Our fellows clinical training experiences encompass all aspects of pulmonary and critical care medicine, including advanced consultative pulmonary medicine, sub-specialty training in advanced lung diseases, lung transplantation, and numerous types of critical care exposure. Our ECMO Program is a Platinum Level Center of Excellence for ECMO, which provides a unique opportunity for fellows to learn from international leaders and experts. Likewise, we have a large renowned lung transplant program and an active interventional bronchoscopy group who train fellows in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and advanced pleural procedures. The diverse patient population and our referral programs provide fellows with an exceptional and unique setting for training in pulmonary and critical care medicine.
Pulmonary Medicine Training
Columbia University has active clinical and research programs in sub-subspecialties of lung disease including cystic fibrosis, interstitial lung disease, COPD (LVRS), alpha-1 antitrypsin deficiency, sleep medicine, lung cancer, interventional bronchoscopy, LAM, and lung transplantation, providing a rich clinical experience in pulmonary medicine with diverse pulmonary pathology.
During the six months of inpatient pulmonary consult at Milstein Hospital, fellows diagnose and manage common and rare pulmonary diseases, and supervise medical student(s) and medical residents on the consult service. The diverse pulmonary pathology encountered stems from our tertiary care referrals, the varied interests of the faculty, and underserved patients from the surrounding neighborhoods. Columbia University has a large Bone Marrow Transplant program providing fellows the opportunity to gain expertise with the management of lung disease in the immunosuppressed patient, especially non-infectious pulmonary complications of malignancy, as well as pulmonary toxicities of medications. The fellows are perform inpatient bronchoscopies, thoracentesis, and placement of pleural tubes, both pigtail catheters and tunneled pleural tubes (PleurX), while on this service.
Our lung transplantation program is one of the oldest in the United States and is the major center for lung transplantation in the New York tri-state area. On this rotation, fellows are exposed to a wide variety of advanced lung diseases, including rare interstitial lung diseases, pulmonary hypertension, and cystic fibrosis, and they learn about post-transplant management, diagnosis, and management of lung transplant complications. In this rotation, fellows gain proficiency in bronchoscopy and transbronchial biopsies with attention to the role of bronchoscopy in post-transplant management and assessment of histologic findings in post-lung transplant patients.
Fellows are trained in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under direct supervision by one of our interventional bronchocsopists. Fellows perform EBUS in varied rotations, including the pulmonary consult service, interventional rotation, and fellows, are encouraged to perform outpatient bronchoscopies on their own patients.
Fellows have a two-week block dedicated to pulmonary physiology training at the beginning of their first year. During this block, fellows learn to read pulmonary function tests (PFTs), participate in Cardiopulmonary Exercise Testing (CPETs) and partake in asynchrony physiology teaching sessions. To supplement this experiential learning, the fellows core curriculum includes topics on pulmonary physiology. After completing their physiology block, pulmonary physiology training is integrated into the six months of inpatient pulmonary consult service. During this time, fellows will learn the diagnosis and management of sleep disorders, the interpretation of sleep studies and the interpretations of PFTs and CPETs.
Our Cardiopulmonary Sleep and Ventilatory Disorders Center, under the direction of Dr. Sanja Jelic, provides expert education in sleep medicine and physiology to our fellows who receive instruction in the interpretation of polysomnography, diagnosis and treatment of sleep disorders, and the techniques of measurement and interpretation of the physiology of sleep and breathing.
Ambulatory Care Training
Fellows maintain a continuity clinic throughout their three years of training where they learn the outpatient management of patients with a broad range of pulmonary disease. Continuity clinic is ½ day session per week.
