Pulmonary, Critical Care & Sleep Medicine - Fellowship Program

The Warren Alpert Medical School of Brown University and its affiliated teaching hospitals offer a 3-4 year training program in Pulmonary and Critical Care Medicine. The medical school faculty of 30 full-time hospital-based Pulmonary/Critical Care clinicians and research scholars provide a broad and diverse environment for clinical education and research training. Four hospitals participate in the clinical program: Rhode Island Hospital, Memorial Hospital of Rhode Island, the VA Medical Center and The Miriam Hospital. Research training may be hospital based or conducted on the University campus. Four fellowship positions are offered each year for training in Pulmonary and Critical Care Medicine. Additional years for research training are encouraged. Positions for the fellowship are filled through the National Resident Matching Program for Pulmonary Diseases. Fellows who wish to pursue an academic career in Pulmonary Medicine may be eligible for fourth and fifth years of training. The purpose of the fellowship is to prepare board eligible or certified internists for a career in clinical or academic Pulmonary and Critical Care Medicine. In all aspects of the educational program, the Fellow is encouraged to develop an attitude of scholarship and the intellectual curiosity to remain in the informational forefront of the discipline throughout his or her professional lifetime. Training is carried out in a scholarly academic atmosphere that provides a wide exposure to clinical Pulmonary and Critical Care Medicine and clinical and basic science research.

Clinical Training

Our Pulmonary/Critical Care Fellowship Program is a 3-year, ACGME certified training program that includes intensive instruction in both clinical medicine. During their 3 years, our fellows will gain extensive experience in in-patient and out-patient pulmonary medicine, as well as critical care training in ICUs that range from general community based to the highest level tertiary care ICU in the region. Pulmonary education will include extensive exposure to pulmonary hypertension, interventional pulmonary, interstitial lung diseases, as well as general pulmonary diseases. Critical care training will give fellows experience in extracorporeal membrane oxygenation, state of the art ventilator technique, trauma critical care, neuro-critical care as well as general medical critical care. If desired, fellow can take extra clinical months for training in elective topics which can occur at our institution or at other institutions. Our program emphasizes competence at a wide variety of pulmonary and critical care procedures and our fellows typically graduate proficient in endotracheal intubations, pulmonary artery catheterization, chest tubes, and many advanced elements of interventional bronchoscopy including endobronchial ultrasound.

Research training

Beginning in the first year of training, fellows are mentored in the choosing of a research project. Research can be done at any of our four sites and is occasionally done off site at affiliated labs. Projects are chosen from a wide variety of subjects including molecular bench research, outcomes, health services, and other clinical projects. Fellows begin a dedicated research block in the second half of their second year that consists of 12 months of protected time in which the only clinical demands are one half day of clinic. At the conclusion of the research block in the third year fellows resume clinical rotations on some months but in others can continue with their research activities if needed. In cases where fellows wish to stay on for additional years of research, funding can often be obtained through the division.

Clinical Rotations

Overview

The first 12 months of the fellowship are relatively structured and devoted to clinical activities. Fellows rotate through the core training hospitals during the first year. The curriculum includes a mix of Pulmonary and Critical Care Medicine. In the second year of the program there is more focus on advanced Critical Care training in tertiary Medical ICUs, Surgical ICUs, a Respiratory Care Unit and a Neurosurgical ICU. After the research block has been completed, fellows resume clinical rotations in the second half of their third year and may also have time for elective rotations. There is some flexibility in the choosing of third year rotations such that more time can be spent on topics of interest or research if desired.

Participating Hospitals

Rhode Island Hospital is a 721-bed tertiary care hospital with a broad spectrum of pulmonary and critical care diseases. It is the state's largest hospital and the third largest hospital in New England. Rhode Island Hospital serves as the Level I Trauma Center for southeastern New England. We are verified by the American College of Surgeons as a Level I Trauma Center with both adult and pediatric capability. The neighboring Women & Infants Hospital on the campus provides unique educational experiences on the obstetrical and gynecologic services for pulmonary fellows. The 18-bed Medical Intensive Care Unit at Rhode Island Hospital has a high turnover of acutely ill patients with multi-system failure and was recently recognized by the National Coalition on Healthcare as one of the ten best in the country. It serves as a referral center for many hospitals throughout southern New England and is one of the most active ECMO centers in region. Rhode Island Hospital also has a 19-bed Respiratory Care Unit. This unit is used for patients without multi-organ failure who are admitted for acute, chronic or impending respiratory failure.

