Rotation and Didactics

Year 1 (Sample)

• July — Pulmonary Consult, CPMC
• August — Anesthesia / PFT + Exercise Study Interpretation, CPMC
• September — ICU (Medical), CPMC
• October — Pulmonary Consult, CPMC
• November — CCU/Echo, CPMC
• December — Elective, CPMC
• January — ICU, ACMC
• February — Pulmonary Consult, ACMC
• March — ICU, ACMC
• April — Ultrasound, ACMC
• May — Pulmonary Consult, CPMC
• June — ICU (Medical), CPMC

Year 2 (Sample)

• July — Research Preparation, CPMC
• August — ICU (Medical), CPMC
• September — Pulmonary Consult, CPMC
• October — Pulmonary Consult, ACMC
• November — Sleep, Stanford
• December — Davies Neuro ICU, CPMC
• January — Research, CPMC
• February — Research, CPMC
• March — Hepatobiliary ICU, CPMC
• April — Pulmonary Consult, CPMC
• May — ICU (Medical), CPMC
• June — Pulmonary Consult, CPMC

Year 3 (Sample)

• July — Research, CPMC
• August — Pulmonary Consult, ACMC
• September — Trauma, ACMC
• October — ICU (Medical), CPMC
• November — Pulmonary Consult, CPMC
• December — Lung Transplant, UCSF
• January — Heart Failure ICU, CPMC
• February — ICU (Surgical), CPMC
• March — Research, CPMC
• April — Pulmonary Consult, ACMC
• May — ICU, ACMC
• June — Pulmonary Consult, ACMC

Blue (Medical) ICU:

• Our full service medical ICU cares for patient’s from San Francisco and northern California as Sutter Health’s flagship tertiary care referral center. Fellows will co-lead mutli-disciplinary rounds with their intensivist on a team that includes IM residents, sub-interns, pharmacists, nurses, nutritionists, social work/case management staff, and sub-specialists.

Green ICU:

• In their second and third years, our fellows will have the opportunity to work on our cardiothoracic surgery/advanced heart failure service and will care for pre and post-operative patients on ECMO, with LVADs and those with recent heart transplantation or lung resection.

Yellow ICU:

• In their second and third years, our fellows will have the opportunity to rotate through our hepatobiliary and renal surgery, transplant service, caring for advanced hepatobiliary diseases and recent transplant recipients.

Neuro ICU:

• CPMC is also home to a bustling neurosurgery and neurointerventional radiology services. Fellows will spend a month managing  the neuro ICU at the Davies campus, a major stroke referral center for the Bay Area.  Parking and shuttle service is available.

Pulmonary Consults:

• Fellows will rotate twice a year on the pulmonary consult service at Van Ness Campus and will have the opportunity to manage a myriad of pulmonary pathology including but not limited to pleural disease, acute/chronic respiratory failure, new diagnoses of interstitial lung disease, pulmonary hypertension, and those needing interventional pulmonology services. Fellows on this rotation have priority for bronchoscopic procedures and will gain high volume hand-on experience throughout their three years of training. Pulmonary operating room block times are Thursday afternoons and all-day Friday.

PFTs/Anesthesia:

• Fellows will spend a month in the beginning of their first year perfecting their approach to airway management in a controlled setting with anesthesia; fellows will also be introduced to PFT interpretation and reading.

Echo/Red (Cardiac) ICU:

• During their first year, fellows will learn to read transthoracic and transesophageal echocardiograms with our cardiology attendings and co-manage a coronary care intensive care unit. For fellows who have had extensive training in a CCU setting during their residency can instead opt to rotate with our advanced heart failure cardiologists

Research:

• Fellows have 6.5 months of dedicated research time spread throughout their three years.

Elective:

• Fellows can spend their elective time furthering their training in any of the above rotations or select from the following disciplines
  • Thoracic Surgery
  • Interventional Radiology
  • Chest Radiology
  • Medical Oncology
  • Radiation Oncology
  • ENT
  • Pulmonary Sub-specialty clinic (sleep, lung nodule/cancer, pulmonary hypertension, interstitial lung disease, interventional pulmonary)

Medical ICU:

• First year fellows will have an opportunity to spend two to three months of their training managing this busy medical ICU and also consulting on surgical ICU patients at this busy and resource-conscious county medical center.

