Shands Hospital at the University of Florida Clinical Rotations:
- Pulmonary Consult Service
- Lung Transplantation and Advanced Lung Disease
Gainesville Regional VA Medical Center Clinical Rotations:
- Consult Service
Training Program Summary:
22 clinical months
- 1 month each: cardiothoracic, neurology and surgical ICUs
- 2-3 months at Orlando Regional Medical Center multisystem ICU
- 1-2 months of lung transplantation and advanced lung disease
- 3-4 months each of ICU and pulmonary consult service at VA medical center
- 3-4 months each of MICU and pulmonary consult service at Shands Hospital at University of Florida
- 14 months of research and elective time
First year of training includes eleven clinical months. Fellows receive orientation and procedure simulation training at the start of fellowship. Education by our dedicated chest radiologist also occurs in the first year.
MICU and Inpatient Pulmonary Consultation Services
An active consultation service is present at each hospital. The fellow will spend 4 months on the Shands Hospital consult service and 4 months combined VA Medical Center consult and MICU service over the course of the fellowship. Two to five consults per day are seen. While at the VA, the fellow will also participate in the Lung Mass Clinic. Pulmonary function tests are reviewed and interpreted by the fellow and faculty on the consult service. Bronchoscopic and pleural procedures to further evaluate in-patient consults are performed by the fellow and faculty on the consult service. The fellow will have the opportunity to teach residents and students doing a pulmonary medicine elective while on the consult service.
During the fellowship, the fellow will rotate through the MICU service at Shands Hospital for 4 months and the VA Medical Center MICU for 4 months. The fellow is responsible for performing or supervising procedures such as intubation, central line placement, Swan-Ganz catheter placement, arterial line placement, and chest tube placement. The fellow supervises and teaches the housestaff on the MICU rotation. In the third year of fellowship, the fellow will spend 2 months in the SICU.
For 3 months during the fellowship, the fellow will rotate on the lung transplant and advanced lung disease service. While on this service, the fellow will have the opportunity to evaluate patients for lung transplantation and to provide care for those patients who have undergone lung transplant. The fellow will also have exposure to management of the patient with advanced lung disease.
Fellows will rotate on the sleep medicine and pulmonary diagnostics rotation for 3 months during their fellowship. While on this rotation, the fellows will interpret polysomnograms under the guidance of Dr. Berry. In addition, fellows will supervise and interpret methacholine challenge tests and cardiopulmonary exercise tests under the guidance of the faculty on the consult service.
Afternoon clinics at Shands Hospital at the University of Florida and Gainesville VA medical center are staffed by the faculty and fellows of the Pulmonary, Critical Care, and Sleep Medicine Division. Fellows have one-half day clinic a week at Shands throughout the fellowship. This permits exposure to a variety of subspecialty clinics, including cystic fibrosis, pulmonary hypertension, lung mass and interstitial lung disease. First and third year fellows also attend the VA Medical Center Clinic one-half day per week, which serves as a general pulmonary continuity experience. During the second year of fellowship, the fellows spend one-half day a week in the sleep medicine clinics, six months at Shands and six months at the VA. When on the Pulmonary Consult Service at Shands Hospital, fellows assist the attending in seeing urgent outpatient consults.
Both hospitals are equipped with state of the art pulmonary function testing and bronchoscopy facilities. Fellows are taught how to perform bronchoscopy, bronchial brushing, bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration. Fellows are also taught how to perform thoracentesis, closed pleural biopsy, and chest tube insertion. Instruction regarding the interpretation of methacholine challenge testing, cardiopulmonary exercise testing, shunt study calculation, and polysomnogram interpretation is provided. For those fellows who are interested in interventional pulmonology, experience with endobronchial laser therapy, endobronchial electrocautery, stent placement, transtracheal oxygen catheter placement, and thoracoscopy is provided. While rotating in the MICU, fellows are taught intubation, chest tube insertion, arterial line placement, central line placement, and Swan-Ganz catheter placement. The fellows perform procedures under faculty supervision.
Each fellow spends 2 months during the third year of fellowship in the Shands Hospital Surgical Intensive Care Unit/Burn Unit under the supervision of the Anesthesia/Critical Care Medicine Service. On this rotation, the fellow is exposed to care of the critically ill post-operative, neurologic injury and trauma patients in the Surgical ICU. Cardiothoracic surgery and ICU exposure is also provided including the opportunity to harvest donor organs and assist with lung transplantation and lung resection surgeries. Fellows experience multisystem ICU patient management on rotations at Orlando Health, a tertiary referral center in downtown Orlando, FL. Housing is provided and fellows participate in patient care and educational activities with medical critical care faculty members and fellows.
Each fellow may spend an elective month on a TB rotation. This includes a one week course and three weeks of attending Public Health Clinics under the supervision of Dr. Michael Lauzardo a division faculty member who is also the principal investigator of the Southeastern National Tuberculosis Center.
Elective rotations are also available in diagnostic radiology with a chest radiologist, pediatric pulmonology, and cardiac catheterization.
Each fellow is provided block time for research and is required to investigate an area of pulmonary or critical care medicine. Both clinical and basic science research experiences are available. Preparation and presentation of a research project is a required aspect of this training program and the preparation and submission of a manuscript is highly encouraged. The program provides training in the areas of study design, performance, statistical analysis, writing, and editing. Each fellow will select and be supervised by a faculty mentor in the conduct of their project after their first year.