Pulmonary/Critical Care Medicine Fellowship

In response to your inquiry, we are providing a brief summary of our Pulmonary/Critical Care Training Program and our General Critical Care Training Program.

We offer both a three-year combined Pulmonary and Critical Care fellowship program and a two-year Critical Care fellowship program that will qualify graduates for Pulmonary and/or Critical Care Board examinations.

These programs are offered in well-structured rotations at UCLA-affiliated hospitals. These hospitals include Cedars-Sinai Medical Center (CSMC), an internationally renowned, 900-bed teaching hospital, VA West Los Angeles Medical Center, Sepulveda VA Medical Center (a unique ambulatory care and research center), Olive View-UCLA Medical Center (a county hospital facility), and Southern California Kaiser Permanente. Thus, the exposure to pulmonary/ critical care patients is extremely broad with a very diverse patient population. The fellowship program is supported by 30 full-time academic faculty members and 20+ clinician-teacher faculty members. The faculty is a dynamic one whose interests cover an extremely broad range of Pulmonary and Critical Care experience, as well as basic and clinical research pursuits. At all participating hospitals, the activities of the Pulmonary/Critical Care Divisions are conducted in a traditional academic fashion. The Fellows are given a great deal of responsibility and assume a leadership role in all clinical areas. Our goal is to provide an atmosphere in which trainees can become excellent clinical pulmonologists/critical care physicians and/or investigators. We emphasize pathways leading either to an academic career or to a career as a practicing Pulmonary/Critical Care specialist and hospitalist. This latter pathway emphasizes experience in managing acutely hospitalized patients and includes understanding the appropriate use of guidelines and pathways, learning effective case management, and becoming skilled in a wide variety of procedures. Although there is a basic structure to our program, it is also flexible enough to accommodate special interests of the Fellows. Since we offer a program leading to eligibility to sit for both Pulmonary and Critical Care Boards, we provide at least eighteen months of clinical rotations and dedicated months of research experience. Involvement in research is a required component of training. In addition, a broad experience in Sleep Medicine is available and provided during the fellowship. An optional fourth year (sleep training) is available at our accredited Sleep fellowship program.

The clinical rotations are in the Respiratory Intensive Care Units, Medical Intensive Care Units, specialty ICU's (including neuron and trauma ICU), Pulmonary Function Labs, Pulmonary Consultation Services, Surgical Consultation Service, Endoscopy Services, Transplant Service, Sleep Medicine Service and a selection from a menu of critical care rotations. Throughout the three- (or two) year program, Fellows participate in clinical and/or basic research activities under the guidance of the full-time faculty. There are numerous areas in which we offer considerable opportunities for Fellows to develop research expertise.

CLINICAL ROTATIONS

Respiratory Intensive Care, Medical Intensive Care, Saperstein Medical Surgical Intensive Care, and Neuro Sciences Units (RICU, MICU, SCCT and NsICU):

The Fellow supervises the activities of the medical house staff and students assigned to the units. The Fellow works closely with the full-time Directors of the RICU, MICU, Med-Surg ICU or NsICU, in separate rotations. Emphasis is placed on learning evidence-based principles of management, as well as highlighting the pathophysiologic aspects of conditions or treatment modalities. The Fellow will learn both the theoretic and practical aspects of all procedures pertinent to the care of critically ill patients. We also offer a unique ICU experience in our medical-surgical ICU, which is closed and run by a full-time attending faculty member and two fellows (with assistance of appropriate consultants). This offers a "real world" experience and one-on-one intensivist training. We offer exceptional experiences in neurointensivist care, trauma and general surgical ICU care. There are also opportunities to rotate through a variety of other critical care units including the Cardiac ICU, Cardiac-Surgical ICU, Anesthesiology, Pediatric ICU, Dialysis Unit, etc.

Endoscopy:

Fiberoptic bronchoscopy is performed by the Fellow under the supervision of one of the staff. Fellows perform over 200 bronchoscopies during their fellowship. These procedures, as well as needle aspiration biopsies, are performed in the Pulmonary/Critical Care Division Procedure Rooms. In addition, CSMC is a major center for YAG laser resection therapy, insertion of stents, use of brachytherapy, and other state-of-the-art devices such as navigational bronchoscopy.

Consultation:

The Fellow provides pulmonary consultation for the medical and surgical teaching services of CSMC or other participating hospitals when rotations are held there. During this period, the Fellow will supervise medical housestaff and students who are on the Pulmonary elective.

Lung Transplantation:

There is a Lung Transplant rotation during which the Fellow sees patients in a bi-weekly Lung Transplant Clinic. These patients are evaluated as possible candidates for lung transplantation or are seen in follow-up post-lung transplantation. The Lung Transplant Fellow is also primarily responsible for the transplant patients admitted to the hospital, working closely with the Director, Associate Director and/or Assistant Director of the Lung Transplant Service. The fellow is trained in all aspects of pre-transplant, perioperative transplant, and short- and long-term transplant management.

Pulmonary Physiology Laboratory:

The Fellow will work in the Pulmonary Laboratory at participating institutions under the supervision of the full-time Director of the Lab and learn performance, calculation and interpretation of pulmonary function tests. The physiologic evaluation of patients includes spirometry, lung volumes by dilution and plethysmographic techniques, diffusion, mechanics and blood gas analysis. In addition, the Lab is uniquely equipped for sophisticated exercise and other special studies (e.g. exercise studies with PA catheter in place, transdiaphragmatic pressure or high altitude studies, etc.).

