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Einstein Medical Center’s Division of Pulmonary Disease/Critical Care Medicine has a long history of excellence in graduate medical education and has been training subspecialty fellows for over 30 years.
The Pulmonary Disease/Critical Care Fellowship Program offers residents an exceptional opportunity to train in an urban environment where the spectrum of illnesses is vast and the acuity is intense. Einstein’s designation as a Level I Trauma Center along with a large medical intensive care unit, well-equipped pulmonary function laboratory and respiratory therapy department insure residents are provided a wealth of educational opportunities. Over 2500 pulmonary function tests and 400 bronchoscopies are performed at the Medical Center annually. Within this environment, our Board-certified faculty provides unsurpassed commitment to resident education and to clinical research.
Graduates of our program are assured the best preparation for a successful career as a pulmonary/critical care physician.
In the medical intensive care unit, pulmonary fellows learn to manage patients with multi-system failure and a variety of life-threatening illnesses. The medical intensive care unit offers a challenging patient mix and exceptional learning opportunities. Each unit team consists of four PGY-1 residents, two senior residents, a subspecialty fellow and the teaching attending. The pulmonary fellow in conjunction with the unit attending conduct daily management rounds and conferences for the medical residents.
Our designation as a Level 1 Trauma Center and participation in a helicopter transport program ensure a broad experience for fellows. Active programs in pulmonary and hepatobiliary disease, infectious disease and transplantation also ensure outstanding learning opportunities for fellows. A state of the art ultrasound scan is available for line placement and cardiac evaluation. In order to kept the census in the ICU to 15 a second ICU team has been created to address the overflow. This team also consults in the surgical and coronary units. This rotation is designated MICU2.
On the pulmonary consult service, subspecialty fellows become adept at performing fiberoptic bronchoscopy, thoracentesis and interpreting chest X-rays and CT scans. In addition, subspecialty fellows interact frequently with house staff and medical students enabling them to acquire substantial teaching experience
The pulmonary consult service team is comprised of the teaching attending, subspecialty fellow, one or two medical residents and one or two medical students. Consults are seen throughout the hospital on the medical-surgical service, rehabilitation unit, long term ventilator unit and the medical step down unit . Ample time is provided to exam the patient, review pertinent clinical and radiographic data prior to presentation to the attending. Comprehensive teaching rounds are held daily and cases are presented at Pulmonary Grand Rounds conference each Thursday. A bronchoscopy simulator is available for the training of fiberoptic bronchoscopy.
During the pulmonary function rotation, subspecialty fellows learn the methodology behind and the performance and interpretation of spirometry, lung volumes and diffusing capacity. In addition, cardiopulmonary exercise and metabolic cart studies to evaluate nutritional needs are available.
Bronchoprovocation studies with methacholine are performed. A body box plethysmograph as well as gas dilution studies are used to assess lung volumes.
Each day all studies are reviewed with the attending physician. The subspecialty fellow assigned to this rotation will give a seminar devoted to pulmonary physiology each month.
This rotation trains pulmonary/critical care fellows in the evaluation and management of respiratory problems outside of the medical intensive care unit. This includes the assessment and management of pulmonary disease affecting patients with cardiac disease as well as post-operative general surgery, neurosurgery, and open heart surgical patients. To this end the fellow will work in a consultative capacity with a pulmonary critical care attending physician in the evaluation and management of respiratory disorders in this group of critically ill patients.
An opportunity is available to rotate in a burn unit at an affiliate institution. In addition, a one-on-one rotation with a thoracic surgeon is available in the evaluation of both outpatients with lung cancer and the observation and participation in operative thoracic procedures.
To acquire a fund of knowledge in the management of the surgical patient undergoing general, spinal and regional block anesthesia. Fellows will be assigned to an anesthesiologist each day by the anesthesia clinical coordinator. Under the supervision of the attending anesthesiologist, the fellow will be able to place central lines, pulmonary artery lines, and arterial lines as well as perform endotracheal intubation. Fellows will observe a variety of different anesthetic techniques and surgeries and will be able to discuss the case with the anesthesiologist. They will become exposed to recognition and therapy of intraoperative anesthetic issues including laryngospasm, bronchospasm, negative pressure, pulmonary edema, etc. Fellows will acquire experience and proficiency in the management of the airway with particular attention to techniques of endotracheal intubation, laryngeal airway masks and double lumen endotracheal tubes.
