Critical Care training

Our Critical Care training program offers the unique ability for fellows to experience caring for critically ill patients within various models of ICU structure. The program is 9.5 months total: 6 months MICU, 3.5 months non Medical ICU.

Six 12-bed Medical Intensive Care Units

• Four general medical ICUs in University Hospital
  • Two of these units are staffed in the traditional academic model with an attending, a fellow, two residents, two interns and medical students

• 1 ICU dedicated to the care of patients with hematologic and oncologic disorders in the James Cancer Hospital
  • This unit is staffed in a collaborative model with Pulmonary Critical Care Medicine faculty, Advanced Practitioners and residents.

Fellow responsibilities on all ICU rotations

• Overseeing the execution of the ICU patient care management plan
• Guiding ventilator management
• Performing and/or supervising critical care procedures (such as intubation, bronchoscopy, venous central line placement, arterial line placement, pulmonary artery catheter placement and interpretation, tube thoracostomy and chest tube management.)

Ohio State University East mixed ICU (medical, cardiac, surgical)

• 18-bed mixed ICU staffed by one pulmonary/critical care faculty member, one fellow, residents and Advanced Practice Providers
• The fellow gets to experience a wide range of critical care models which require different levels of involvement and team dynamics.

Non-medical ICU training

Non-medical ICU training occurs via the following rotations:

1. F2s spend one half-month as part of the SICU CC team, caring for all surgical patients including trauma patients.
2. F3s spend one half month caring for all post-operative cardiac patients in the ICU
3. F3s spend one half month caring for all critically ill neurologic patients in the Neurologic ICU.
4. Fellows also see surgical critical care patients in a consultative manner when on consult rotations at University Hospital and OSU East Hospital.
5. The Surgical, Anesthesia and Neurological CC fellows also rotate in the MICU as part of our cross-disciplinary training in critical care.

Pulmonary Medicine training

Training in pulmonary medicine occurs via several venues:

Inpatient Pulmonary Consult services

• See approximately 800-900 consults per year
• Includes all aspects of pulmonary consultative medicine
• Three consult teams (one based in the James Cancer Hospital, one based in the Ross Heart Hospital, and one based at University Hospital East, each with a faculty, fellow and 0-2 residents/students).

The majority of the patients are pulmonary in nature but there are critical care consults and ventilator management for patients requiring mechanical ventilation on cardiology services in the Ross Heart Hospital, in the James Bone Marrow Transplant Unit and in the University Hospital Surgical Intensive Care Unit; we only provide consultative service for these ICUs and are not responsible for the primary care of these patients.

Through these experiences the fellow will be exposed to the entire spectrum of pulmonary procedures including:

• Chest tube placement and management
• Pleural catheter placement
• Pleurodesis and bronchoscopic procedures (such as bronchoalveolar lavage, transbronchial and needle biopsies, cryotherapy, stent placement and brachytherapy.)

Lung Transplant

All fellows spend one month rotating on the Lung Transplant Service.

This is a combined inpatient and outpatient experience designed to encompass all aspects of care for this patient population. The fellows attend pre-transplant evaluation clinics, post-transplant clinics, round on the inpatient service and participate in all related procedures for the month. Additional elective time on this service or in the outpatient transplant clinic is available for those fellows who are interested.

Outpatient Pulmonary Medicine training

Training in outpatient pulmonary medicine occurs via fellow clinics which are located in the Martha Morehouse Medical Plaza. Fellows maintain a outpatient clinic one half day per week throughout their fellowship. 

Fellows will have a continuity clinic in general pulmonary medicine for 23 months. The final 12 months of clinic will be done in six month blocks in a variety of the sub-subspecialty clinics.

Fellows have the opportunity to rotate through the following subspecialty clinics:

• Pulmonary hypertension,
• Pulmonary transplantation,
• Cystic fibrosis,
• TB,
• ILD,
• Lung cancer,
• COPD,
• Asthma,
• Sarcoid,
• Interventional pulmonary, and
• Other programs that can be modified to the fellow’s interest.

Pulmonary Hypertension

All fellows spend two weeks rotating on the Pulmonary Hypertension service with both inpatient and outpatient experiences.

Procedural training

Our graduating fellows are well-trained in bronchoscopic procedures including transbronchial biopsies, endobronchial biopsies, transbronchial needle aspirations, and bronchoalveolar lavages. In addition, our fellows are highly proficient in pleural procedures such as thoracenteses and chest tube placement. Another strength of our program is the rigorous training in airway management. Airway management training involves a combination of didactic sessions, simulation training, and hands-on experience. Our fellows are the primary airway providers for patients in the intensive care units (ICU). Finally there are ample opportunities for other ICU procedures including vascular access and lumbar punctures.

