Program Overview

Schedule

We’ve developed a schedule that supports high quality patient care, excellent education, and best supports maintaining wellness through the rigors of a 3-year pulmonary and critical care fellowship. We use a block schedule with each block being two weeks long. Below, is an outline of the schedule for each of the 3 years of fellowship.

Year 1:

  • Orientation: 2 weeks
  • University Health – Truman Medical Center ICU: 6 weeks
  • University Health – Truman Medical Center ICU nights: 6 weeks
  • University Health – Truman Medical Center Pulmonary Consults: 8 weeks
  • University Health – Truman Medical Center Clinic Float: 4 weeks
  • St. Luke’s Hospital Pulmonary Consults: 8 weeks
  • Research/PFTs/SICU/Electives/other: 18 weeks

Year 2:

  • University Health – Truman Medical Center ICU: 4 weeks
  • University Health – Truman Medical Center ICU nights: 4 weeks
  • University Health – Truman Medical Center Pulmonary Consults: 4 weeks
  • University Health – Truman Medical Center Clinic Float: 4 weeks
  • St. Luke’s Hospital ICU: 6 weeks
  • St. Luke’s Hospital Pulmonary Consults: 8 weeks
  • St. Luke’s Hospital NSICU: 6 weeks
  • SLH CVICU/Interventional Pulmonology/Research/PFTs/SICU/Electives: 16 weeks

Year 3:

  • University Health – Truman Medical Center ICU: 6 weeks
  • University Health – Truman Medical Center ICU nights: 4 weeks
  • University Health – Truman Medical Center Pulmonary Consults: 6 weeks
  • University Health – Truman Medical Center Clinic Float: 4 weeks
  • St. Luke’s Hospital ICU: 4 weeks
  • St. Luke’s Hospital Pulmonary Consults: 2 weeks
  • St. Luke’s Hospital NSICU: 8 weeks
  • SLH CVICU/Interventional Pulmonology/Research/PFTs/SICU/Electives: 18 weeks

Rotation Descriptions

University Health - Truman Medical Center ICU

Fellows will work in our high acuity medical ICU under the guidance of dedicated Pulmonary and Critical Care faculty. You will treat a diverse group of critically ill patients with widely varying pathologies. You will learn how to provide comprehensive and high-quality critical care for any patient that may come through the doors. As the fellow, you are given an excellent balance of autonomy and supervision. Care is taken to make sure that you are seen as a leader of the team. You will work with pharmacists, residents and students of varying levels. You will also lead AM multidisciplinary rounds with social work, PT/OT, dietician, and palliative care. You will be able to perform all ICU level procedures such as intubation, central venous access, bronchoscopy, chest tube placement, lumbar puncture, and many others. We have access to all relevant subspecialties and many advanced supportive devices including CRRT, inhaled/intravenous pulmonary vasodilators, and temporary mechanical circulatory support devices. The only things we transfer for are transplant evaluations, ECMO, or cardiac surgery.

University Health - Truman Medical Center Pulmonary Consults

Fellows work closely with a pulmonary attending on the inpatient consult service. You will typically have 5-15 patients to follow with pathologies ranging from simple COPD exacerbations to new diagnoses of pulmonary arterial hypertension, interstitial lung disease, and many more. While on the consult service, you will perform all inpatient and outpatient pulmonary procedures including robotic assisted navigational bronchoscopy, EBUS, bronchoscopies, thoracentesis, chest tube placement, and indwelling pleural catheter (Pleur-x) placement among others.

Saint Lukes Hospital – Medical/Surgical/Trauma (MST) and Coronary Care Unit (CCU)

The MST/CICU rotation provides fellows with a rich, high-acuity clinical experience in a diverse and dynamic critical care environment. Fellows are actively involved in the management of complex medical patients and are exposed to a wide range of advanced life-saving interventions and procedures. As a supervising fellow, you will play a key leadership role by guiding medical residents, medical students, pharmacists, and nurse practitioners. This collaborative model fosters a multidisciplinary, patient-centered approach to care and promotes the development of teaching and leadership skills Fellows are granted meaningful autonomy while receiving close mentorship from highly experienced pulmonary and critical care faculty. In addition to the core MICU experience, this rotation integrates time in the Coronary Intensive Care Unit (CICU), where fellows collaborate with cardiology fellows and attendings in the management of critically ill cardiac patients. Procedural opportunities include central and arterial line placement, intubation and mechanical ventilation management, bronchoscopy, thoracentesis and paracentesis, chest tube placement and management. Fellows can also gain experience in advanced critical care therapies such as Swan-Ganz (pulmonary artery) catheter placement and hemodynamic interpretation, intra-aortic balloon pump (IABP) management, and management of advanced cardiac arrhythmias. Fellows can expect to manage 14–20 patients per day during peak service. Fellows will also provide two weekend day coverage per 2-week block of service.

Saint Lukes Hospital – Neurosurgical ICU (NSICU)

The NSICU rotation offers fellows a unique and comprehensive exposure to advanced neurointerventional and neurosurgical care, providing experiences not typically available in other rotations. Fellows work closely alongside a highly skilled team, including dedicated nurse practitioners and anesthesiology residents. Guidance is provided by a diverse and experienced faculty, including specialists in anesthesia critical care and pulmonary critical care, offering a wide range of perspectives in the management of complex neurocritical patients. During the rotation, fellows will care for a high-acuity patient population with a broad spectrum of neurologic and neurosurgical conditions, including traumatic brain injuries, brain tumors, ischemic and hemorrhagic strokes, subarachnoid hemorrhages, and spinal cord injuries. Procedural opportunities include, intubation and mechanical ventilation management, central and arterial line placement, bronchoscopy, assisting with percutaneous tracheostomy placement and ongoing management. As fellows progress, they may be given the responsibility to lead multidisciplinary rounds. These rounds bring together anesthesiology residents, nurse practitioners, pharmacists, pharmacy residents, and dietitians—promoting a team-based approach to complex critical care.

Conferences

We have a robust didactic/conference curriculum designed to augment fellow education and provide focused board review as well as practical clinical education.

  • Weekly Pulmonary lectures organized in block style with categories based on ABIM’s Blueprint for the Pulmonary Boards
  • Bi-weekly Interstitial Lung Disease Multidisciplinary Discussion held in concert with the University of Missouri, chest radiology, and rheumatology to discuss difficult or ambiguous cases in Interstitial Lung Disease.
  • Bi-weekly Critical Care lectures covering a broad base of topics relevant for all aspects of critical care
  • Bi-monthly Thoracic Oncology Conference more colloquially referred to as “Tumor Board” where pulmonary nodules/masses or known lung cancers are discussed amongst pulmonologists, radiologists, oncologists, thoracic surgery, and radiation oncologists.

Research

There are ample opportunities for research at both University Health – Truman Medical Center and St. Luke’s Medical Center. Projects can range from simple case reports/series to participating in high level randomized controlled trials.

Medical Meeting (CME)

Fellows are encouraged to attend national/international meetings such as CHEST, ATS, and SCCM to present their research and learn up and coming changes in the field of Pulmonary and Critical Care.