Pulmonary and Critical Care Fellowship Program at the University of Virginia 2008
Pulmonary and Critical Care Fellowship The Pulmonary and Critical Care Fellowship Program at the University of Virginia is a three-year program, which provides a strong background in clinical pulmonary medicine and the management of critically ill patients. One year of research is incorporated into the fellowship in a 12-month block. This may be in either clinical or basic science areas. Additional research time at the end of the fellowship for those preparing for research intensive careers may be accommodated if additional funding is obtained. At the end of the fellowship, participants will be eligible to take both the Pulmonary Medicine and the Critical Care Certification Exams. THE CHARLOTTESVILLE AREA The scenic Blue Ridge Mountains serve as a backdrop to Charlottesville and the University of Virginia. The city of 115,000 offers a wide variety of recreational and cultural activities. Hiking, biking and jogging are popular, as are spectator sports, football, basketball and soccer. Theater, opera and music of all types are available in the Charlottesville area. Ethnic and gourmet restaurants, coffee bars, a micro-brewery and several local wineries add to the character of the city. Washington, D.C. and Richmond are close enough to visit and enjoy, while living in a safe and low traffic environment. The area is popular with tourists who visit the Grounds of the University, the homes of Thomas Jefferson, James Madison, and James Monroe and tour the wineries of Albemarle County.
The University was founded by Thomas Jefferson in 1819. Total student enrollment is about 18,000. The University has achieved and maintained national status in academics, service, research and athletics. It is consistently ranked among the best public institutions in the country.
The School of Medicine is the 10th oldest medical school in the United States, opening in March of 1825. The 680 bed University Hospital is just over 10 years old and is continually being updated to remain state of the art. For the last 5 years it was ranked in the top 100 hospitals in the country by the US News and World Report survey. There are seven intensive care units and a number of specialized programs drawing patients from three states. The University is moving toward computerized medical records and currently clinic notes, discharge summaries and laboratory reports going back several months are available at terminals on the wards and in the clinic. Interdisciplinary programs are a vital part of the University philosophy and enrich the experience for all involved.
The pulmonary division was ranked 28th in the country by US News and World Report. It has eight full time faculty, with a variety of clinical interests. The pulmonary division is small enough to provide extensive direct interaction between faculty and fellows, while providing training in all aspects of pulmonary and critical care medicine. The division provides inpatient care and consultation and staffs the Medical Intensive Care Unit. Outpatients services for more than 3000 patients/year are provided in the pulmonary clinic with adjacent pulmonary function laboratory and allergy testing laboratory. Procedures are performed in the multidisciplinary endoscopy unit. Specialized clinical programs provide expertise in sleep disorders, lung transplantation and cystic fibrosis. The division works closely with thoracic surgery and otolaryngology in interdisciplinary projects.
Sleep Disorders Center - The pulmonary division directs the Multidisciplinary Sleep Disorders center, working closely with the pediatric, otolaryngology and neurology and psychiatry departments. The sleep laboratory is state of the art. The 4-bed laboratory performs 90-100 overnight studies per month, evaluating adults and children with sleep related problems. Although sleep apnea syndromes make up a large part of the caseload, all types of sleep disorders are seen. There is ongoing research in the treatment of obstructive sleep apnea. Pulmonary fellows gain experience in patient evaluation and in the techniques and interpretation of nocturnal polysomnography. With additional elective or research time, fellows can qualify for the Sleep Disorders special competency certification. Lung Transplantation - The lung transplantation program has been active at the University of Virginia since 1990. Over one hundred and thirty patients have received lung transplants. The pulmonary division provides most of the preoperative and long term care for these patients. The initial evaluation is done by Dr. Mark Robbins, the Medical Director of the Pulmonary Transplantation Service. The patients are then discussed with the entire transplant team. Patients waiting for lung transplant are followed in the Pulmonary Transplant Clinic. After their immediate post-operative period on the Thoracic Surgery service, patients return to the Pulmonary transplant clinic for lifelong follow-up. The consult fellow assists with inpatient management and diagnostic bronchoscopy. Fellows may also elect to spend time on the transplant service, seeing both patients with acute problems and successful long-term post-transplant patients. Adult Cystic Fibrosis - Dr. Robbins is also the director to the adult branch of the University of Virginia Cystic Fibrosis Center. Patients with cystic fibrosis first come to the University as children followed in the pediatric department. In their late teens, they move to the adult CF service under Dr. Robbins, for both inpatient and outpatient followup. This is the only clinic for adults with cystic fibrosis in Virginia and also serves patients from West Virginia. For those who chose lung transplantation in the later stages of their disease, the transition to the lung transplant clinic is smooth with no loss in continuity of care. Lung Volume Reduction Surgery - For patients with severe emphysema who do not wish transplantation, lung volume reduction surgery may offer improved function. The pulmonary division and thoracic surgery division are collaborating on investigating this procedure to try to determine which patients will be helped by it. As with lung transplant, patients are initially evaluated by the pulmonary service and long term follow up is in both pulmonary and thoracic surgery clinics. Detailed evaluation of pulmonary structure and function will help in understanding the effects of the procedure.