We have a strong Interventional Pulmonology program and our PCCM fellows have the opportunity to receive training in advanced bronchoscopic, airway and pleural procedures. Finally, all our fellows complete didactic, simulation and hands-on training to achieve competency in critical care ultrasound.

The fellowship program consists of a minimum of 18 months of clinical exposure, the majority of which occurs during the first year. We have a large and diverse patient population and currently have eight core clinical rotations. In addition to these rotations, F2 fellows rotate with the surgical critical care team and F3 fellows rotate with the thoracic surgical critical care team and the neurologic critical care team.

Night call is fulfilled via a night float rotation. When not on night float, fellows have no overnight call responsibilities. F1 fellows do approximately two weeks of night float, F2 fellows four weeks and F3 fellows four weeks. Two-three fellows split a four-week block of night float and when not on service, the fellow has no clinical responsibilities except for their continuity clinic. Night float and all clinical rotations are structured to comply with ACGME work hour guidelines.

Year one

Fellows will rotate among the core service rotations, spending approximately the same amount of time on each rotation. Additionally, first years will rotate through outpatient subspecialty pulmonary medicine clinics.

Pulmonary medical school

A unique feature of our fellowship is that we have a month-long orientation program in July of the F1 year which we call Pulmonary Medical School. This month is free from clinical responsibilities. F1 fellows use this time to:

• Review the basics of pulmonary physiology
• Learn the fundamentals of of pulmonary and critical care medicine
• Spend time in our simulation lab mastering the basics of bronchoscopy, airway management, thoracentesis, chest tubes and other essential procedures

When not in class or in the simulation lab, F1 fellows spend time with upper level fellows on core rotations, participating in the care of patients, and getting oriented to the medical center. This rotation also provides a unique opportunity for each new class to get to know one another and to begin building bonds that will last a lifetime.

Core clinical rotations

• University Hospital MICUs
• The Arthur James Cancer Hospital MICU
• University Hospital/James Cancer Hospital Pulm/CC Consult Service
• University Hospital/Ross Heart Hospital Pulm/CC Consult Service
• University Hospital East MICU
• University Hospital East Pulm Consult Service
• Pulmonary Hypertension
• Ambulatory Pulmonary subspeciality block
• Sleep medicine
• PFT interpretation
• Procedure rotation

Years two and three

The primary focus of the second and third years of fellowship is research training. During this time fellows also complete the remaining clinical rotations to meet the 18 month requirement. This include core rotations described above, as well as rotations in the surgical critical care unit, cardiothoracic ICU, and the neurocritical care unit. Fellows also spend time on the pulmonary hypertension and lung transplant services. Finally, depending on the track selected, fellows can select or design an elective rotation to obtain additional clinical training for their chosen career path.

The fellowship program is structured to optimize flexibility in training, to promote career development and to encourage the science of investigation. The first year is dedicated to building a solid foundation in Pulmonary/Critical Care Medicine while the second and third years are designed to be more flexible to be tailored to an individual’s career goals. Most fellows will have between 12-16 months of research/scholarship time. Each fellow will complete an Individual Career Development Plan annually with the option to select from one of the following pathways/tracks:

Basic/Translational or Clinical Research tracks

Fellows on these tracks spend significant amounts of time doing dedicated basic/translational or clinical/health services research, with the intention of becoming funded physician-scientists.

• Year 1: 12 clinical blocks, 1 research/career exploration block
• Year 2: 4-6 clinical blocks, 7-9 research blocks
• Year 3: 4-6 clinical blocks, 7-9 research blocks

Clinical Educator track

Fellows on this track are preparing for careers as Clinician Educators, spending time building curricula, studying educational interventions and building teaching and educational leadership skills. An option is available to obtain a Master’s degree in Biomedical Education from Ohio State's College of Education and Human Ecology.

• Year 1: 12 clinical blocks, 1 research/career exploration block
• Year 2: 6-8 clinical blocks, 5-7 research blocks
• Year 3: 6-8 clinical blocks, 5-7 research blocks

Clinician Administrator track

Fellows on this track are preparing for careers as future health care administrators and leaders. They spend time performing quality improvement (QI) projects, serving on hospital committees and developing leadership skills. Fellows on this track receive mentorship from senior administrative leaders and are required to complete Six Sigma Green Belt certification during fellowship.

