Pulmonary fellows at Penn progress through individually tailored programs that prepare them for eligibility for the pulmonary, critical care, and/or sleep boards of the ABIM. For example, to be eligible for both the Pulmonary and Critical Care boards, fellows will train for 3.5 years. The first 18 months of training are focused on clinical training in pulmonary medicine and critical care training, and the final 24 months are dedicated to research. Many pursue additional research career development beyond fellowship training as instructors in Medicine. The training sequence is flexible. To be board-eligible in sleep medicine as well, the fellow must participate in an additional year of clinical sleep training.
The Hospital of the University of Pennsylvania (HUP) serves as home base for clinical fellowship training. HUP, a 695-bed teaching hospital located on the university campus, was the first hospital in the nation to provide bedside training for medical students. The hospital functions as a primary care center for the neighboring inner-city community and provides tertiary referral care to patients from the region as well as across the nation. HUP has distinguished itself through its multidisciplinary approach to patient care.
Fellowship training also takes place at the Philadelphia Veterans Administration Medical Center (VAMC) and Penn Presbyterian Medical Center. The VA is located across the street from HUP and serves a major role in clinical training. Penn Presbyterian is a community and tertiary care hospital situated five blocks from HUP and fully integrated into Penn's clinical activities.
Core Clinical Training in Pulmonary Medicine
All fellows complete 18 months of intensive training in clinical pulmonary medicine and critical care. Currently the first 18 months of fellowship features rotations including:
- Medical Intensive Care Unit (MICU)
- Pulmonary consultation service
- Procedure and resuscitation service
- Veterans Affairs Medical Center (VAMC)
- Advanced lung disease service
- Trauma unit
- Cardiovascular surgical ICU
- Neurological ICU
- Cardiac care unit
- Pulmonary diagnostic services (including opportunities for intubations and learning echocardiography)
- Pulmonary diagnostic laboratory
- Interventional pulmonary service
In addition, fellows participate in their own outpatient pulmonary practice one half-day a week throughout the year. Pulmonary outpatient training continues throughout the remainder of the fellowship, as does required participation in the daily teaching conferences of the Division.
Ambulatory Care Training
Training in outpatient medicine is a major component of the fellowship experience at Penn. Such training takes place in a wide variety of venues, providing fellows with a diverse experience and exposure to a broad spectrum of patient populations.
During the first two years, each pulmonary fellow sees outpatients one half-day a week in a General Pulmonary Continuity Clinic, closely supervised by teaching faculty. In the first year, this is supplemented by ambulatory experiences at the VAMC in general pulmonary and sleep. Beginning the second year of training and continuing through the third year, in addition to maintaining their own continuity practice, fellows select subspecialty clinics to attend on a regular basis. Fellows may choose from a menu of general faculty practices and a variety of specialized outpatient programs, including:
- Sleep medicine
- Lung transplantation
- Cystic fibrosis
- Pulmonary vascular disease
- Interstitial lung disease
- Lung cancer
In the third year, each fellow is assigned to the practice of one of Penn's faculty in a preceptorship that provides exposure to a wide variety of complex pulmonary disorders and allows for a one-on-one experience between fellow and attending.
Conferences represent an important educational component in fellowship training and complement the hands-on experience obtained at the bedside. Each academic year begins with the Summer Lecture Series. This three-month course is comprised of over 35 lectures covering a spectrum of topics fundamental to the practice of Pulmonary and Critical Care Medicine. Thereafter, multidisciplinary clinical conferences are scheduled every day of the week for the remainder of the year. These include the following:
- Pulmonary/Allergy and Immunology Conference
- Pulmonary Clinical Case Conference
- Lung Center Conference
- Radiology Teaching Conference
- Interstitial Lung Disease Conference
- Interventional Pulmonology Conference
- Lung Cancer Lecture Series
- Critical Care Conference
- Journal Club
- Sleep Conference
In addition, there are conferences focused on the research interests within the division including a basic science conference and a clinical science conference.
Specialized Training Pathways
In addition to the core programs in Pulmonary Medicine and Critical Care, fellows have the option of pursuing specialized training in a conventional or innovative area of special clinical interest. Several of these tracks are described below.
All fellows will receive a core education in sleep in their first two years of fellowship through a lecture series, participation in sleep clinics, and a regular polysomnogram conference. Fellows interested in making sleep disorders the focus of their career have the opportunity to pursue additional in-depth clinical training in sleep medicine, focusing on both respiratory and non-respiratory disorders of sleep. This will require an additional year of clinical work focusing on sleep in the ACGME-accredited sleep fellowship. Pulmonary fellows are accepted directly into the sleep fellowship without an additional application process.
Advanced Lung Disease and Lung Transplantation
A specialized pathway is available for in-depth clinical training focusing on the care of patients with advanced, disabling lung disorders. Areas of exposure include:
- Lung transplantation
- Lung volume reduction surgery
- Vasodilator therapy for pulmonary hypertension
- Pulmonary thromboendarterectomy for chronic pulmonary embolism
- Use of anti-inflammatory and antifibrotic agents in the treatment of interstitial lung diseases
A specialized pathway incorporating an additional year of training has been established to train fellows in advanced bronchoscopic, pleuroscopic and other techniques employed in the care of patients with lung disease. Skills acquired as part of this training include:
- Laser bronchoscopy
- Insertion of tracheal and bronchial stents
- Rigid bronchoscopy
- Endobronchial brachytherapy
- Insertion of chest tubes and Pleurex catheters
- Percutaneous tracheostomy
By special arrangement, fellows may develop their own advanced clinical training pathways. In recent years, fellows have extended their core clinical training with advanced studies in allergy and immunology, critical care administration, post-graduate education administration, and international health.