Fellows have outpatient rotation where they participate in various sub-subspecialty clinics. Fellows also have the opportunity to have subspecialty clinic ½ day per week in additional to their continuity clinic as a third-year fellow. The fellows gain expertise in the diagnosis and outpatient management of advanced lung disease and experience the highly specialized, multidisciplinary approach implemented in these clinical centers to optimally manage these complex diseases. Available subspecialty clinics include:
- Lung Transplant
- Interstitial Lung Disease
- Pulmonary Hypertension
- Cystic Fibrosis
- Sleep Clinic
- Interventional Pulmonology
- Lung nodule clinic
Critical Care Training
Columbia University Irving Medical Center has 117 Intensive Care Unit beds, not including Pediatric and Neonatal ICUs. The fellows spend between 6 and 8 months rotating in our Medical Intensive Care Units, which are comprised of two active 12-bed units (MICU-A and MICU-B) and a 12-bed mixed medical/surgical ICU at the Allen Hospital. Fellows also spend time on our critical care consult service, intermediate-care unit, and other subspecialty ICUs at Columbia (CTICU, SICU, and NICU). To supplement airway experiences and training in the MICUs, first-year fellows also have an anesthesia rotation.
The patient population in our MICUs is diverse, both a busy inner-city MICU where patients are admitted from the surrounding neighborhoods, and a tertiary referral MICU for complicated, critically ill patients including patients with refractory hypoxemic respiratory failure on ECMO. Columbia University has extensive programs in transplant medicine including lung, liver, and kidney for which we provide pre-transplant care. During these rotations fellows are trained in critical care ultrasound, u/s guidance of critical care procedures, endotracheal intubation, and ECMO. All our units provide interprofessional training experiences as our fellows work closely with our ICU pharmacists, nurses, respiratory therapists, physical therapists, occupational therapists, and speech therapists. As fellows progress through their first year and gain critical care knowledge and expertise, they are provided the opportunity to lead rounds and independently manage the ICU with indirect supervision.
Medical Intensive Care Unit
MICU-A is a 12-bed unit, staffed by full-time nurse practitioners (NP) and is the home of our medical ECMO program. MICU-A offers a unique opportunity for fellows to manage patients supported by ECMO. Likewise, this rotation offers a robust interprofessional training experience in that fellows both educate and learn from the NPs as they work together in the ICU. The fellow is expected to be involved in all aspects of medical decision-making and patient care during the time that they are assigned clinical responsibility.
MICU-B is a 12-bed unit, staffed by internal medicine residents. Under the supervision of the ICU attending, the fellow cares for critically ill patients, supervises procedures, and is actively involved in education of the residents through small group teaching sessions and bedside teaching.
Night coverage of our intensive care units is provided by in-house critical care attending faculty, allowing for protected time for the fellow to sleep, recharge, and maintain their well-being.
Allen Intensive Care Unit
The Allen ICU is a 12-bed mixed medical/surgical ICU where fellows work with internal medicine residents in an urban community hospital setting. Fellows rotate here towards the end of their second year and are afforded the opportunity to lead ICU rounds with indirect supervision.
Critical Care Consult Service
Fellows provide critical care consultative service to all patients in the medical intermediate care unit and the non-medical intensive care units (neurologic intensive care unit, cardiac care unit, surgical intensive care unit). During this rotation, fellows become proficient in providing consultative care to critically ill patients with the full range of critical illness in multiple different settings.
Extracorporeal Membrane Oxygenation (ECMO) Program
As part of the Center for Acute Respiratory Failure, our adult ECMO program is one of the largest in the world. During the MICU/ECMO rotation, fellows participate in screening and discussing potential outside hospital ECMO transfers and are involved in the daily management of our medical ECMO patients. Many fellows pursue additional ECMO training during elective blocks and some identify ECMO as a clinical niche and obtain advanced training during the third year.
In addition to Medical Critical Care Rotations, fellows spend time rotating through the other nationally recognized subspecialty intensive care units at our institution to learn all aspects of critical care medicine.
- Cardiothoracic Intensive Care Unit (CTICU)
- Surgical Intensive Care Unit (SICU)
- Neurologic Intensive Care Unit (NICU)
First-year fellows have a two-week rotation on the anesthesia service where they learn endotracheal intubation by direct laryngoscopy and laryngeal mask airway placement in a controlled environment.