Pulmonary & Critical Care
300 Cedar Street
TAC–441 South
P.O. Box 208057
New Haven, CT 06520-8057
Tel: 203.785.4162
Fax: 203.785.3826
In total you will complete at least a total of 18 months of clinical training: 6 months are devoted to pulmonary medicine, at least 6 months are devoted to the care of the critically ill medical patient, and 6 months of a combination of other pulmonary and critical care experiences. The bulk of clinical training (12 of 18 months) will be in the first year of fellowship and the remaining 6 months of clinical training are scattered through the second and third year. Fellows receive extensive training in many PCCM related procedures including diagnostic and therapeutic bronchoscopy, pulmonary artery catheterization, pulmonary function testing, and cardiopulmonary exercise testing. In addition PCCM fellows receive focused experience in the assessment and treatment of patients with sleep disordered breathing in the Yale Center for Sleep Medicine. Throughout the 36 months of PCCM fellowship, fellows participate in a continuity clinic, the Winchester tuberculosis clinic and many other educational activities in the section and around the school of medicine.
Five hospitals participate in the clinical training of PCCM fellows including: Yale New Haven Hospital (YNHH), a tertiary care University and Community Hospital: The West Haven Veteran's Administration Hospital (WHVAMC), Hospital of St. Raphael , a private community hospital, Bridgeport Hospital, a community hospital with specialty burn unit, and the Hospital for Special Care, a comprehensive rehabilitation hospital specializing in ventilator dependence, weaning and respiratory rehabilitation.
The Y-NHH and VA Consult Services are mainstays of pulmonary care at both institutions. Each is staffed by a Section attending and year 01 Pulmonary and Critical Care Medicine (PCCM) fellow on a rotating basis. These services provide consults in all of the adult non-MICU wards at Y-NHH and VA-CHS. The Consult Service also covers all pulmonary issues on surgical and other non-medical wards at both institutions. An average 3-6 new consults are seen daily.
The Medical Intensive Care Unit (MICU) at Y-NHH is regarded as one of the region's elite ICUs. The MICU proper, housed on 5-4, has 14 beds and admits approximately 1,000 patients per year. The MICU team cares for an average census of 18-24 critically ill patients throughout the hospital. This census can rise into the thirties during busy months. Because of the high census, the MICU is now covered at all times by two teams, each consisting of a PCCM attending, a PCCM fellow, two residents, and two interns, in addition to Emergency Medicine residents and Yale medical students. Yale faculty spend an average of 10-14 hours per day in the MICU, leading work rounds seven days per week and conducting attending rounds 3-5 days per week. Recent achievements include the development and implementation of several successful management protocols, inauguration of a new Step Down Unit on 5-7, creation of a new MICU syllabus for house staff on CD-ROM, and dramatic decreases in the incidence of nosocomial catheter and pulmonary infections. In addition, the MICU is a haven for clinical research, with multiple faculty conducting studies in acute lung injury, cognitive impairment, diabetes management, weaning from mechanical ventilation, and end-of-life care. The activities in the MICU were recently recognized with a Press Ganey Compass Award. Patients can be transferred to the MICU at any time of day or night. For additional Information or to transfer a patient please contact Mark Siegel, M.D., Medical Director of the MICU.
The Pulmonary and Critical Care Section has recently taken on the task of providing state-of-the-art critical care to patients in the Neurosciences Intensive Care Unit on 6-2 of Y-NHH. Patients are admitted to the unit with a wide range of Neurosurgical and Neurological diagnoses, including intracranial bleeds, head trauma, acute stroke, refractory seizures, and Guillain-Barre Syndrome. Advanced care including continuous intracranial monitoring is available routinely as is support from outstanding Neuroradiologists at Yale. Multidisciplinary rounds occur each morning with members of the Neurosurgical and Neurology teams. The Pulmonary & Critical Care team consists of a PCCM faculty member and fellow who are available throughout the day to provide critical care support to patients and to ensure that all advanced care for all organ systems are supported to optimize outcomes for patients with life-threatening Neurological and Neurosurgical disorders.
The Hospital of Saint Raphael is a 500-bed community hospital located in New Haven about 5 minutes from Yale New Haven Hospital . It is the 4 th largest hospital in Connecticut and has a 10 bed ICU and two full time PCCM physicians, Drs. Herb Knight and Roger Elias. In addition several private pulmonary groups that care for patients in the medical intensive care unit and medical floors. PCCM fellows interact with both private and staff physicians. Inpatient coverage is provided by house staff and a physician assistants service. This dual educational experience provides fellows exposure to both Critical Care and Pulmonary Medicine.
The Section of Pulmonary and Critical Care Medicine at the VA, directed by Dr. Hilary Cain, has active clinical, educational, and research activities, and provides the bulk of the outpatient training for the pulmonary fellowship. Clinics at the West Haven and Newington campuses received over 1,200 new consultations last year under the direction of Drs Carolyn Rochester and Hilary Cain, respectively. As noted above, an active 4 bed sleep laboratory has been established under the direction of Dr. Klar Yaggi. Under Dr. Cain the medical intensive care unit recently expanded to 6 beds. A Pulmonary Rehabilitation Program under Dr. Rochester has now been established and has been accepting patients for over a year. Dr. Cain also runs the VA PFT Laboratory which is an active site of fellow physiology training.
