Clinical Training

Pulmonary Fellowship Training


Fellows rotate between two hospitals, Boston Medical Center and the Boston VA Medical Center; together, these facilities provide rich and diverse clinical material. Boston Medical Center, formed by the merger of Boston City Hospital and Boston University Medical Center Hospital, provides a unique clinical training ground for subspecialty training in pulmonary and critical care medicine. The Menino Pavilion (formerly Boston City Hospital) has a long tradition of providing high quality care to indigent patients and continues to attract a large number of inner city, immigrant, and HIV-positive patients, consistent with its roots as Boston’s only public hospital. Meanwhile, the East Newton Pavilion (formerly Boston University Hospital) provides a full range of tertiary level medical care with active programs in thoracic oncology, solid organ and bone marrow transplantation, cardiac catheterization and cardiac surgery. As a referral center for the entire New England region, the Boston VA provides fellows with the opportunity to direct the initial evaluation of lung cancer, manage severe airway diseases, and work-up a host of rare infiltrative lung diseases.

First year fellows rotate through six clinical rotations twice through the year. The clinical rotations and fellow responsibilities include:

ICU at Boston Medical Center (BMC) Menino Pavilion

This is a hands-on critical care rotation in which the fellow is dedicated to a 20-bed critical care unit. This is a busy, urban ICU where most patients are directly admitted from the emergency room and present with a wide array of acute problems. Under the supervision of the ICU attending, fellows oversee care of critically ill patients and perform procedures. To facilitate their role as academicians, fellows are actively involved in the education of the medical house staff. Fellows lead daily “Vent Rounds” with the ICU respiratory therapist and critical care nurse. In this capacity, fellows expand their knowledge base of ventilator management and expedite the weaning of patients from the ventilator.

Pulmonary Consult Service

In this rotation, the fellow is responsible for all in-patient pulmonary consultations and performance of inpatient bronchoscopies. The consult service retains the flavor of Boston City Hospital and fellows have the opportunity to see patients with a wide range of acute pulmonary problems, including a large number of international health problems (TB and other infectious diseases), pulmonary complications of HIV, sickle cell disease, and obstetric pulmonary problems.  The fellow is also responsible for critical care consultative services to patients in the other critical care units of BMC including the CCU and SICU. Reflecting the tertiary level of care provided at ENC, patients present with complex medical problems including pulmonary complications of bone marrow and solid organ transplantation, rheumatologic disorders, malignancy and chemotherapy related lung disease. In addition, there are active thoracic oncology, neurosurgery, cardiac surgery and interventional cardiology services, providing the fellow with a broad exposure to numerous complex, pulmonary problems typical of an academic medical center.

Physiology Rotation

The Pulmonary Hypertension Center at Boston Medical Center is a tertiary referral center for patients with a variety of pulmonary vascular diseases.  Fellows on this rotation work with Dr. Harrison Farber and Dr. Elizabeth Klings daily in the care of patients admitted to the Pulmonary Hypertension Service.  The fellow on this rotation performs all the right heart catheterizations for patients undergoing evaluation for pulmonary hypertension.  The pulmonary hypertension team performs more than 250 right heart catheterizations per year.  In addition, the fellow on the physiology rotation will read and interpret the pulmonary function tests performed daily at Boston Medical Center, with attending supervision and education on the finer points of PFT interpretation.  The physiology fellow is also responsible for the management of the Pleural Service patients and will place and management chest tubes under the supervision of the Pleural Service attending.  This main theme of this rotation is the physiology of the the parenchymal, pleural and vascular systems of the lung.

ICU at Boston Medical Center (BMC) Newton Pavilion

Similar to the Menino Campus ICU experience, the pulmonary fellow on this rotation is caring for an inner city patient population presenting with acute critical care illness.  The fellow on this rotation is working with a team comprised of residents and critical care nurse practitioners.  The patients in this ICU tend to have serious chronic medical conditions including chronic renal failure, oncological problems, cardiac issues, and post-transplant complications.  This fellow is also available to assist the physiology fellow with right heart catheterizations in the catheterization lab.

VA Outpatient/ Pulmonary Acute Care Clinic

In this rotation the fellow performs outpatient consults and outpatient pulmonary workups. In this role, fellows perform a variety of outpatient procedures including referral for bronchoscopy, pleural biopsies, thoracenteses. Fellows are directly responsible for the evaluation and presentation of new lung cancer cases to the multidisciplinary Lung Cancer Board. The clinic also has medical residents that rotate through, and the clinic is supervised daily by a pulmonary attending. Since physicians throughout New England refer patients to this clinic, there is a rich and diverse array of pulmonary pathology.

VA inpatient consult/Procedures

This is a combined pulmonary and critical care medicine rotation. Fellows are responsible for consults on the inpatient medical service; maintaining contact with and assisting the MICU team and ICU attending physician; performing and supervising procedures in the MICU (bronchoscopies, Swan-Ganz catheters, central line placement); and the supervision and education of medical residents assigned to the MICU team; and performing outpatient bronchoscopies referred for this procedure by the Pulmonary Acute Care Clinic and the continuity clinics. The first year fellows share approximately 200 bronchoscopies annually during this rotation. The Fellows are also responsible for providing critical care consultative services for patients in the surgical critical care and coronary care units of the VAMC.

Cardiopulmonary Exercise Testing Rotation:

Fellows rotate through the CPET lab during the second and third years. In this capacity, they are responsible for assessing the appropriateness of the indication for CPET, as well as the evaluation, execution, and analysis of the study. Fellows review each CPET on an individual basis with a supervising attending. The educational goals of this rotation include becoming familiar with the indications and contraindications for CPET, determining the impact of co-morbid medical conditions on exercise physiology, and the utilization of CPET for pre-operative assessment for patients prior to thoracic surgery.