• Year 1: 12 clinical blocks, 1 research/career exploration block
• Year 2: 6-8 clinical blocks, 5-7 research blocks
• Year 3: 6-8 clinical blocks, 5-7 research blocks

Options are available to obtain one of several potentially relevant master’s degrees:

• Master of Health Administration from the College of Public Health
• Master of Public Health from the College of Public Health
• Working Professionals Master of Business Administration from the Max M. Fisher College of Business 

Clinical Scholar track

Fellows on this track are preparing for careers as academic clinicians. They spend time developing mastery in a specific clinical subspecialty, participating in clinical electives, and engaging in scholarly activity such as systematic reviews or practice guidelines.

• Year 1: 12 clinical blocks, 1 research/career exploration block
• Year 2: 6-8 clinical blocks, 5-7 research blocks
• Year 3: 6-8 clinical blocks, 5-7 research blocks

Clinical Excellence track

Fellows on this track are preparing for careers as Pulmonary/Critical Care physicians practicing in community contexts. They spend their time building a broad-based clinical and procedural skillset while often developing mastery in a specific clinical subspecialty.

• Year 1: 12 clinical blocks, 1 research/career exploration block
• Year 2: 8-10 clinical blocks, 3-5 research blocks
• Year 3: 8-10 clinical blocks, 3-5 research blocks

We are committed to advancing patient care through innovative research and training the next generation of physician-scientists. The goal of our research training program is to give our fellows the opportunity to pursue a personalized research experience that is tailored to their career goals. These projects are completed under the guidance of faculty mentors and program leadership to foster intellectual development and hone critical thinking skills. We are committed to providing whatever support is necessary to allow our fellow to be successful in their research efforts. This includes access to our Division's T32 training grant for aging-related lung disease research. Other research and career development programs that our fellows have access to include 1) CATALYST, Ohio State's interdisciplinary health services and implementation science research program; and 2) Ohio State's Global Health Scholars Program.

Year one

The research training process begins midway through the first year during a month-long break from clinical responsibilities known as Research Month. During this month first year fellows meet one on one with the associate program director to discuss their research interests and goals and attend overviews of potential projects by faculty mentors that are eager to work with fellows. Mentors can be selected from the wide array of NIH-funded investigators in the Division or the wider OSU community. Following the overviews, fellows meet with potential faculty mentors to discuss potential projects and ultimately select a project that aligns with their interests and career goals. Once a project and mentor are selected, fellows complete a brief research proposal that outlines the goals of the project and an individualized training plan.

In addition to selecting a research project, fellows also attend didactic sessions on the fundamentals of clinical and laboratory research methodologies. They also explore opportunities for advanced degree programs (e.g. Masters of Medical Science, MPH, MBA, or Masters of Medical Education). Research month provides an opportunity for fellows to focus on career development and to begin the process of track selection.

Years two and three

The goal of the second and third years is for fellows to complete their research, and to prepare their findings for abstract submission and publication. Fellows are strongly encouraged to present their work at national conferences such as the ATS International Meeting, Society of Critical Care Medicine Critical Care Congress or CHEST Annual Meeting. Some fellows also choose to attend smaller scientific meetings (e.g. Gordon Research Conferences, Keystone Meetings) depending on their research focus.

The amount of protected time for research during the second and third years is tailored to each individual fellow's needs and career goals through the process of track selection. Fellows that are interested in pursuing a career as a physician-scientist are provided a significant amount of protected time through our research tracks. Fellows on other tracks also have protected time for research and scholarship.

Fellows that choose to pursue advanced degree programs will begin their coursework during the second year and, in most cases, complete their degrees prior to graduation. Additional protected time is provided for fellows pursuing advanced degree training.

There are multiple pulmonary/critical care conferences scheduled each week, which cover both clinical practice and research. The overall goal of our conferences is to foster learning and engender discussion about topics pertinent to the practice of pulmonary/critical care medicine. We strongly believe in teaching based on the principles of evidence-based medicine, defined as the integration of best research evidence with clinical expertise and patient values.

All fellows are expected to attend conference. Fellows must attend at least 70% of conferences over the three-year fellowship in order to be eligible for graduation, and 70% within each academic year to be promoted and to remain eligible to moonlight. Conferences that are missed can be made up by watching the recording of the conference, if available, but live attendance is strongly preferred and should be the default.

Pulmonary Research Conference

Pulmonary Research Conference is held weekly on Monday or Tuesday. This conference includes clinical, translational, and basic science research presentations by pulmonary/critical care and sleep faculty from OSU and visiting professors from outside institutions. Graduating fellows present findings from their research projects at this venue prior to graduation.