Hospital for Special Care has 200 beds and is licensed as a Long-Term Acute Care Hospital (LTAC). The Hospital services patients with chronic respiratory diseases from spinal cord/neuromuscular disorders, COPD, chronic ventilator dependency and long term weaning from mechanical ventilation. Acute rehabilitation is also provided.
Fellows are required to do a one-month rotation in the pulmonary and sleep laboratories run by the section of Pulmonary and Critical Care. During this rotation, fellows learn about all the PFTs done in clinical practice including, spirometry, lung volume measurement (helium dilution and body plethysmography), diffusing capacity measurement, methacholine challenge testing, altitude studies, exercise oximetry and cardiopulmonary exercise testing (CPET). In the PFT lab, the fellow is responsible for interpreting all the PFT and reviewing them with the PFT attending of the month. This should be done on a daily or near daily basis. The studies are picked up from the PFT lab and then reviewed. Readings are usually written out by hand or filled out on a form. After the fellow completes the stack he/she should arrange to meet with the attending to go over the studies. Early in the rotation, fellows will review most of the studies with the attending, but as the fellow becomes more knowledgeable the team will only review the more complicated studies. Attendings are required to review all the studies and sign them once they are transcribed. Ideally, the fellow and attending should meet on a daily basis, however, this is not always possible so PFT rounds should be at least a few time a week. In addition to reading all the PFTs for the month, fellows are required to spend in the PFT lab learning the about the administration of the PFT lab and calibrating and maintaining equipment.
Training in Sleep Medicine occurs during Rotations through the Yale Center for Sleep Medicine and the VACHCS sleep laboratory. The curriculum for this sleep rotation includes understanding the following areas of sleep medicine: fundamentals of the neurobiology and structure of sleep, fundamentals of the effects of sleep on organ system physiology, fundamentals of the pharmacology of drugs affecting sleep and wakefulness, classification of sleep disorders, basics of polysomnography, knowledge about ambulatory techniques for the monitoring of sleep disordered breathing, obstructive sleep apnea syndrome and related conditions, nocturnal hypoventilation management, and the basics of the differential diagnosis of excessive daytime sleepiness.
Bridgeport Shriner's Burn unit/SICU: The burn unit is a unique and highly specialized care environment, part of the Section of Trauma Burns and Surgical Critical Care. In 2003 there are only 61 verified Burn Centers in the United States . As the only burn center in the state of Connecticut we have the privilege and responsibility to receive and care for injuries for which Burn Centers are especially equipped and trained to manage. Burn care is challenging and rewarding. Great suffering and debilitating injuries threatens patient care and it is a specialized understanding of this patient population that makes burn centers the superior locale for anyone to have had experienced this misfortune. The Burn Center is an outstanding model of interdisciplinary care including Occupational & Physical Therapy, Dietary, Respiratory & Pulmonary services, Social Work and Chaplain services. Thermal injuries with inhalation injuries, electrical, chemical and exfoliative skin disorders are typical.
Interventional bronchoscopy/thoracic surgery: This has been an extremely popular rotation with fellows. Fellows spend time working with the thoracic surgery service in the operating room, inpatient units and with outpatients. Fellows learn interventional bronchoscopy, chest tube placement, VATS, and other important thoracic procedures. Please contact the program director if you are interested in participating in this rotation.
Critical Care Radiology. This is another extremely popular rotation that fellows choose to pursue. As radiographic studies are a critical part of our field, learning how to interpret radiographic studies of the thorax are critical. Fellow meet on a daily basis in the thoracic radiology suite and read films with the thoracic radiology service. Films include CT scans (HRCT and CT angiograms, standard CT), CXR (routine and all the hospital ICU boards).
Anesthesiology.Fellows can opt to rotate through the operating room and the technical skills of intubation, vascular access and difficult airway management.
Renal replacement (CVVH/HD in the ICU). This is a new rotation that fellows can opt to experience. Fellows can rotate with the hemodialysis service and see patients on HD and CVVH. Although fellows do receive extensive exposure to renal replacement during their ICU experiences, this rotation gives the option of a focused experience and exposure to teaching by nephrologists specializing in renal replacement.
Neuroscience Critical Care Unit. This is a new opportunity for PCCM fellows to obtain non-MICU critical care experience
Research/independent study in CCM.Fellows can design their own rotation as long as it is approved by the program director and fulfill the requirement of the ACGME. Examples include a rotation in lung transplant, or tuberculosis. Physiology/sleep.PCCM fellows may opt to do spend more time in the PFT and/or sleep labs. Please see the rotation description above for a description of the rotation.
Subspecialty Clinic rotation.Fellows can opt to spend time seeing patients in one or all of the PCCM sections subspecialty clinics. Fellows can spend each day in one of the clinics listed below seeing patients with an attending that specializing in that lung disease.
©
Yale School of Medicine
Last updated
2/29/08
Privacy policy Site editor
