During the three years of fellowship training, fellows will experience a mix of pulmonary, critical care, inpatient, outpatient, clinical, academic and research activities.
The pulmonary section performs more than 800 bronchoscopies (fiberoptic and rigid) per year. Fellows will develop competence in all aspects of bronchoscopy, including:
- Bronchoalveolar lavage
- Endobronchial and transbronchial biopsies
- Transbronchial needle aspiration (conventional and ultrasound guided—convex and radial EBUS)
- Navigational bronchoscopy
Additional experience in interventional bronchoscopy techniques is gained by working alongside our IP faculty. Fellows will also acquire competence in pleural procedures such as:
- Thoracostomy tube insertion (tunneled and non-tunneled)
Pulmonary diagnostic testing experience includes time learning clinical pulmonary physiology by interpreting pulmonary function tests, cardiopulmonary exercise tests, inhalation challenge studies and sleep studies.
During the ICU rotations, fellows will develop expertise in invasive and noninvasive hemodynamic monitoring procedures. They will acquire both the technical proficiency necessary for these procedures and judgmental skills essential to their appropriate use.
The remaining time during the second and third years of fellowship is designed to be flexible and individualized. Fellows may elect for additional inpatient critical care experiences involving rotations in other intensive care units, such as:
- Coronary care
- Cardiothoracic surgery
The clinical pulmonary exposure also involves cross-specialty consultations in the transplantation programs, including:
- Bone marrow, heart and kidney transplants
- Thoracic oncology
- Thoracic surgery
- Pulmonary pathology
After successful completion of the three-year program, fellows will meet all requirements for the American Board of Internal Medicine subspecialty board examinations for pulmonary disease and critical care medicine. All fellows who have graduated from the program have successfully achieved dual certification.
Most of our clinical training is offered at the Wake Forest Baptist Health Medical Center campus, which operates 1,004 acute care, rehabilitation and psychiatric care beds. Within the main hospital are general medicine nursing units, 33 intermediate care and 85 medical-surgical intensive care beds. Fellows care for patients in three inpatient venues:
- Medical and surgical intensive care units (ICU)
- Pulmonary intermediate care service
- Pulmonary medicine consultation service
These are busy rotations, with the section averaging more than 800 inpatient consults and nearly 3,500 admissions to the medical intensive care unit (MICU) every year. Within each venue, fellows are paired 1:1 with attending faculty for the rotation. During their first year, fellows are exposed to the entire spectrum of pulmonary and critical care diseases by spending time both in the ICU and on busy consultative services.
In the outpatient venue, approximately 7,000 outpatients are seen in the Pulmonary Clinic annually. All fellows experience a longitudinal continuity care clinic where they care for patients with the full spectrum of pulmonary diseases as their primary pulmonary specialty physician. These clinics occur one half-day every week except when the fellow is rotating on an inpatient service. Additionally, all fellows spend two months each year on an outpatient pulmonary medicine rotation.
During this rotation, fellows do not have inpatient duties, and they rotate through faculty general pulmonary clinics and subspecialty clinics in:
- Severe asthma
- Pulmonary hypertension
- Cystic fibrosis
- Thoracic oncology/interventional pulmonary
Salisbury, North Carolina and Kernersville, NC
Fellows spend four to six weeks per year gaining additional experience and training at the VA. The program offers clinical experiences in the comprehensive assessment and management of patients with sleep disorders. A team of faculty based primarily at the VA hospital, complemented by our sleep-certified pulmonary critical care faculty from Wake Forest, has created a superb experience in clinical sleep medicine.
Additionally, our faculty hold general pulmonary clinics for veterans with lung cancer and other pulmonary disease. This provides fellows with additional experience in outpatient evaluations, diagnostic and interventional bronchoscopy, and sample acquisition for appropriate molecular and genetic analysis.
Lastly, our fellows access a high-fidelity bronchoscopy simulator through the VA, which affords additional guided bronchoscopy training in a simulated patient environment. The training curriculum for this simulator has been adapted by our own faculty for use in fellowship training.
Conferences and Didactics
Fellows participate in a number of weekly and monthly conferences to help broaden their understanding of pulmonary issues.
The faculty and fellows in our section are engaged in exciting and productive investigation in several areas. During the first year of fellowship, each fellow develops their own ideas for investigation with mentoring from our faculty. During the second and third fellowship years, each fellow will be given protected time to pursue their chosen project.
Our Research Curriculum is anchored by an Introduction to Research course covering the following topics:
- Session # 1: Choosing a Research Question
- What is Research/Choosing a Research Question
- Session #2: Use of Library Resources
- Hands-on Computer Class: How to conduct a literature search; EndNote and other reference management programs
- Session #3: Wake One Data/Navigating IRB
- Wake One Data Extraction; Navigating IRB at Wake: The Nuts and Bolts
- Session #4: Study Designs
- Classification of observational studies: sampling scheme and time frame; structure, advantages and disadvantages of major observational designs; importance of sampling scheme in studies of diagnostic test accuracy; practice naming designs.
- Session #5: Stats and Data Visualization
- Stats 1: chi-sqr, t-test, ANOVA, linear regression; data Visualization
- Session #6: Power/Sample Size
All fellows receive at least six months of protected research time; the content, timing, and structure is individualized based on the fellow’s project and career plans. For fellows interested in establishing a research career, additional support is offered. Our Research Career Development Option includes:
- Nine months protected time for research
- Personal research mentoring committee
- Application for fourth year funding opportunities, such as
- NIH NRSA Grants
- NIH T32 Training Grants
- Cystic Fibrosis Foundation Grants
- Wake Forest Department of Medicine Translational Science Fellowship
- This fellowship includes earning a master’s degree in Clinical and Population Translational Science
All third-year fellows present a section conference where they summarize their work. Each year many of our fellows also present their work for national audiences at conferences such as ATS, CHEST, and SCCM. Several fellow projects also result in peer-reviewed publications.