The University of Miami/Jackson Memorial Hospital Pulmonary and Critical Care Fellowship Training Program is accredited by the Association of Clinical Graduate Medical Education. The overall objective of our program is to prepare trainees for a wide spectrum of career opportunities, including academic teaching and patient care in respiratory and critical care medicine, biomedical research, and community-based specialty practice. The program generally offers two tracts: two years of Critical Care Medicine with a total of four positions or three years of Pulmonary/Critical Care Medicine with a total of twenty two positions. Applicants may apply only for one of the tracts, not for both. We offer for selected trainees interested in careers as physician-scientists a special curriculum with 12 months of dedicated research time and the possibility to enhance their training in research by completing a certificate in clinical research at the University of Miami translational research institute. The two year program makes trainees eligible for certification by the American Board of Internal Medicine in Critical Care whereas the three-year program makes trainees eligible for certification by the American Board of Internal Medicine in Pulmonary Diseases and Critical Care. The program is conducted at several facilities: Jackson Memorial Hospital (a county hospital), the Miami Veterans Affairs Hospital, the University of Miami Hospital, and The Sylvester Cancer Center.
#1 Pulmonary/Critical Care Tract:
Pulmonary Consultation Services:
The pulmonary consultation service (Jackson Memorial Hospital, Veterans Affairs Medical Center, and University of Miami Hospital) will develop the fellows’ skills to provide effective and proficient consultations based on scientific principles for patients with respiratory disorders to the requesting health care practitioner. Fellows will be exposed to a large spectrum of disease entities from commonly encountered to rare and unusual problems. This exposure will ultimately enable the fellows to effectively work as consultants in a variety of environments, such as private practice setting, as well as in a large hospital based practice, or in an academic center. The fellows will be exposed to and learn the technical aspects of pulmonary procedures such as bronchoscopies, transbronchial biopsies and other procedures. They are expected to appreciate a consultation as both a patient oriented diagnostic and management tool as well as an educational experience for themselves and the requesting health care practitioner.
Pulmonary Medicine Continuity Clinic:
Jackson Medical Center and VA Medical Center:
The Pulmonary Medicine Continuity Clinic will develop and maintain the fellows’ skills necessary to provide effective continuity care for patients with pulmonary problems in the outpatient setting. Fellows will start to develop the skills necessary in the diagnosis and management of common ambulatory respiratory problems. They will be exposed to patients with more complex pulmonary problems and with proper supervision will learn how to address these problems. They will become aware of appropriate preventive health measures. They will develop skill to effectively serve as outpatient consultants and convey their findings and solutions of patients’ problems to the requesting physicians. They will collaborate with other health care professionals and coordinate their patients’ management with ancillary health care entities such as home health care, durable medical equipment suppliers, social services and community support services.
Specialty Clinics Rotation:
The Specialty Clinics Rotation gives the fellows the opportunity to work in clinics that are dedicated to the treatment of specific diseases. For the most part, these clinics manage unique patients with rare diseases. The clinics vary in their structure and function with some providing short-term consultation for referring physicians and others providing longitudinal care over longer periods. All bring together clinicians, basic scientists, nurses, case managers, research coordinators and other personal devoted to the understanding the pathogenesis, finding new treatments, and delivering the finest care to the patients under their wings. Fellows will be given a weekly schedule and rotate through specified clinics throughout the week. The clinics involve patients with cystic fibrosis, non-CF bronchiectasis, interstitial lung diseases, lung transplantation, Pulmonary Hypertension, Sarcodosis and sleep medicine.
Pulmonary Procedures Rotation:
The Interventional Pulmonology rotation provides education in all aspects of standard bronchoscopy and pleural disease. Trainees also gain exposure to advanced diagnostic and therapeutic bronchoscopic and pleural techniques.
This is a combined effort between the University of Miami, Jackson Health System and Florida Department of Health. It is a rotation is a unique opportunity for pulmonary fellows to learn about difficult tuberculosis cases located at the Department of Health Tuberculosis Center, one of the few left in the entire country. In the afternoons, fellows are expected to learn and read about pulmonary function test and cardio-pulmonary exercise testing.
Critical Care Rotation:
The critical care rotation is designed to provide fellows with a well rounded education in the management of critically ill patients. While focused on medical patients, trainees completing the program will have sufficient experience to competently provide critical care for surgical and trauma patients as well. A modern intensive care unit does not exist in isolation, but functions as anintegral part of the hospital setting, coexisting and coordinating with other services, including medical, ancillary, quality management, and administrative. Fellows will be trained in the necessary skill sufficient to permit competent administration of an intensive care unit.