Fellows Case Conference

Fellows case conference is held twice monthly and is led by one or two fellows. Format includes a formal case presentation and an evidence-based review of a clinical question using the PICO format. Fellows receive formal training from program leadership prior to their presentations and feedback is provided from a faculty member at each session.

Pulmonary/Critical Care Medicine Core Didactic Conference

Pulmonary/Critical Care Medicine core didactic conference occurs 2-3 times per month. This curriculum is on a three-year cycle, with some topics covered yearly and others covered once every three years. It utilizes a multi-format conference and is organized by the chief fand program directors. It involves a series of rotating topics mapped to the ABIM pulmonary and critical care medicine board preparation blueprint. These didactic lectures focus on clinical management of sub subspecialty patients and are given by faculty from Pulmonary/CCM division and other clinical departments.

Research Work in Progress

The conference is held weekly and provides a venue for trainees to present their ongoing work to faculty and colleagues. Second year PCCM fellows and research trainees present at this venue to seek feedback, review grant proposals and pitch ideas for new projects.

Ultrasound Didactic Curriculum

Ultrasound didactic curriculum occurs every other month and is led by a faculty member with extensive ultrasound expertise. These sessions provide hands on training in core point of care ultrasound image acquisition and interpretation skills.

Resident Chest Conference

The quarterly Internal Medicine resident chest conference is a fellow led series where fellows give presentations outlining the basic interpretation of CXR and CT chest imaging. Case-based questions are also generally included in these presentations.

Interstitial Lung Disease Conference

Interstitial Lung Disease conference is a bi-monthly multidisciplinary case conference where imaging, pathology and general management of ILD patients are discussed, in collaboration with faculty from pathology and chest radiology.

Clinical Journal Club

Clinical Journal club occurs monthly and is facilitated by a fellow with faculty mentorship. Recent publications pertinent to pulmonary and critical care medicine are reviewed. The goal of this conference is to teach fellows how to critically review research studies with particular attention to study design and statistical analysis. The fellows are expected to learn the principles of study design, power analysis, statistical comparison of parametric and non-parametric measures, confidence intervals, relative risk and life table and survival analysis. Fellows also gain experience in different methods of data presentation and the applicability of research to patient care.

Morbidity and Mortality Conference

Morbidity and mortality conference occurs bimonthly and is an opportunity to discuss challenging cases or unexpected clinical outcomes in a safe and supportive environment. If available, autopsy findings are reviewed. This conference is facilitated by the chief fellows and, when applicable, faculty from pathology.

Internal Medical Grand Rounds

Internal Medical Grand Rounds, held weekly, includes reviews of topics pertinent to both Pulmonary and Critical Care Medicine and other Internal Medicine specialties. Both OSU faculty and nationally recognized experts from other institutions are invited to present at this conference.

Multidisciplinary Critical Care Conference

Multidisciplinary critical are conference occurs on the first, second and third Fridays of every month. Trainees from all critical care training programs across the institution including pulmonary/critical care, neurocritical care, surgical critical, anesthesia critical care regularly attend this conference. In addition, trainees from other members of the multidisciplinary critical are teams including ICU advanced practice providers and critical care pharmacists participate. The conference series has three main components: critical care didactics, journal club, and grand rounds. It is facilitated by program leadership from all the above training programs.

Fellows Monthly Meeting

Fellows monthly meeting is an opportunity for the fellows and program leadership to discuss updates in the program, and a forum for fellows to share their thoughts on issues pertinent to their training.

Simulation Sessions

Simulation sessions occur monthly in the Clinical Skills Education and Assessment Center located in the Health Services Library (Prior Hall). These sessions utilize high fidelity simulations and are an opportunity for fellows to hone procedural, decision-making and clinical management skills in a collaborative context with co-fellows. They are facilitated by the chief fellows.

 Prerequisites

• MD, DO, or equivalent degree
• Be eligible for an Ohio training certificate or permanent medical license
• Have successfully completed three years of U.S. postgraduate training by the time of entry into the fellowship programHold U.S. citizenship, permanent residency or current Education
• Commission for Foreign Medical Graduates certificate

Application documents

The following is a list of the required documents necessary to complete the application for our Pulmonary and Critical Care Fellowship.

• USMLE Step 1, 2, 3 or COMLEX scores
• A letter from your residency program director (submitted via ERAS)
• Three reference letters (submitted via ERAS) – one must be from a pulmonary or critical care faculty member or pulmonary and critical care fellowship program director
• A recent photograph of the applicant

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