Ambulatory Care Experience:

Our Fellows work in a variety of outpatient clinical settings. These include a meaningful weekly continuity clinic held at VA West Los Angeles and Southern California Kaiser Permanente, complemented by ambulatory experiences in pulmonary clinics at Sepulveda VA and Olive View-UCLA Medical Center. In addition, specialty clinics include Transplant Clinic, Cystic Fibrosis Clinic, and Sleep Clinics.

Sleep Medicine:

We have a separate accredited Sleep Fellowship Program (one year) which provides opportunities for an additional year of training and board certification. Our fellows attend sleep clinics and have excellent sleep exposure as well.

Educational Program:

While there is no substitute for seeing as much clinical material as possible, we complement the clinical experience with an extensive didactic program for the Fellows. In addition, the attending staff is always available for discussion of special or emerging problems. While on these rotations, the Fellows will also participate in the teaching functions of the Division. There is a full schedule of educational activities and numerous weekly conferences covering all aspects of Pulmonary and Critical Care Medicine (clinical and basic sciences pertinent to Pulmonary and Critical Care Medicine).

Thoracic Surgery:

We have a well-established Thoracic Surgery Department boasting one of the largest video-assisted thoracoscopy centers, performing more than 900 cases per year. Weekly Thoracic Surgery conferences, with a multi-disciplinary approach, provide an ideal milieu for teaching and learning.

RESEARCH AREAS

Involvement in research is an integral part of our program. Identification of the fellows' research interests and mentoring occur within the first year to enable maximum experience, training, and meaningful productivity (abstracts, papers, presentations at national meetings, etc.). The scope of research is broad, from basic to clinical (including outcomes) research.

Molecular and Cell Biology of Lung Cancer:

We have a well-funded, well-established program that is active in this area. This program is based at VA West Los Angeles, and studies involve various biologic and genetic aspects of lung cancer. At Cedars-Sinai, a major new emphasis in the cell biology of lung cancer is underway.

Respiratory Muscle Physiology, Cell Biology and Molecular Biology:

There is an active program of investigation of the diaphragm and other respiratory muscles. Studies are performed on animal models integrating physiology in vivo and in vitro with cell biologic and molecular biologic aspects on topics that have important implications for the clinical arena. Clinical studies are also performed using state-of-the-art modalities for respiratory muscle function testing and/or muscle biopsies for cellular analysis. These programs are based at CSMC.

Pulmonary Hypertension:

a.) Basic research into mechanisms underlying vascular smooth muscle proliferation in PAH.
b.) Includes hemodynamic and exercise studies in pulmonary hypertension, as well as use of new or experimental therapies clinically.

Lung Volume Reduction Surgery for Emphysema:

Extensive clinical and basic research studies have been developed. CSMC is one of the 17 centers in the USA involved in the NETT trial for emphysema. Other novel bronchoscopic approaches to "lung volume reduction" are also being studied.

COPD

Cutting edge studies such as stent insertion to reduce dynamic hyper-inflation in emphysema patients and other bronchoscopic means of volume reduction are active, as well as pharmacologic approaches.

Lung Transplantation:

CSMC has a clinical and experimental lung transplant program in place. Fellows will have the opportunity to learn management of recipients and participate in research studies on rejection, organ preservation and revascularization of tracheal and bronchial anastomosis and transplant immunology.

AIDS/Pulmonary Infectious Diseases:

This is clinical research involving multicenter/national protocols.

Fabry's Disease

CSMC is one of the centers studying exercise tolerance in patients with Fabry's disease.

Exercise and Pulmonary Physiology/Pathophysiology:

We have well-established programs in these areas which have been in place over many years. A series of research protocols involving Fabry's disease, obesity, and others are underway.

Health Services Research:

Fellows have the opportunity to be involved in studies concerning clinical outcomes and resource management in the field of Pulmonary/Critical Care Medicine.

This correspondence can only scratch the surface and is a brief overview of the Cedars-Sinai Pulmonary/Critical Care Training Program which should be supplemented by an on-site visit in order to see the Divisional activities first hand at all campuses. We look forward to meeting you during your visit.

Zab Mosenifar, M.D.,
Professor and Executive Vice Chairman, Department of Medicine
Director, Division of Pulmonary/Critical Care Medicine
Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA
Michael I. Lewis, M.D., Professor of Medicine
Director, Respiratory Intensive Care Unit
Director, Pulmonary/Critical Care Medicine Fellowship Program
Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA
Jeremy Falk, M.D., Assistant Professor of Clinical Medicine
Associate Director, Lung Transplant Program
Co-Director, Pulmonary/Critical Care Medicine Fellowship Program
Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA

For more information about the Pulmonary/Critical Care Medicine Fellowship, please contact:

Debra Craig
Divison of Pulmonary/Critical Care Medicine
Cedars-Sinai Medical Center
8700 Beverly Boulevard, Room 6732
Los Angeles, CA 90048
Phone: 310-423-1835
Fax: 310-423-0129
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