Fellowship in Pulmonary & Critical Care Medicine at Northwell Health
The Fellowship in Pulmonary Disease and Critical Care Medicine includes at least 24 months of clinical training with eight months devoted to patient care responsibility in critical care units. This training occurs primarily at two tertiary care institutions, Long Island Jewish Medical Center and North Shore University Hospital. These two institutions are the major referral centers for an extensive network of hospitals within Northwell Health.
Our trainees benefit from exposure to a clinically diverse group of patients presenting with a wide spectrum of disease. Clinical training includes:
- Active participation in two large pulmonary consultative services at the hospitals
- Education in the performance and interpretation of pulmonary function and cardiopulmonary exercise tests
- Instruction in pulmonary procedures, including:
- Endobronchial ultrasound
- Pleural procedures
- Critical care ultrasonography and echocardiography
- Fiber-optic evaluation of swallowing
- Diagnosis and treatment of sleep disorders
Fellows spend one month at NYC Health + Hospitals/Queens, where they gain valuable experience in the tuberculosis clinic, as well as experience with pulmonary consultative services.
Critical care training includes six months divided between the medical intensive care units of Long Island Jewish Medical Center and North Shore University Hospital, where fellows manage every aspect of critical illness. Fellows perform all procedures on these critically ill patients, including airway management, endotracheal intubation, central line placement, arterial line placement, hemodialysis access, thoracentesis, paracentesis, lumbar puncture, chest tube placement, percutaneous tracheostomy, bronchoscopy, critical care ultrasonography and echocardiography, including transesophageal echocardiography.
Fellows are trained to be self-reliant and to be able to manage any situation in a critical care unit. They perform mandatory rotations in the neurosurgical intensive care unit, surgical intensive care unit, cardiothoracic intensive care unit and eICU (telemedicine). Fellows perform rounds in the respiratory care unit at Long Island Jewish Hospital, which provides care to patients with acute pulmonary illnesses, those receiving mechanical and noninvasive ventilation outside the intensive care unit, and patients with advanced illness.
All rotations are two to four weeks in duration and are divided equally between North Shore University Hospital and Long Island Jewish Medical Center:
- Pulmonary consultative services: 6-7 rotations
- Medical intensive care unit: 6-7 rotations
- Procedures (bronchoscopy, FEESST): 3 rotations
- Respiratory care unit: 3 rotations
- PFT lab: 0.5 rotation
- Sleep: 2 rotations
- SICU: 1 rotation
- NSICU: 1 rotation
- CTICU: 1 rotation
- NYC H+H/Queens Pulmonary/TB Clinic: 3 rotations
- Vacation: one month per year
7-8 rotations for elective/research
During the consultation rotation, fellows respond to requests for pulmonary consultation throughout both hospitals. North Shore University Hospital is a tertiary care center and Level I trauma center that receives patients from all parts of Long Island and Eastern Queens. Long Island Jewish Medical Center is a tertiary care center that is located in Queens, the most ethnically diverse county in the country.
In addition, fellows assist the faculty in the management of all inpatients from the faculty practice. Patients are presented daily to an assigned faculty member, who supervises patient management along with the education of fellows and staff. Medical students rotate from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Albert Einstein College of Medicine, Stony Brook University and NYIT. The fellow is also responsible for presenting interesting patients at our weekly radiology and clinical case conferences.
Fellows play a major role in the care of patients in the medical intensive care units of Long Island Jewish Medical Center and North Shore University Hospital. They supervise emergency department (ED) residents, medical students and nurse practitioners in the evaluation and care of patients with critical illness. Fellows perform all procedures in the Medical Intensive Care Unit (MICU) and perform all triage decisions under the supervision of a critical care attending.
Critical care ultrasonography is performed daily, with interesting images stored on our dedicated ultrasound picture archiving and communication system (PACS) for review at our weekly ultrasound conference. Fellows perform critical care echocardiography and transesophageal echocardiography under the supervision of echo-boarded pulmonary critical care faculty attendings. They do not take in-house overnight calls, as there are 24/7 intensivist faculty at both hospitals.
There are mandatory rotations in the surgical intensive care unit (SICU), neurosurgical intensive care unit (NSICU), cardiothoracic intensive care unit (CTICU) and electronic intensive care unit (eICU) as well.
Respiratory care unit
The Respiratory Care Unit (RCU) is a 12-bed unit at Long Island Jewish Medical Center. This modern facility provides care not only to patients receiving mechanical ventilation outside the MICU, but also to patients admitted primarily with pulmonary conditions and advanced illness. The unit is staffed by respiratory therapists and nurse practitioners supervised by the Division's faculty and fellows. Fellows acquire skills in managing mechanical ventilator support, as well as in the rehabilitation of these challenging patients. The fellows organize and conduct daily rounds with the RCU attending, nurse practitioners and respiratory therapists.
