Pulmonary & Critical Care Fellowship

Program Overview

Loyola Medicine has a fully accredited and highly competitive three-year combined Pulmonary and Critical Care Fellowship program with a total complement of 13 clinical fellows. It offers a comprehensive program of quality patient care, research and education.

Our program’s strength lies in the large and varied patient base, the variety of clinical experiences offered and a faculty dedicated to teaching. Our fellows are trained to be skilled clinician educators through intense clinical exposure and opportunities to teach residents and medical students.

Our fellows rotate through multiple institutions during the course of their fellowship:

Loyola University Medical Center

Loyola University Medical Center provides a broad rang of patient experience with approximately 1,000 acute care beds of which 150 are adult intensive care beds. The hospital is rated as having the highest patient acuity level in Illinois.

The lung transplantation program is one of only seven programs to have performed over 500 transplants. We have an active Sleep Center and perform over 1,300 sleep studies. We have a busy interventional bronchoscopy program that performs stenting, laser, endobronchial ultrasound and brachytherapy.

Edward Hines, Jr. VA Hospital

The Edward Hines, Jr. VA Hospital is the largest in the Midwest and is a referral base for other VA hospitals. Large patient base with obstructive lung disease and lung cancer.

Additionally the Hines VA is one of the ALS referral centers for the region. We have a busy interventional bronchoscopy program with navigational bronchoscopy and endobronchial ultrasound available.

Goals and Program Content

The subspecialty fellowship program in both pulmonary disease and critical care medicine will provide training and supervised experience at a sufficient level to acquire the competency of a specialist in both disciplines. The combined training program is three years in duration.

The clinical experience in pulmonary disease will include opportunities to observe and manage inpatients and outpatients with a wide variety of pulmonary disorders. Fellows will have the opportunity to assume continuing responsibility for acute and chronically ill patients in order to learn the natural history of pulmonary disease, as well as the effectiveness of therapeutic programs.

There will be an educational emphasis on pulmonary physiology and its correlation with clinical disorders. Fellows will gain experience in procedural skills such as bronchoscopy and exposure to advanced bronchoscopy and interventional pulmonology. They will be actively involved in the care of post-lung transplant patients and patients with advanced lung disease and pulmonary hypertension.

The training in critical care medicine will provide at least fifteen months of meaningful patient care responsibility in critical care units. In addition to medical intensive care, trainees will obtain additional clinical training with experiences in neurosurgical, cardiac, surgical, and cardiothoracic surgery intensive care units.

The trainee will have opportunities to assume responsibility under appropriate supervision for the care of patients throughout their stay in critical care units and to monitor the subsequent course of patients throughout the remainder of their hospital stay. The fellow will acquire skills required to organize, administer, and direct a critical care unit and work effectively as a member of a multidisciplinary team.

The combined fellowship provides trainees with exposure to research, quality improvement and practice management skills to help them in their future careers.

Overview of Clinical Educational Programs

Critical Care

Medical Intensive Care

Fellows rotate through the MICU at Loyola University Medical Center and Edward Hines, Jr. VA Hospital. There is a night float fellow at the Loyola MICU on weeknights (Monday through Friday). Fellows oversee the care of critically ill patients and are responsible for the teaching and guidance of residents and students on the service.

Non-medical Intensive Care

Fellows gain experience in non-medical intensive care through rotations in the trauma, neuro and cardiothoracic ICU.

Lung Transplantation

Loyola University Medical Center has one of the most active lung transplantation programs in the country. The pulmonary division directs all pre- and post- operative care of these patients. The fellow has an opportunity to care for these patients and familiarize themselves with the challenges of managing immunosuppression and lung rejection.

Advanced Lung Disease

On this elective, fellows rotate through subspecialty clinics in interstitial lung disease, pulmonary hypertension and lung transplant and learn the management of patients with advanced lung disease and post-transplant.

Procedure

On this rotation, fellows develop the skill to perform bronchoscopy and bronchoscopic procedures including transbronchial biopsies, brushing and bronchoalveolar lavage. They get the opportunity to learn endobronchial ultrasound (EBUS) and cryotherapy.

In addition, they assist in navigational bronchoscopy, stent and endobronchial valve placement. Fellows also gain expertise in thoracentesis, chest tube and indwelling pleural catheter placement.

Consults

The goal of this rotation is to expose fellows to a broad range of pulmonary diseases and to develop the skills for providing appropriate consultation to other medical services. They also round on the inpatient pulmonary hypertension service with the pulmonary hypertension faculty and become familiar with the management of these complex patients.

Sleep Medicine

The sleep labs at Loyola and VA hospitals each perform over 1,500 attended and unattended sleep studies. On this rotation, fellows develop a deep understanding of sleep medicine with exposure to patients with a wide array of sleep disorders besides sleep-disordered breathing. Training will include reading sleep studies, attending sleep clinics and conferences.

Ventilator Service

The division provides a ventilator management service to patients at RML Specialty Hospital located in Hinsdale, Illinois (10 miles from the Loyola University Medical Center). Fellows will have a two to four week rotation during which they will learn about chronic respiratory failure and weaning

Ambulatory Care

In the first and second year, the fellow will have ambulatory care clinics alternating at Loyola University Medical Centerand Hines VA for one-half day per week.

Fellows gain expertise in the management of wide range of pulmonary diseases and familiarize with all aspects of outpatient clinical practice such as billing and coding, ordering oxygen, CPAP and other respiratory assist devices.

There is also a continuity clinic in sleep medicine through which they gain experience in the management of patients with sleep disorders such as sleep apnea and insomnia. In the third year, fellows rotate through two sub-subspecialty clinics of their choice, including asthma, cystic fibrosis, pulmonary hypertension, thoracic oncology, lung transplant, interstitial lung disease and sleep.