In addition to these units there is a 15-bed neurosurgical ICU that fellows rotate through. All fellows attend a once-a-week clinic at Rhode Island Hospital and the VA Medical Center as part of their longitudinal experience of outpatient pulmonary care as well as a monthly sleep medicine clinic. The overnight sleep laboratories affiliated with Rhode Island Hospital have received national certification from the Association of Sleep Disorders Centers. This laboratory provides unique diagnostic and research capabilities for the entire Brown community and serves referrals from the entire region.

Memorial Hospital of Rhode Island serves a community of 190,000 people in Pawtucket and the surrounding Blackstone Valley region. It is the second largest teaching hospital in the state and is the recipient of nearly five million dollars in federal funds, which support research in a variety of academic disciplines. The hospital is the designated primary care affiliate of the Warren Alpert Medical School of Brown University and supports residencies in Family Medicine and Primary Internal Medicine. The pulmonary fellow, therefore, serves as a consultant to a large number of primary care specialists and trainees. The Occupational Medicine Program of the Memorial Hospital of Rhode Island has an active outpatient service and is available for elective work by our pulmonary fellows.

The VA Medical Center is a 100-bed teaching hospital staffed by internal medicine residents from all of the Warren Alpert Medical School of Brown University affiliated programs. The pulmonary fellow is responsible for an active consultation service with consults from the Medical, Surgical and Psychiatric services. The VA system offers a unique educational experience for the pulmonary fellow by providing an environment with autonomy in decision making and a large number of patients with a variety of lung diseases willing to participate in clinical research. A large number of patients with respiratory failure are cared for in the 8-bed Medical Intensive Care/Coronary Care/Surgical Intensive Care Unit. The pulmonary fellow makes daily rounds in this ICU. The VA Medical Center has a large ambulatory pulmonary service and all first and second year fellows attend a once-a-week clinic as part of their longitudinal experience of outpatient pulmonary care. In addition, fellows consult on outpatients while rotating at the VA Medical Center.

The Miriam Hospital is a 247-bed, acute care general hospital in Providence and is a major teaching site for the Alpert School of Medicine. The ICU is a 16-bed, combined medical/surgical/cardiac unit which provides a very broad educational experience with an emphasis on collaborative rounds with these varied services. In addition the medically-ill patients, cardiac patients in this unit provide extensive experience in cardiogenic shock, intra-aortic balloon pumps, hemodynamic monitoring and pacing. Extensive experience with critically-ill post-operative patients is also obtained here.

Research Experience

We feel that direct involvement of the fellows in a research program will greatly enhance their scholarly development, provide a foundation for logical and critical thinking, and encourage lifelong habits of continuing scholarship. One goal of this experience is to interest fellows in a career in academic medicine. Through their research experience, our fellows:

  1. Learn the design and interpretation of research studies
  2. Learn to evaluate investigative methods and the interpretation of their data
  3. Develop competence in critical assessment of the medical literature and of the results of their work.

The first year fellows are introduced to the research interests of the faculty at our weekly research conferences. During the early springtime of the first year, each first-year fellow will discuss projects with various faculty members and then decide on a research theme. Research opportunities are available in both clinical and basic science within the department in the areas of Sleep, Pulmonary and Critical Care Medicine. In addition, ample opportunities exist outside the department for joint research projects.

One faculty member acts as preceptor for the research project and meets frequently with the fellow to review their work. In addition, fellows and faculty meet at weekly work-in-progress seminars to discuss ongoing projects. Visiting faculty from both American and International institutions visit the Pulmonary Division as well as lecture at pulmonary research conferences. It is expected that a fellow will initiate and complete 1-2 projects during their fellowship experience. Fellows who desire to pursue an academic career are urged to stay beyond the third year to continue their research endeavors under the preceptorship of one of the faculty.

