During the year of clinical training, fellows will have a curated balance of inpatient and outpatient time, including:
- Five months of dedicated inpatient time including:
- Three months on our primary advanced lung disease and transplantation service
- One month of inpatient time in our cardiovascular ICU on the post-lung team
- Two weeks on the ECMO service
- Two weeks on the transplant infectious disease service
- Five and a half months of dedicated outpatient time
- Two weeks of inpatient attending responsibilities
- Four weeks of vacation to be taken during outpatient blocks
- Mixed multidisciplinary didactic series of lectures, chalk talks, simulation
- Quarterly feedback sessions with program leadership
Fellow enrichment opportunities
- Four weeks of elective time, HLA lab, and transplant pathology instruction to be taken during outpatient blocks
- Up to five donor runs to experience organ procurement
- Education and experience in the interpretation and management of organs on EVLP
- Experience and education in the review of donor offers
- Experience in the conduct of transplant related procedures
- Protected research/quality improvement time
- Protected and funded participation in national and international meetings
- Active weekly participation at the lung transplant selection committee
Elective/sub-specialization opportunities
- Transplant infectious disease**
- Cardiothoracic intensive care**
- Extracorporeal membrane oxygenation
- Donor management Interventional pulmonology
- Cystic fibrosis
- Pulmonary hypertension
- Interstitial lung disease
- Advanced COPD
- Clinical Research
** 1 block week required as part of curriculum and not included in 4 weeks of electives
Advanced lung disease service: On ALDS the fellow will primarily rotate on “Index/Acute” Team A service where they will get detailed and robust experience managing high acuity inpatient evaluations, postoperative index lung transplant patients, and higher acuity admissions of longitudinal transplant patients.
Fellows will also spend some time on our “Team B” service managing longitudinal patients coming for augmented immunosuppression for rejection, less acute inpatient evaluations, and extrapulmonary transplant related complications. Depending on individual training decisions, fellows may manage patients with advanced pulmonary hypertension on parenteral vasodilator therapies and advanced COPD following endobronchial valve placement.
Cardiovascular ICU: While embedded in our cardiothoracic ICU, the fellow will experience the monitoring and management decisions inherent in the immediate postoperative period. Fellows will join the dedicated post-lung transplant team within the ICU, and function as an integrated member of the APP staffed team. Here the fellow will work directly with our Anesthesia/Critical Care colleagues and will also spend some time rotating on the post-heart transplant team to better understand the commonalities and differences within thoracic transplantation.
Transplant infectious disease: The goal of this rotation is to get exposure to the depth and breadth of the infectious considerations for transplant recipients. On this service, fellows will gain familiarity with the changing infectious complications at different temporal stages of immunosuppression post-transplant.
ECMO: Fellows will rotate with our thoracic surgeons and medical intensivists on theECMO consult service. They will gain familiarity with how different ECMO platforms/configurations are used to optimize candidates with different bridging priorities, support candidates during surgery, and protect grafts if needed after transplant.
HLA/immunology: Fellows will learn more about next generation HLA sequencing, and receive one-on-one review of high yield topics in transplant immunology with the HLA lab director. This will take place over several dedicated days throughout the first three months.
Histopathology: Fellows will obtain one-on-one instruction from our thoracic pathologists including a dedicated lecture and hands on case review. This will take place over several dedicated days throughout the first 3 months.
Lung Transplant Clinic: Fellows will have their own primary template which they will staff with rotating clinic attendings. Clinics will range from two to four and a half days per week depending on the time of year, and if the fellow has chosen to pursue additional disease sub-specialization. Fellows will not have any in-person clinic responsibilities while on inpatient lung transplant service.
