Pulmonary & Critical Care Medicine Fellowship

Clinical Training Overview

Clinical training comprises the entire first year and parts of the second and third years of the fellowship.

Year one is divided into 12 four-week rotations. These consist of rotations at University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), the Veterans Affairs Medical Center/Puget Sound Health Care System-Seattle (VAMC), and the Fred Hutchinson Cancer Research Center (FHCRC).

In the second and third years, rotations are primarily in outpatient pulmonary clinics at the UWMC, HMC and FHCRC.

Clinical Rotations

The fellow's clinical responsibilities vary depending on service and hospital. At each location, the fellow works under the direct supervision of a designated attending physician. The on-call schedule varies between rotations, but there is no in-house call during the fellowship.

University of Washington Medical Center
Pulmonary Consultation: The fellow supervises a team consisting of a medical resident and medical student(s) in performing in-patient and occasional emergent out-patient pulmonary consultations.  Also attends one half-day general pulmonary clinic. Patient population is largely tertiary care.

Lung Transplant: The fellow sees and manages lung transplant patients in both inpatient and outpatient settings.

Medical/Transplant Intensive Care Unit: The fellow supervises five medical residents in providing intensive care to patients in the MICU (closed unit) including post-operative liver, lung and kidney-pancreas transplant recipients. MICU patients are often transferred in from outside hospitals.

Fellows on a comparative pulmonary physiology outing with Dr. David Pierson

Surgical Intensive Care Unit:  The fellow supervises housestaff from surgery, anesthesiology, and emergency medicine in providing care to post-operative surgical patients.

Harborview Medical Center
Pulmonary Consultation: The fellow supervises a team of medical residents and/or students in providing inpatient consultation.  Also attends one half-day out-patient clinic.

Neurologic Critical Care Service: The fellow supervises residents in providing care to critically ill patients with neurologic injuries, working closely with the neurosurgical service.

Medical Intensive Care Unit: The fellow supervises four residents and four interns in the care of critically ill medical patients in this large public hospital setting.

Trauma Critical Care: The fellow participates in the multi-disciplinary care of critically ill patients with traumatic injuries. Includes experience with trauma resuscitation in the Emergency Department.

Veterans Affairs Medical Center
Medical Intensive Care Unit: Fellow supervises housestaff and ACPs providing critical care to veterans.

Pulmonary Consultation: The population of the VA provides ample exposure to chronic lung disease and lung neoplasms. Attends one half-day general pulmonary clinic.

Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
The fellow provides pulmonary consultation and supervises critical care services to an inpatient population of oncology patients, including bone marrow/stem cell recipients.
The Oncology-Bone Marrow Transplant ICU is closed and staffed with ACPs.


University of Washington Medical Center
Subspecialty Clinics: This rotation involves the fellows in the half-day subspecialty clinics at UWMC (adult cystic fibrosis, pulmonary vascular disease, interstitial lung disease, sleep, and neuromuscular disease) and HMC (tuberculosis).

Associated Specialty Clinics:
This rotation includes the fellows in clinics related to pulmonary medicine, including allergy, laryngology, and thoracic surgery.

Fred Hutchinson Cancer Research Center
Outpatient consultation and procedures are provided by the fellow during this one-month rotation.

Continuity Clinic
All second and third year fellows will attend one half-day pulmonary clinic per week at one of the primary clinical sites (UWMC, HMC, or VAMC).

Two months of clinical elective time is provided.

Educational Activities

Several scheduled weekly conferences and seminars supplement the fellow's clinical training. These include curricula in clinical pulmonary medicine and critical care (presented by faculty and fellows) to prepare for the board exams in both areas.

Fellows present cases in rotation at the weekly Seattle Area Chest Grand Rounds. When on service at those sites they also participate in the additional chest conferences at VAMC, MAMC and UWMC.

chest grand rounds
Seattle Area Chest Grand Rounds

Other regular division teaching activities include weekly post-clinic conferences, a bi-weekly research seminar, a monthly journal club, and weekly or biweekly meetings of research interest groups in cell biology, gas exchange, pulmonary circulation, exercise physiology, and clinical research.

During the second and/or third year of fellowship training, fellows will participate as small group instructors in Human Biology 541 for second-year medical students.  The Division encourages and supports the fellows attendance and participation at regional and national scientific meetings.

Procedures and Areas of Training

Under supervision and instruction by the faculty, fellows gain mastery in all of the procedures related to the practice of pulmonary and critical care medicine, including fiberoptic bronchoscopy and related procedures, polysomnography, and exercise testing.

Procedures such as estabishing central venous access, passage of pulmonary arterial balloon flotation catheters, and radial arterial catheterization are generally learned during residency training in internal medicine, completion of which is a requirement for entrance to the program.  However, supplementary training in these procedures as well as in airway management, is provided under the supervision of division faculty as required.

During their clinical training, fellows acquire a basic knowledge of all relevant areas ofpathogenesis, pathophysiology, manifestations, clinical assessment, and management of pulmonary disease.  In addition, they acquire in-depth knowledge in the most common and otherwise most important diseases and conditions, including chronic obstructive pulmonary disease, asthma, tuberculosis, pulmonary aspects of HIV infection, and the different forms of acute respiratory failure.

Education and training of all fellows in the areas of occupational safety and health care regulations, critical assessment and decision analysis, continuous quality improvement, psychosocial, economic, and ethical issues, teaching skills, research methodology, and professionalism, are also provided by the training program.

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