Albert 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.

Medical Intensive Care

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.

Pulmonary Consult Service

On the pulmonary consult service, subspecialty fellows become adept at performing fiberoptic bronchoscopy, thoracentesis and pleural biopsies 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 short term nursing facility. 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.

Pulmonary Function Rotation

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.

Surgical Intensive Care Unit

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 either a pulmonary critical care attending physician or surgical/anesthesia intensivist in the evaluation and management of respiratory disorders in this group of critically ill patients.

The SICU/HSU consultation service is a component of the clinical activity of the pulmonary critical care division. Fellows are supervised by certified anesthesiologists and cardiothoracic surgeons on this rotation. This format will stress the integration of historical and physical findings with hemodynamic, laboratory, and radiographic data. Bedside skills will be stressed in the detection and management of the disease process and in the assessment of therapeutic interventions.

Infectious Diseases

Pulmonary fellows will acquire proficiency in dealing with fever, infections, and the prevention of infections in critical care patients. The pulmonary fellow will perform infectious disease consultations in the critical care units learning to evaluate and manage fever in the critical care patient with attention to nosocomial and community acquired pneumonias. Fellows round on patients on the consultation service on a daily basis. Patients will be interviewed and examined with respect to their infectious or febrile problems. All pertinent laboratory and radiographic data will be reviewed. On a daily basis an infectious diseases attending will make rounds with the fellow. All patients on the service will be interviewed and examined. The fellow will present his/her findings and plan of action. Rounds will include both didactic and bedside teaching on a daily basis. The consultation service will serve all the critical care units of the Albert Einstein Medical Center. Review of microbiological materials in the laboratory is performed on a weekly basis.

Anesthesiology

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.

Cardiac Care Unit

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. A radiology viewing room is located within the unit. 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.

Sleep Laboratory Rotation

The sleep lab rotation is located at the Lankenau Hospital under the supervision of Dr. Donald Peterson who also holds an academic appointment at Thomas Jefferson School of Medicine. Dr. Peterson has had formal training in sleep medicine and has run the sleep lab and clinic at Lankenau for over 15 years. The lab is equipped with the state of the art polysomnography equipment and has the capacity to study 2- 3 patients per night.

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. Understand the physiology of sleep and sleep disorders. 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. The sleep lab rotation also enables the fellow to interact with a variety of healthcare professionals in the treatment of patients with sleep apnea and also gain experience in sleep related research projects.

Ambulatory Outpatient Pulmonary Clinic

In order to provide the trainee with the opportunity to follow patients with chronic illnesses a mandatory day per week ambulatory clinic meets each Monday. To maintain continuity of care each fellow will have a book of patients, which will be his roster to follow over the two years. Additions will be made from the discharges from the hospital as well as referrals coming from other medical and subspecialty clinics. Third year fellows will see new outpatients during a weekly outpatient clinic and follow those patients with the attending for 6 months during their last year. This will ensure that the Monday continuity clinic does not become too crowded (no more than 4 fellows in attendance). 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 of 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.

Long Term Acute Care (LTAC)

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. Patients on this unit come from Albert 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. The fellow will participate in the weekly multidisciplinary care conference when patients under his/her care are being discussed.