Each room in the CCU is hardwired and capable of complete hemodynamic monitoring, which allows for pulmonary artery catheterization, temporary pacemaker insertion, intra-aortic balloon insertion, electrical cardioversion, and other invasive procedures. The CCU housestaff medical team consists of one cardiology fellow, one pulmonary fellow, two upper year medical residents, and four interns.
The primary goal of the CCU rotation for the pulmonary fellow is to acquire expertise in bedside evaluations, ordering and interpreting diagnostic studies, and ordering and performing bedside and cardiopulmonary interventions. Fellows learn to effectively supervise and teach medical residents and to achieve the high level of professionalism necessary to interact effectively with patients, families and other health professionals.
In addition an opportunity is available for the fellow to perform RHC in the cardiac catheterizaztion lab.
A six-bed sleep center is available on our campus supervised by Dr. G. Murali.The fellows will develop an understanding of the techniques available to monitor and diagnose a variety of sleep disorders with special emphasis on cardiopulmonary disorders. The physiology of sleep and sleep disorders will be emphasized. The fellow will understand the indications for a number of different studies offered in a sleep laboratory and to distinguish between obstructive and central sleep apnea. The opportunity to score and interpret complex polysomnographic recordings is available to pulmonary and critical care fellows. Sleep training is performed on a weekly basis during the nine months of research.
In order to provide the trainee with the opportunity to follow patients with chronic illnesses a mandatory ½ day per week ambulatory clinic is required. To maintain continuity of care each fellow will have a book of patients, which will be his roster to follow over the three years. Additions will be made from the discharges from the hospital as well as referrals coming from other medical and subspecialty clinics. The fellow will make all scheduled appointments with the patient and clinic staff and arrange for all pulmonary function tests, radiographic studies and procedures as required.
Fellows will learn the subtleties in the physical examination of the pulmonary patient and arrive at a differential diagnosis and treatment plan of the patient. Fellows will gain an appreciation for the chronic nature and long term management of the pulmonary patient following hospitalizations with particular attention to continuity of care. Fellows will communicate with the patient’s family and referring physician with particular attention to ethical end-of-life issues, smoking cessation counseling, vaccination, and the scheduling of procedures.
The long term acute care unit provides care for patients with complicated medical problems who require continued acute care at a level that cannot be provided on a general medical floor. It is housed in the Willowcrest Nursing Unit of the Medical Center. Patients on this unit come from Einstein Medical Center and as referrals from throughout the area. The majority of these patients have active respiratory problems including chronic mechanical ventilator dependency. The pulmonary/critical care fellows will be involved in the daily care of these patients developing an approach to ventilator and airway management.
In the LTAC fellows will understand the interdisciplinary nature of the care of the chronic ventilatory dependent patient, the nutritional and physical therapy needs of the chronic vent. dependent patient, and recognize the various weaning methods utilized to wean the dependent patient with particular attention to relationship with the respiratory therapy staff.
The pulmonary/critical care fellow will be responsible for answering consults. He/she will review all prior hospital records, interview and examine the patient, and review all radiographic studies. Subsequently a differential diagnosis and management plan will be formulated.
An elective in the infectious disease division is available. Consults are seen in both the critical care units and the inpatient floor consultation service. There is a monthly joint pulmonary/infectious disease conference devoted to issues in infectious diseases and their management. Presentations are given by both infectious disease and pulmonary fellows.
Einstein Medical Center Philadelphia School of Radiologic Technology has developed a partnership agreement with Philadelphia University
Congratulations to senior students LeighAnn Sulzbach and Sarah Sliwinski for winning Third Place in the annual Philadelphia Society of Radiologic Technologists’ 2012 Student Day TechnoBowl competition
Philadelphia, PA, June 29, 2009 - With fierce determination and tremendous aptitude, the team of psychiatry residents from Einstein Medical Center was crowned national champions of Mind Games, a Jeopardy-style game held at the American Psychiatric Association's (APA) annual meeting.
Renowned Rehabilitation Facility MossRehab is Exclusive Site of U.S. Clinical Trials of ReWalk™ Philadelphia (June 30, 2009) - MossRehab, one of the nation's leading rehabilitation hospitals
Philadelphia, PA, July 8, 2009 - Hipolito (Pol) Custodio, III, MD, fourth year resident in Obstetrics and Gynecology (Ob/Gyn) at Einstein Medical Center, won the "Resident Bowl," an annual quiz competition sponsored by the Obstetrical Society of Philadelphia.