twenty beds that are shared between medical intensive care and surgical intensive care services. During MICU rotations, our fellows get exposed to several procedures including intubation, flexible bronchoscopy, chest tube placement and management. Fellows will also be intimately involved in reviewing and critiquing all mortalities that occur in the medical intensive care unit.
Medical Step-Down Unit & Respiratory Care Unit
The fellows carry out daily teaching rounds and manage all patients on the medical step-down unit and respiratory care unit. This includes a variety of critically ill patients and chronically vented patients with other medical comorbidities. Ventilator management is the primary focus in the respiratory care unit, however fellows also get exposure to the management of high-flow nasal cannula and non-invasive positive pressure ventilation during this rotation. Fellows also approve all non-invasive positive pressure ventilation orders throughout the hospital.
Emergency Department
Fellows are actively involved in the evaluation of patients in the Emergency Department for admission to the ICU, medical step down unit, and respiratory care unit.
Elective Rotations
A total of five months of elective rotation time is provided to each fellow, spread out in increasing proportions throughout the three years of training. This promotes broad-based training in all aspects of pulmonary and critical care and still provides the opportunity for trainees to select their areas of greatest interest. Available electives include ambulatory subspecialty pulmonology, sleep medicine, cardiothoracic ICU, surgical ICU, anesthesiology, thoracic radiology, ENT, advanced heart failure, among others.
Pulmonary Fellow’s Clinic
Our fellow’s continuity clinic is held each Wednesday morning at our Center for Community Health. Fellows manage their own panel of patients, with support from our faculty, and are expected to attend clinic during each rotation other than MICU. Our clinic is supported by multiple medical assistants, a dedicated pulmonary nurse, and has the capability to perform in office spirometry.
Board Review
An active weekly board review is held covering both pulmonary and critical care topics.
Quality Improvement/Safety Initiatives
The fellows are actively involved with hospital-wide quality improvement projects.
Graded Levels of Responsibility for each Level of Training
Throughout all aspects of patient care, fellows work closely under the supervision of full-time faculty members. The faculty is comprised of experienced, board certified, pulmonary, critical care and sleep medicine physicians. The medical intensive care unit and the clinical pulmonary service are each directed by a full-time board certified/eligible critical care or pulmonary physician. Fellows are supervised one-on-one by an attending physician for every procedure. Medical students and residents are supervised by fellows and attending physicians. The program director is responsible for the overall supervision of all trainees.