Our three-year curriculum combines busy clinical services with purpose-designed rotation experiences to give you the experience you need to practice excellent pulmonary and critical care medicine. Our fellows enjoy a great balance of direct and indirect supervision, with increasing autonomy as their skills grow. Specific workshops and lectures increase your medical knowledge and procedural competence in a safe learning environment. There are excellent opportunities for research, including fourth-year opportunities for those wishing to pursue a physician-scientist career.
During the three years of fellowship training, fellows will experience a mix of pulmonary, critical care, inpatient, outpatient, clinical, academic, and research activities. Below is a sample schedule illustrating the general structure of our fellowship.
Most of our clinical training is offered at the Atrium Health Wake Forest Baptist 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. Learn more about Atrium Health Wake Forest Baptist. Fellows care for patients in three inpatient venues:
- Medical intensive care unit
- Surgical intensive care units (ICU)
- Pulmonary medicine inpatient 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. During each rotation 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.
Inpatient Pulmonary Training
Our inpatient consultation service averages more than 800 inpatient consults annually. Fellows partner with our inpatient COPD pathway, including our respiratory care navigators and nurse practitioner to create a seamless transition from hospital to office care. In addition, our fellows provide expert consultation for patients on all hospital services, including (but not limited to) general medical, general surgical, obstetrics and gynecology, transplant, oncology, burn surgery, cardiovascular surgery, and otolaryngology.
Outpatient Pulmonary Training
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 day every week except when the fellow is rotating on an inpatient service. Additionally, all fellows rotate several times on our outpatient pulmonary medicine (OPPM) 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 and bronchiectasis
- Lung nodule evaluation
Bronchoscopy and Pleural Procedure Training
Fellows are part of our pulmonary procedure team (PPT), a team of pulmonologists with expertise in advanced diagnostic bronchoscopy, pleural procedures, and interventional pulmonology. Our section performs roughly 1,000 bronchoscopies (fiberoptic and rigid) per year. Fellows will develop competence in all aspects of bronchoscopy, including:
- Diagnostic bronchoscopy and bronchoalveolar lavage
- Fluoroscopic-guided bronchoscopy
- Endobronchial and transbronchial lung biopsy
- Transbronchial needle aspiration (conventional and ultrasound guided—linear and radial EBUS)
- Robotic shape-sensing bronchoscopy
Fellows will also acquire competence in pleural procedures such as:
- Pleural ultrasonography
- Thoracotomy tube insertion and removal (tunneled and non-tunneled techniques)
Pulmonary Function Testing and Interpretation
Pulmonary diagnostic testing experience includes time learning clinical pulmonary physiology by interpreting pulmonary function tests, cardiopulmonary exercise tests, inhalation challenge studies and sleep studies.
Our Medical Center has several intensive care units. Our fellows gain experience in medical, oncology-specific, and non-medical specialty ICUs. During MICU rotations, fellows are the primary proceduralist and will develop expertise in invasive hemodynamic monitoring procedures, endotracheal intubation and mechanical ventilation, and ultrasound-guided intravascular access. They will acquire both the technical proficiency necessary for these procedures and judgmental skills essential to their appropriate use. Fellows take a graduated active role in leading patient clinical management with a clinical team including interns, residents, pharmacists, nurses, respiratory therapists, physical therapists, nurse case managers and an attending physician. They also play an active role as a medical educator to house staff from internal medicine, family medicine, emergency medicine, and anesthesiology. Second- and third-year trainees rotate in our oncology specialty ICU where they gain experience leading a team that includes advance practice providers (NPs and PAs). All our ICUs utilize bedside ultrasound and support a point-of-care ultrasound curriculum facilitated by our critical care faculty.
As a quaternary referral center, our ICU patient population has high acuity, including a high percentage of patients receiving vasoactive medications and mechanical ventilation. Fellows gain access to real-time data about our ICU population, and report daily in our quality and safety huddle to assist with our ongoing safety and quality improvement efforts.
Each fellow’s non-medical ICU rotations occur in specialty intensive care units, such as:
- Trauma and Emergency General Surgery ICU
- Burn ICU
- Neurocritical ICU
- Cardiothoracic ICU
Fellows participate in several conferences to help establish and increase their knowledge of pulmonary and critical care medicine. Many of our conferences are case based, to provide authentic discussion regarding real-world management strategies. Fellows, pulmonary and critical care attendings, and invited guest lecturers regularly attend. We have a robust web platform for collaboration in an online classroom environment, and when on campus we gather in our well-equipped section conference room. All conferences are recorded to allow for review by fellows on night float or vacation and as part of preparations for board exams.
PCCM Regularly Scheduled Series
- Radiology Conference
- Pulmonary Critical Care Board Review Series
- Critical Care Conferences
- Quarterly PCCM Workshops
- Research Roundtable (Projects in progress)
- Outpatient Pulmonary Curriculum
- Clinical Case Conference
- Morbidity and Mortality / Safety and Quality Conference
- Research Conference
- Pulmonary / Critical Care Journal Club
- Multispecialty Case Conference
- Fellow Business Meeting
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 has protected time to pursue their chosen project.
All fellows receive at least six months of protected time for research; 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:
- Up to 18 months’ time for research during the three-year fellowship
- Personal research mentoring committee
- Support for your application seeking fourth-year funding. Several opportunities exist, 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.