Pulmonary Consultation Service Fellows spend 6-9 months of the 3-year fellowship on the consultation service. Patients from the medical, surgical, neurologic and obstetric units are seen, including critically ill patients in the surgical and neurological ICU's and the cardiac care unit. A sleep disorders consultation service is also provided. The fellows perform bronchoscopies, pleural biopsies, brachytherapy, and placement of trans-tracheal oxygen catheters and chest tubes under supervision of the attending physician.
Pulmonary Function Laboratory Early in the first year fellows spend a month in the pulmonary function lab, learning the physiologic basis of pulmonary function testing. Fellows learn to perform and interpret pulmonary function tests.
Sleep Laboratory The fellows spend a minimum of one month in the sleep laboratory learning both the techniques and the interpretation of overnight polysomnography.
Transplant / Cystic fibrosis One month is spent with Dr. Robbins, seeing patients in all stages of the lung transplant process. This includes those waiting for transplant as well as recent and long-term post-operative patients. In addition, the fellow will see adult cystic fibrosis patients both inpatient and in the clinic.
Intensive Care Units The pulmonary/critical care fellows spend at least six months in the medical intensive care unit, caring for critically ill patients with complicated medical problems. Admissions come from the medical wards, the Emergency Room and transfers from other hospitals in the referral area. Fellows evaluate and treat both common and unusual cases, under the guidance of the attending faculty, who are all Critical Care Board Certified. Extensive experience is gained in ventilator management and hemodynamic monitoring techniques, including Swan-Ganz and arterial catheter placement. The fellows also develop skill in intubation, central venous access, and percutaneous thoracotomy and tracheostomy. The critical care experience is broaden by time spent in the Surgical Intensive Care Unit, Neurologic ICU, Coronary Care Unit and Thoracic and Cardiovascular Surgery Post-Operative Unit. In these units pulmonary fellows care for patients with trauma, postoperative complications, strokes and spinal cord injury as well as cardiovascular disease.
Outpatient Pulmonary Clinic The outpatient clinic sees 3000 patients annually. Pulmonary fellows have one ½ day clinic per week, seeing 2 new patients and several returning patients. Fellows follow patients throughout their three years.
Allergy The fellow will work with Dr. Thomas Platts-Mills and other faculty of the Allergy Division. The role of allergy in asthma, the principles of skin testing, environmental control and immunotherapy will be covered. The opportunity also exists for involvement in ongoing research projects.
Chest Radiography Fellows will become proficient in the evaluation of chest radiography by reading xrays and CT scans with the attending radiologists. Fellows will have the opportunity to view radiology teaching materials, teaching file films and other materials, in addition to daily chest radiograph reading.
Pulmonary Pathology The fellows work with Dr. Mark Stoler of the Pathology Department reviewing bronchoscopic, open lung biopsy and related clinical and autopsy cases and teaching file materials.
Clinical Pulmonary & X-Ray Conferences This weekly conference is run by the fellows, who present interesting or challenging cases. The case is discussed and the x-rays are reviewed by the attending physicians. The fellow prepares a brief presentation with a literature review pertaining to some aspect of the case. These conferences are held on each Wednesday of the month.
Pulmonary and Critical Care Topics This conference is held weekly on Thursday. The pathophysiology of lung diseases is reviewed as well as recent advances in the understanding or treatment of these disorders. Over the three years of the fellowship all aspects of pulmonary medicine are covered. Subspecialty faculty, guest faculty, presents topics and pulmonary and critical care fellows. Twelve lectures cover non-clinical topics, such as medical policy, ethics and legal issues.
Pulmonary Pathology Fellows and attendings meet with Dr. Stoler on the first and third Thursday of each month. Pathology specimens from bronchoscopies and pleural biopsies performed by the pulmonary service and selected surgical specimens from the previous week are reviewed.
