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 five 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 22-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. In addition, the ICU fellow is responsible for performing right heart catheterizations on patients admitted to the pulmonary hypertension service.

Consults at the BMC-Menino Pavilion

In this rotation, the fellow is responsible for all in-patient pulmonary consultations, performance of inpatient and outpatient bronchoscopies, and interpretation of pulmonary function tests. 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. Finally, there is an active pulmonary hypertension service; through which fellows gains expertise in diagnosing and treating various causes of pulmonary hypertension.

Consults at the BMC- East Newton Pavilion (ENC)

This is a combined pulmonary and critical care medicine rotation. The fellow is responsible for all pulmonary consults in the ENC pavilion and provides 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.

ICU at Boston Medical Center (BMC) Newton Pavilion

This is a hands-on critical care rotation in which the fellow is dedicated to the medical critical care units on the Newon Pavilion. 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 with a team of interns and residents. The Pulmonary and Critical Care Medicine service co-manages neurocritical care patients in the intensive care units located on the Newton Pavilion along with the Neurocritical Care faculty members. To facilitate their role as academicians, fellows are actively involved in the education of the medical house staff. In this capacity, fellows lead daily ‘Vent Rounds’, during which they teach residents about ventilator management and expedite the weaning of patients from the ventilator. Other shared teaching responsibilities include leading didactic teaching sessions that cover a core curriculum of ICU topics. In addition, the ICU fellow is responsible for performing right heart catheterizations on patients admitted to the pulmonary hypertension service.

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 bronchscopies 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.