Clinical training in critical care medicine takes place at all three teaching hospitals, Jackson Memorial Hospital, Veterans Affairs Medical Center and the University Of Miami Hospital. Fellows will spend a minimum of nine months and not more than fifteen months in a critical care unit. The program incorporates three months of training in a non-medical intensive care unit, i.e. Surgical Intensive Care Unit, Trauma Intensive Care Unit, Neurosurgical Intensive Care Unit, or Chest Surgical (Transplant) Intensive Care Unit. Fellows will gain an understanding of the pathophysiology of a broad range of critical illnesses including respiratory failure of various causes, sepsis and septic shock, hemorrhage and hemorrhagic shock, renal failure, hepatic failure, status epileptics, acute stroke, acute cardiac events including myocardial infarction and cardiogenic shock and many other conditions. Fellows will learn and master therapeutic techniques including invasive and noninvasive ventilatory support, resuscitation, invasive monitoring and bedside diagnostic techniques, intubation, pacemaker insertion, tube thoracostomy, use of vasoactive agents conscious sedation and therapeutic sedation, and nutrition support in the critically ill. These rotations are also designed to instruct the fellows in aspects of intensive care unit administration. Fellows will be intimately involved in evaluating patients for appropriateness of intensive care. They will become familiar with anticipated staff loads based on patient acuity, thus learning how to utilize an intermediate care setting. Fellows will participate in quality management activities of the intensive care unit under the direct supervision of the attending. They will become familiar with the intricacies of explaining critical illness to families of patient, with associated issues such as advance directives. Autopsy and morbidity/mortality conferences will be attended when relevant.
Pulmonary and Critical Care Medicine Reading List
Visit the American Thoracic Society website for the current ATS Reading List. This list is reviewed by the ATS Training Committee and updated annually.
As part of the academic environment a research component is included in the three year pulmonary/critical care fellowship program. The division is engaged in many grant supported basic science and clinical research projects. All fellows are expected to participate in one or more of these projects. During their first year of training fellows will have an opportunity to obtain information about ongoing research through formal divisional research conferences, discussion with the program director and with individual faculty. After eight months of their first year of fellowship (in March of the following year after beginning of their fellowship in July) fellows will submit a research protocol signed by their tutors/mentor to the Research Committee. This committee will evaluate the merits of the protocol and determine whether the research will be conducted concomitantly with other assignments or whether a block of dedicated research months will be given to the fellow. Fellows will be assigned according to their preference to a faculty member as tutor/mentor, who will closely supervise the fellow to assure a productive learning experience. Fellows are expected to present their research results at national meetings and achieve publication of their work in peer reviewed journals. Fellows will learn about study design and critical interpretation of research data.
#2 Critical Care Tract:
The University of Miami/Jackson Memorial Hospital Critical Care Fellowship Training Program offers 4 approved positions. The program is accredited by the Association of Clinical Graduate Medical Education. The overall objective of our program is to prepare trainees for a wide spectrum of career opportunities, including academic teaching and patient care in critical care medicine, biomedical research, and community-based specialty practice. Typically, trainees spend two year in the program, consisting of rotations in a variety of critical care and related settings: specialized medical, general surgical, cariothoracic, neuroscience, trauma and bone marrow transplant intensive care units; pulmonary and anesthesia rotations; and clinical research. This two-year program makes trainees eligible for certification by the American Board of Internal Medicine in Critical Care Medicine. The mix of hospitals and variety of intensive settings provides a rich training environment spanning the gamut of modern intensive care. Fellow responsibilities vary by rotation, an include mentoring of junior trainees, as well as increasing clinical responsibility with progression through fellowship.
The Critical Care Medicine fellowship operates in close coordination with the Pulmonary/Critical Care fellowship and uses the same facilities (JMH, VAMC, UMH, UMHC). There are shared divisional Grand Rounds, journal clubs, imaging training, as well as many other conferences and learning activities. Enrolles in the Critical Care Medicine fellowship typically spend somewhat more time in training devoted to specifically to critical care than do trainees in the dual tract program. An abbreviated one year program may be available for graduates of other Internal Medicine subspecialty fellowships.