Thoracic Tumor Board This conference reviews clinical, radiologic and pathologic information on patients with known or suspected lung tumors. Pulmonary, thoracic surgery, pathology, and medical and radiation oncology services attend the conference. Journal Club Monthly Journal Club meets every third Friday of each month. One or two articles are reviewed in detail. Research Conference Research Conference meets on the second and fourth Thursday each month. New proposals, work in progress and completed projects may be reviewed. All Fellows will present their research here in at various stages. Attending physicians research is also presented.
Fellows spend 12-16 months, working with a faculty member in ongoing research projects. The research block begins in January of the second year and continues through December of the third year. During the first months of the second year fellows meet with members of the faculty to chose a research preceptor and project. Projects may be in clinical or basic science areas. Fellows present their research at the American Thoracic Society meeting in the spring of their third year and are expected to publish their results in a national journal. Current research projects range from cellular mechanisms of lung injury to the role of surgery in-patients with endstage emphysema. Research expertise can be gained in in situ hybridization, immuno-histochemical staining, and cellular immunology. In addition, the use of genetic models in respiratory physiology, in vitro lung and muscle preparations and in vivo animal models can be learned. Clinical studies involve the fellow in protocol development, data gathering and analysis.
THE FACULTY
Dr. Truwit is the Head of Pulmonary and Critical Care Division, Medical Director of the Medical Intensive Care Unit and Director of the Critical Care Fellowship Program. His clinical interests are in critical care medicine, particularly respiratory failure. Currently he is active in the study of the effectiveness of lung reduction surgery, as well as magnetic resonance imaging of the lung.
Dr. Brown's clinical interests are in COPD and Sleep Medicine. She also attends in the medical intensive care unit.
Dr. Esau is Director of the Pulmonary and Critical Care Fellowship Program. Her clinical interests include ventilatory failure and the failure to wean patients. She also sees a number of patients with sleep apnea and other sleep disorders.
Dr. Koenig is active in the Sleep Disorders Center and is certified in Sleep Medicine. He is also directs the Occupational Lung Disease and is doing research in COPD and asthma.
Dr. Mehrad's clinical interests are Interstitial lung diseases, lung infections. His research interests are Lung inflammation, antimicrobial host defense.
Dr. Patel is developing a community based affiliated pulmonary clinic and intensive care practice at Augusta Hospital. His research interests are in identifying cardiac issues in patients on mechanical ventilation.
Dr. Robbins is the Medical Director for the Lung Transplant Program and follows all patients before and after lung transplantation. He also directs the multidisciplinary clinic for adult cystic fibrosis patients.
Dr. Rose's clinical interests include pneumonia and asthma. He conducts research evaluating the roles of leukocyte adhesion molecules and chemokines in animal models of pneumonia and asthma."
Dr. Shim is studying the role of lipid inflammatory mediators like leukotrienes, lipoxin and or prostaglandin in the pathogenesis of obstructive airway diseases like asthma and COPD.
Dr. Suratt is the Director of the Sleep Disorders Center. His research examines the anatomic mechanisms of upper airway obstruction during sleep. He has developed a porcine model for further study of obstructive sleep apnea, including new approaches to surgical treatment for patients unable to tolerate CPAP. Dr. Suratt also directs the General Clinic Research Center Sleep Laboratory.
Dr. Vinayak is the Medical Director of the MICU. His clinical interests are Critical care, pulmonary hypertension, heart-lung interactions
Dr. Verghese has special clinical interest in pulmonary fibrosis. He will be working with Dr. Patel in the developing the Augusta hospital pulmonary and intensive care practice.
PULMONARY-CRITICAL CARE FELLOWS Elizabeth Foreman, MD, Third Year; Residency: Mayo Clinic Florida Raed Wahab, MD, Third Year; Residency: University of Kansas Bill Barker, MD, Second Year; Residency: Medical College of Ohio Jasmine Shah, MD, Second Year; Residency: University of Tennessee Kyle Enfield, MD, First Year; Residency: University of Virginia
Steve Herndon, MD, First Year; Residency: University of South Carolina APPLICATION PROCEDURE
The University of Virginia Pulmonary and Critical Care Fellowship Program participates in the National Resident Matching Program and applicants must register with the NRMP. We participate in the ERAS online service. If you are not participating in the ERAS you may send an application form, Dean's letter, medical school transcript and reference letters from at least two attending physicians in your program to the address listed below. Interviews will be held in March and April 2008.
Please address all application materials to: E-mail: dby3e @hscmail.mcc.virginia.edu |
