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Pulmonary and Critical Care Medicine Rotations and Clinics

Clinical time in the Pulmonary and Critical Care Medicine Fellowship program at IU School of Medicine is balanced between pulmonary and critical care rotations to meet training requirements. The first year of training consists of 13 blocks of clinical rotations, and the remaining clinical months are divided among the remaining two years.

Immersion Month
Month-long orientation in July with a mix of didactics, hands on procedural training, and spending time with the upper level fellows to become familiar with the medical system prior to starting clinical rotations in Block 2.

Ambulatory
 
During this rotation, fellows receive broad exposure to various sub-subspecialties in pulmonary medicine including cystic fibrosis, pulmonary hypertension, severe asthma, interstitial lung disease and interventional pulmonary. This occurs across several sites in our system within the Indianapolis area.

Bronchoscopy/Pulmonary Function Testing
 
This is a very popular rotation at University Hospital and fellows are able to participate in placement of tracheal stents and endobronchial valves with opportunities for certification in robotic bronchoscopy if desired.

Consults
Each of these services provide significant breadth in pathology seen. There are few unique aspects to each service as highlighted below.

  • Eskenazi Pulmonary Consults
    • Fellows will interpret pulmonary function testing and have opportunities to perform advanced bronchoscopy procedures.Fellows will also see patients in the urgent pulmonary clinic and are responsible for seven nights of ICU call and one weekend of inpatient rounding in the ICU.
  • Methodist Pulmonary Consults
    • This service provides inpatient pulmonary consultative care with opportunities to learn advanced bronchoscopy skills from fellowship trained interventional pulmonologists.
  • University Pulmonary Consults
    • The consult service at University Hospital frequently sees patients who are immunosuppressed or have atypical presentations of their illness. As the site of our system’s bone marrow and liver transplant programs, fellows gain extensive experience in both pre- and post-transplant care of these patients.
  • VAMC Pulmonary Consults
    • Fellows on this service interpret pulmonary function testing and have ample opportunity to participate in advanced bronchoscopy procedures. Fellows share call and weekend responsibilities with the ICU fellow, covering two weeks of home call and two weekends of inpatient rounding.

Eskenazi Hospital Medical ICU
Eskenazi Hospital is home to one of three level one trauma centers in the state and has the most experienced burn center as well. We have two ICU teams in the MICU with residents and APPs. Fellows on this service are responsible for seven nights of home call and one weekend of rounding.

IU Health West
 
This provides opportunities for fellows to work one-on-one with an attending in a more community-like setting. No overnight call is required. Fellows work one day each weekend.

IU Health Methodist Hospital Cardiac Medical Critical Care
 
This service cares for patients for acute conditions such as severe pulmonary hypertension and acutely decompensated heart failure requiring mechanical assist devices. Fellows will also gain experience with interpretation of pulmonary artery catheters Additionally, this block provides the opportunity to work primarily one-on-one with an attending (sometimes there will be a fourth year student on the rotation as well). No overnight call is required. Fellows are only assigned one week at a time and will cover the weekend associated with that week.

VA Medical Clinic Medical ICU
 
This service includes both residents and interns. The Indianapolis VA Medical Center has the capability of caring for very critically ill patients, providing a solid educational experience. Fellows are responsible for covering two weeks of home call and two weekends of inpatient rounding.

Methodist Hospital Cardiovascular Surgical Critical Care
This block provides experience in co-management of post-cardiothoracic surgery patients alongside the surgical teams. There is significant breadth of exposure to post-surgical care and includes care of patients with mechanical left ventricular support devices. There are no call requirements on this service, but fellows may cover a weekend as an off service fellow.

Methodist Hospital Neurocritical Care
 
This block includes residents and/or interns and provides opportunity to learn as part of a multidisciplinary team caring for patients with a variety of neurologic conditions requiring ICU level care. There are no call requirements on this service, but fellows may cover a weekend as an off service fellow.

Methodist Hospital Transplant/ECMO
 
This service is divided into inpatient and outpatient experiences. When on the inpatient service, fellows will round on patients on ECMO and those who have recently undergone lung transplantation. The outpatient service will allow fellows to participate in the care of clinic patients in both the pre- and post-transplant period, attend transplant listing meetings, and assist with post-transplant bronchoscopies. There are no call requirements and the fellow will work one weekend of their choosing.

University Hospital Medical ICU
 
This is an extremely busy ICU which primarily houses patients with end-stage liver diseases, advanced GI problems such as necrotizing pancreatitis, and malignancy. There is no overnight call on this rotation. This rotation in done in two-week increments and the fellow will be assigned to work one of the two weekends.

Continuity Clinics

Each fellow will have a general pulmonary clinic at Eskenazi Health every other week for all three years of fellowship, alternating with a clinic at a different site. If desired, sub-subspecialty continuity experience is possible in the following areas:

  • Cystic fibrosis
  • Interstitial lung disease
  • Interventional pulmonary
  • Lung transplantation
  • Neuromuscular diseases Clinic
  • Post ICU survivor
  • Pulmonary nodule/thoracic oncology clinic
  • Pulmonary hypertension
  • Sarcoidosis
  • Severe asthma