Pulmonary Function Test (PFT) Laboratory
Fellows rotate through the PFT Laboratory, acquiring skill in the performance and interpretation of pulmonary function tests and cardiopulmonary exercise studies. Pulmonary function tests are always interpreted under the supervision of the faculty. In addition, fellows participate in the pulmonary rehabilitation program, following patients and conducting weekly discussion groups with patients enrolled in the program.
Bronchoscopy training occurs in the bronchoscopy suite at each hospital, which is equipped with modern video-bronchoscopy and fluoroscopy equipment. Over 900 procedures are performed each year, and fellows achieve competence in flexible fiber-optic bronchoscopy and endobronchial ultrasound (EBUS) under the tutelage of our expert faculty. Fellows learn how to perform biopsy and needle aspiration of the lung, hilum and mediastinum and they perform navigational bronchoscopy.
Therapeutic modalities, including cryotherapy, are available. In addition, fellows are trained to perform thoracentesis, PleuRx catheter placement, and chest tube placement under the guidance of expert faculty.
Fellows are actively involved in the evaluation of swallowing disorders, participating actively in performing inpatient and outpatient fiber-optic endoscopic evaluation of speech and swallowing (FEESS) procedures via video laryngoscopy.
The Division has the expertise and equipment to train fellows in critical care ultrasonography, giving them the skills they need to guide thoracentesis and vascular access and to diagnose a range of disorders in critically ill patients. Each year, first-year fellows attend the Citywide Ultrasound Course sponsored by the Cooperative Ultrasound Project, which provides a rigorous introduction to ultrasonography. Fellows are trained in critical care echocardiography, including transesophageal, and a few highly motivated fellows have taken the echocardiography boards each year. We expect that most fellows will be certified in Critical Care Echocardiography, a certification that was just approved by The National Board of Echocardiography, in the future.
The Sleep Disorders Center is an essential part of the three-year experience and fellows participate in the outpatient evaluation of patients at the Sleep Disorders Center and in the interpretation of polysomnograms and other sleep laboratory evaluations.
- North Shore University Hospital/LIJ Pulmonary Clinic
- NYC Health + Hospitals/ Queens TB Clinic
- Pulmonary Faculty Practice
- Pulmonary Hypertension and Advanced Lung Disease (Arunabh Talwar, MD)
- Cystic Fibrosis (Janice Wang, MD)
- Sleep Disorders Clinic (Harly Greenberg, MD)
The outpatient clinical experiences are a major strength of this program. Each fellow participates in a continuity clinic experience one half-day per week in six-month blocks at our faculty practice office setting, which also holds general pulmonary disease clinics and specialized clinics that focus on specific diseases. Fellows are the primary physicians for patients seen in these continuity clinics; all clinic sessions are supervised by faculty members who provide both expert patient care and conduct ongoing and extramurally funded clinical research.
There are several specialized continuity clinics, all of which care for large numbers of patients and conduct active research programs that earn them national and international reputations. Fellows have the opportunity to participate in all of the activities of these programs, which include:
- The Jack Gorvoy Cystic Fibrosis Center, one of the largest Cystic Fibrosis (CF) Foundation-accredited Care Centers in the region. It is also part of the CF Foundation’s Therapeutic Development Network (TDN), performing cutting edge clinical research in CF. Our dedicated CF faculty, nurse practitioners, and clinical research associates actively manage and conduct clinical and basic research trials for our adult CF patients. To date, there are over 100 adult patients with CF enrolled in our center.
- The Center for Pulmonary Hypertension and Advanced Lung Disease, the first program in Long Island dedicated to the care of these complex patients. The center currently receives referrals from the entire New York metropolitan area. Our faculty, a nurse practitioner, and research associates care for patients with these challenging diseases and maintain an active registry of patients and their clinical data that facilitates federally funded clinical trials and basic science studies.
- The Ambulatory Pulmonary Rehabilitation Program, staffed by dedicated respiratory therapists who provide ongoing services for a large number of patients. Fellows evaluate and participate in the care of patients undergoing an active program of physical rehabilitation, counseling and psychosocial support.
- The Sleep Disorders Center, one of the largest American Academy of Sleep Medicine-accredited sleep disorder centers in the region. Dedicated sleep
medicine faculty provide care for patients with the full spectrum of adult sleep disorders. Fellows have the opportunity to participate in the sleep medicine clinic, the sleep disorders laboratory and in sleep medicine related clinical research.