Pulmonary Consults:

• Fellows will spend two months during their first year on the pulmonary consult service which in addition to general pulmonary consults is known for managing active tuberculosis including those with MDR and XDR disease. Currently, CPMC is a referral center for those requiring advance bronchoscopy or interventional pulmonology service and our fellows serve as a conduit for referral, continuity of care.

ED Ultrasound:

• Fellows have will spend two to four weeks on an ultrasound rotation run by the ED US fellowship department managing and scanning a high volume of patients four to five days in the week on average.

Trauma ICU:

• Fellows will spend two to four weeks on a busy surgical service at the Highland Level one trauma center learning to run primary trauma surveys, resuscitation and co-managing surgical ICU patients.

Sleep Medicine

• Fellows will have the opportunity to learn alongside sleep medicine fellows at the Stanford Sleep Medicine Center in Redwood City during this required one-month rotation. Fellows will rotate through the sleep clinic on four days of the week, attend didactics on ½ day a week, and rotate through sleep specialty clinic (restless leg, narcolepsy, parasomnia, ENT) for a ½ day a week. Parking is free.

Lung Transplant

• 3rd year fellows will rotate through a busy and well-renowned lung transplant service at the University of California-San Francisco for a month. Fellows will assist in the management of hospitalized advanced lung disease patients and recent transplant recipients. There is also an opportunity to rotate through the advanced lung disease clinic evaluating pre-transplant referrals and managing post-transplant recipients.

Through a partnership with the University of California San Francisco Pulmonary Critical Care Fellowship and a CPMC-Highland lecture series fellows will have a wealth of educational opportunities to enrich their fellowship experience.

• The CPMC-Highland pulmonary critical care departments meet twice a week for fellow didactics. The fellows play an integral part in the meetings and on average will lead one conference a month (range 0-2) during their fellowship.
• Responsibilities are shared amongst the fellows and include active participation in faculty led lectures, curating patient lists, or leading case presentation discussion.
• Conference themes include:
  • Faculty core lectures on foundational topics in pulmonary critical care medicine
  • Journal Club-Clinical & Basic Science Articles Reviews
  • Fellow Case Presentation Conference
  • Attending Case Conference Review
  • ICU Morbidity & Mortality
  • ILD Multidisciplinary Conference
  • Board review series
  • Lung Pathology Multidisciplinary  Conference
  • Bronchoscopy and PFT Quality Assurance
  • Industry Sponsored Guest Lectures/Product demonstration

On the first day of fellowship, first year fellows will participate in an all-day orientation sessions at both CPMC and Highland Hospital led by the 2nd and 3rd year fellows. To ease the transition fellows will receive tours, EHR tutorials, and procedural skill introduction/refresher to bronchoscopy, airway management, and line /chest tube placement.

During the first two months of fellowship, fellows will also participate in afternoon didactics geared to equip new fellows with the tools necessary to handle commonly encountered clinical scenarios and pulmonary consult questions.

On Friday mornings first year fellows will participate in the weekly UCSF Pulmonary and Critical Care Physiology series from 8 to 9 am and in the Chest Radiology Case Review from 9 to 10 am alongside UCSF pulmonary fellows.

Established and led by pulmonology this multidisciplinary conference occurs weekly on Wednesdays and allows fellows to participate in complex clinical decision making with regards to thoracic neoplasms.

For those interested, fellows can listen in on a weekly lecture series on basic to advanced interventional pulmonary topics.

• The best way to demonstrate mastered knowledge of a clinical topic is to teach it. Fortunately, at CPMC fellows can volunteer to teach internal medicine residents and Dartmouth medical students during pulmonary themed lunch lectures, critical care rounds, IM intern didactic series, ultrasound bedside rounds, or board review series.
• Our critical care fellows have been praised for their educational acumen and have won fellow of the year award recognizing their dedication.