Education and Conferences:

 

Pulmonary/Critical Care Medical School: introductory lecture series for incoming pulmonary fellows aimed at providing a foundation in basic pulmonary physiology, pulmonary function testing, bronchoscopy, mechanical ventilation and airway management. Also, includes “hands-on” learning for airway management, ultrasound basic skills, bronchoscopy introduction and CPR.

Airway Curriculum:

During first month of fellowship a complete hands-on course will be given to all new fellows and every six weeks a dedicated 4 hours of difficult airway techniques/lecture will be given. First and Third year fellows are expected to attend the Airway course at Baltimore (free of charge). https://ceme.org/content/practical-emergency-airway-management-11       

Ultrasound curriculum:  This is a three year curriculum that will help the fellows to become proficient in Critical Care ultrasound (CC US) and basic Critical Care echocardiography by the end of their fellowship. 

During the first year, fellows will acquire general knowledge about CC US and some of the emergency protocols used. During the second year, they will focus more on CC Echo while continuing to improve their CC US skills. During the third year, they will work on completing a CC US imaging portfolio, which will help them to refine their imaging skills.

 

First Year:

At the beginning of the year, overall basic CC US theory will be given during the PCCM school lectures.

 

A.   PCCM Med school:

-      Vascular access on mannequins at the stimulation center

-      CC echo basic views on Vimedex mannequins at the simulation center

-      Fellows should watch EM Sono videos:

o   #1 Practical Scanning

o   Simplifying Doppler US

 

B.    Block 1: Pleura and Thoracic:

-      Basic anatomy for thoracentesis and chest tube placement

-      Lung ultrasound

-      FALLS and BLUES protocols

-      Fellows should watch EM Sono videos:

o   #4 EFAST exam pneumothorax

o   #14 The RUSH Exam – Rush Exam thoracic

-      Fellows should read:

o    BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313.

-      Assessment at bedside: first week of October

 

C.    Block 2: FAST/RUSH:

-      Basic abdominal ultrasound

-      1/2 day training sessions with ED / Trauma faculty E-FAST exams

-      Fellows should watch EM Sono videos:

o   #2 EFAST exam Hemopericardium

o   #3 EFAST exam Hemoperitoneum

o   #14 The RUSH Exam

-      Assessment at bedside: first week of January

 

D.   Block 3: Echocardiogram:

-      4 basic views and their anatomy and IVC

-      Fellows should watch EM Sono videos:

o   #13 Focused Echo Introductory Module

o   Clinical Cases

-      Assessment at bedside: first week of April

 

E.    Block 4: DVT and assessment of fluid responsiveness:

-      DVT assessment

-      Measures for fluid responsiveness

-      Fellows should watch EM Sono videos:

o   #5 Vascular Access

o   #12 Lower extremity DVT ultrasound

o   #6 Aorta ultrasound

-      Assessment at bedside: Last week of June

 

 

 

Second Year: 

The second year will be dedicated to practice the already learned CC US skills and to incorporate them into patient care. For this the fellows will have to submit a case each block where they incorporated CC US to their decision making in patient care. 

 

A.  Block 1: LV function: 

- Assessment at bedside: first week of October

 

B.  Block 2: RV function: 

- Assessment at bedside: first week of January

 

C.  Block 3: Valves assessment:

- Assessment at bedside: first week of April

 

D.  Block 4: CO estimation:

- Assessment at bedside: last week of June

 

 

Third Year:

The third year will be dedicated for the fellows to practice on their own and obtain images for their portfolio. The fellows will be required to present a CC US portfolio (USB will be provided) with the following views. The images will be reviewed by the ultrasound faculty, and if adequate this will be accepted, if not adequate then new images will requested to be submitted. 

 

Required images for Portfolio

 

a.    Cardiac Study (10 studies with the following images per study)--> Total: 50 images

a.    Parasternal long axis view

b.    Parasternal short axis view

c.    Apical four-chamber view

d.    Subcostal long axis view

e.    Inferior vena cava longitudinal view

 

b.   Lung/Pleural Study (3 studies with the following images per study)--> Total: 9 images

a.    Pleural effusion (any size)

b.    Sliding lung

c.    Consolidation

 

c.    Abdominal Study (4 studies with the following images per study)--> Total: 12 images

a.    Left kidney longitudinal view with splenorenal space

b.    Right kidney longitudinal view with hepatorenal recess

c.    Abdominal aorta longitudinal view

d.    Bladder transverse view

 

d.    Vascular Diagnostic DVT Study (3 studies with the following images per study - include right and left legs)--> Total: 24 images

a.    Right common femoral vein with compression

b.    Left common femoral vein with compression

c.    Right common femoral vein at saphenous intake with compression

d.    Left common femoral vein at saphenous intake with compression

e.    Right superficial femoral vein with compression

f.     Left superficial femoral vein with compression

g.    Right popliteal vein with compression

h.    Left popliteal vein with compression

 

Total number of required images for portfolio completion: 94

    

Conferences:

There are several pulmonary/critical care specific conferences scheduled each week, which cover both clinical practice and research topics.  Fellows must attend at least 70% of conferences over their 3-year fellowship in order to be eligible for graduation. 

Tuesday:

-          Board Review Series: Biweekly one hour lectures.

-          Critical Care Journal Club: Biweekly at the VA Medical Center one hour discussion of the most recent trials in critical care medicine with an emphasis on trial design and statistical analysis.

Wednesday: Department of Medicine Grand Rounds

Thursday: Pulmonary and Critical Care Grand Rounds

Friday: Case Conference, Jeopardy, and Fellow's monthly meeting