Fellows have the opportunity to work with colleagues in other departments and divisions within our medical center and at other academic institutions in order to supplement and enhance their education. Electives include, but are not limited to, the following:
- Thoracic surgery
- Ear, nose and throat
- Allergy clinic
- Palliative care
- Critical care ultrasonography and echocardiography
- Burn unit (Nassau University Medical Center)
- Interventional pulmonology
- Lung transplant
Our weekly conference schedule includes clinical, core and multidisciplinary conferences. All conferences are teleconferenced between North Shore University Hospital and LIJ Medical Center, and our outpatient site. Fellows participate in a continuity care clinic experience throughout the length of the training period for one half-day per week. In addition, every fellow is expected to choose an area of clinical or basic science research and pursue it actively under the guidance of a faculty member.
Every year, our fellows present their research at the American Thoracic Society international meeting, American College of Chest Physicians (ACCP), Northwell Health’s Annual Academic Day and the Department of Medicine Lawrence Scherr Awards. The best testament to the ultrasonographic skill of our fellows is that they serve as instructors for the several local and national ultrasound courses that are sponsored by ACCP each year. In addition, each fellow participates in a quality improvement project.
- Radiology Case Conference
- Critical Care Physiology
- Sleep Conference
- Ultrasound Conference
- Lung Cancer Conference
7:45am, Monter Cancer Center
- Clinical Case Management Conference
- Medical Grand Rounds
- Pathology Conference
- Research Conference and Morbidity & Mortality Conference
- Division of Pulmonary Disease, Critical Care and Sleep Grand Rounds
- Journal Club
12pm, bimonthly, teleconference
Radiology Case Conference
PCCM faculty and faculty from the Department of Radiology supervise fellows as they interpret chest radiographs and CT scans.
Fellows review ultrasound studies that are performed weekly in our critical care units and on pulmonary consults. Pulmonary and Critical Care Medicine faculty provide ongoing didactic and practical instruction and review of interesting and challenging studies.
Critical Care Physiology
Weekly presentation and review of critical care physiology including hemodynamics, cardiopulmonary interactions and airway mechanics.
This multidisciplinary weekly conference is attended by Pulmonary/Sleep attending physicians, sleep fellows, PCCM fellows, sleep technologists, and psychologist members of the faculty with interests in the non-respiratory aspects of sleep.
Lung Cancer Conference
This is a multidisciplinary conference involving oncology, radiation oncology, radiology, pathology and thoracic surgery. Diagnosis and treatment of lung cancer patients is discussed.
Clinical Case Management Conference
One patient from each hospital is presented weekly by the consult fellows, focusing on a specific management question with brief review of the relevant literature.
Medical Grand Rounds
Medical Grand Rounds occur weekly and are sponsored by the Department of Medicine. Speakers often include faculty from our Division and guest speakers with national reputations as experts in pulmonary disease and critical care medicine.
Fellows critically review and discuss current articles from the literature.
Fellows and faculty meet to discuss research in progress.
Fellows review the previous month's interesting pathology from patients who underwent bronchoscopy with faculty from the pathology department.
M & M Conference
Challenging patients and mortalities are presented and analyzed critically with review of relevant literature. Faculty and fellows from other divisions in the Department of Medicine that were involved in the clinical care of the patients are invited to participate.
Division of Pulmonary Disease, Critical Care and Sleep Grand Rounds
Grand Rounds occur weekly. Core pulmonary and critical care topics are presented by divisional faculty and fellows and by visiting faculty from other academic institutions. The conference is attended by pulmonary faculty and fellows, and many of the voluntary physicians in the medical center.
Annual summer core conferences
Every July, incoming fellows participate in didactic and practical conferences that include airway training, management of mechanical ventilation, procedural training, critical care ultrasonography and respiratory physiology. During this 3- 4 week period, fellows are free of clinical responsibilities. Some of the areas covered include:
First year fellows learn how to manage airways, intubate patients, and manage complex code situations using simulators.
First year fellows learn to utilize and troubleshoot different ventilator modes.
Senior fellows present physiology topics utilizing John B. West’s case-based physiology approach.
Citywide Ultrasound Course/Cooperative Ultrasound Project Critical Care Ultrasonography Course
Our first year fellows participate in a four-day intensive, hands on ultrasound training course that is offered to all fellowship programs in the New York metropolitan area.
Bioskills Course in Advanced Critical Care Procedures
Fellows learn the safe performance of percutaneous tracheostomy, chest tube and pleural catheter placement in an advanced bioskills (cadaver) laboratory.