The Interventional and Advanced Diagnostic Pulmonology Fellowship provides intense pulmonary procedural training with the goal of developing future leaders in the field. Because this is a procedural training program, you spend the majority of your time providing interventional pulmonary consultative service and planning, conducting and following up on interventional procedures.
A human cadaver lab and a state-of-the-art medical simulation center are used during this fellowship to augment procedural experience and ensure optimal hands-on training while ensuring patient safety. An animal lab is available in which you may design and perform animal studies, and acquire basic skills and enhanced exposure to new and advanced techniques. A complete text and video library also is available.
Upon completion of the Interventional and Advanced Diagnostic Pulmonology Fellowship, you should be able to:
- Recognize the technical aspects, roles and limitations of interventional pulmonary procedures, including rigid and flexible bronchoscopic techniques, pleuroscopy, thoracostomy placement and management, thoracic ultrasound interpretation, and percutaneous tracheostomy placement
- Use endobronchial ultrasound (radial and linear array), electromagnetic navigation and advanced imaging (autofluorescence and narrow-band imaging) to least invasively diagnose and stage thoracic disease
- Use electromagnetic and other navigation methods to deploy fiducial markers to direct radiotherapy
- Use rigid bronchoscopic techniques, such as blunt dissection, laser and silicone stent deployment, to treat benign and malignant endobronchial disease
- Use flexible bronchoscopic techniques, such as laser, electrocautery, argon plasma coagulation and self-deploying stent placement, to treat benign and malignant endobronchial disease
- Place and care for indwelling pleural catheters for recurrent, symptomatic pleural effusions
- Use rigid and semi-rigid pleuroscope techniques to characterize, diagnose and treat pleural disease
- Place and care for thoracostomy tubes
- Place and care for percutaneous tracheostomy tubes
- Begin the process of overseeing and teaching skills and techniques to general pulmonary fellows
- Integrate proper documentation, reimbursement and billing into your practice
- Recognize necessary equipment and other resources needed to start and maintain an independent interventional pulmonary service
The curriculum includes a series of didactic lectures. These lectures are provided by the interventional pulmonary staff, other pulmonary and critical care physicians, radiologists, oncologists, and thoracic and general surgeons.
In addition to weekly pulmonary divisional and research conferences, there are interventional pulmonary conferences and meetings. As an advanced fellow, you are responsible for presenting at several of these forums and for coordinating intermittent interventional pulmonary meetings.
Regular meetings are held between fellows and mentors to design and conduct research protocols. Fellows also work with other members of the Division of Pulmonary and Critical Care Medicine who have diverse skills and investigative backgrounds.
Fellows have dedicated time for research projects. The development of or participation in at least one prospective interventional study is required. Fellows also complete at least one retrospective study and one review article. You are encouraged to initiate the planning and dialogue of at least one of these studies prior to beginning the fellowship.
You are expected to enroll patients into approved clinical protocols in which you are involved.
Publications and presentations
Each of the prospective studies you develop should generate results and information suitable for publication in a major pulmonary, oncology or thoracic surgery subspecialty journal. Two additional critical manuscripts also are expected. These may include a major subject review, case report or a retrospective review. The development of abstracts for at least two of the major national thoracic diseases meetings is anticipated.
Fellows have opportunities to teach rotating pulmonary and critical care fellows in the endoscopy suites, as well as teach residents and fellows during conferences.
To ensure you gain proficiency and develop the corresponding technical skills, your performance is monitored throughout the Interventional and Advanced Diagnostic Pulmonology Fellowship. You are formally evaluated by your supervising faculty member after each clinical rotation and then meet with the program director to review the evaluations. You also have opportunities to regularly evaluate the faculty.
Fellows cover emergency bronchoscopy call approximately one week every two months. You will have responsibility for disposition of outpatients after interventional procedures and are expected to round on all inpatients after interventional procedures. Occasionally, this may require brief rounds on the weekends. You are expected to carry a pager in the evening to field calls from patients who may have complications or questions. If you want to be involved in weekend and night coverage for interventional procedures, that is possible on request, though weekend and night interventions are uncommon.
The Interventional and Advanced Diagnostic Pulmonology Fellowship is designed for one year of focused training and research, so moonlighting is generally not allowed.