Recent fellow research projects:

  • Dennis Oyieng'o, MD; Ultrasound Measures of Diaphragm Thickness and Liberation from Mechanical Ventilation; Preceptors: F. Dennis McCool, MD and Eric Gartman, MD
  • Debasree Banerjee, MD; Sudden Cardiac Death in Pulmonary Hypertension: Splice Variants of Na Channel SCN5A; Preceptor: Corey Ventetuolo, MD, MS
  • Sameer Shah, MD; Does PAP therapy improve airway hyperreactivity?; Preceptors: F. Dennis McCool, MD and Eric Gartman, MD
  • Nicholas Csikesz, MD; A Physician-based Intervention to Prevent COPD Exacerbation Re-admissions; Preceptor: Linda Nici, MD
  • Alix Morse, MD; Gene expression in sepsis: in search of a rapid diagnostic tool; Preceptors: Mitchell Levy, MD, Corey Ventetuolo, MD, MS, Jason Aliotta, MD
  • Timothy Amass, MD; Family Care Rituals in the ICU- A prospective multicenter, multinational trial; Preceptor: Mitchell Levy, MD
  • Janelle Baptiste, MD; Lung Cancer Screening with Low Dose CT: Findings in One year of VA population; Preceptor, Linda Nici, MD
  • Andrew Foderaro, MD; Retinal vascular changes and pulmonary hypertension; Preceptor Corey Ventetuolo, MD, MS

Other Curriculum Highlights

Interventional Pulmonology

We offer extensive training for the fellows in bronchoscopy and have expanded our practice and training in interventional pulmonology. Our clinical and training experience in this field continues to grow every year. We are performing a variety of interventional bronchoscopic procedures including airway stenting, endobronchial brachytherapy, electrocautery and various biopsy techniques. In addition to these procedures, our fellows gain extensive experience with large and small chest tube placement. Fellows will also be exposed to procedures including medical thoracoscopy and endobronchial ultrasound (EBUS). Our fellows consistently graduate each having done close to a hundred bronchoscopies.

Pulmonary Vascular Diseases

Rhode Island Hospital has recently been accredited as a Pulmonary Hypertension Comprehensive Care Center. Drs. Corey Ventetuolo and James Klinger lead a team that diagnoses and manages hundreds of cases each year as well as conducts significant bench and clinical research in the field. Fellows will work with them on several rotations and perform or assist in all cardiac catheterizations and vasodilator trials done on these patients.

Extracorporeal Membrane Oxygenation (ECMO) Program

Along with members of the division of Cardio-thoracic Surgery, our division runs the Rhode Island Hospital (RIH) ECMO service. RIH was recently accredited as an ECMO Center of Excellence, and this service provides care to patients in all ICUs who need this therapy for respiratory failure, cardiogenic shock, or other severe illnesses. We are one of the most active centers in our region and a major referral center. Our fellows will actively participate in the care of these patients in the medical ICU and have the opportunity for additional advanced training during their fellowship.

Sleep Medicine

Sleep medicine is a major part of the training of the Pulmonary Division. There is a separate Sleep Clinic at Rhode Island Hospital that the fellows assigned to the Rhode Island Hospital ambulatory experience rotate through. The sleep patients are integrated into the Pulmonary Clinic at the VA Medical Center. Fellows who want a more extensive experience in sleep medicine may elect to do research related to sleep in their second year. The opportunity exists for post graduate studies in Sleep Medicine at Rhode Island Hospital after completion of the three-year Pulmonary and Critical Care Fellowship.

Pulmonary Function Training

Fellows interpret the various pulmonary function studies done in the laboratory including the results of spirometry, lung volumes, diffusing studies, arterial blood gases, exercise studies, bronchial inhalation challenges and sleep studies. Cardiopulmonary Exercise testing (CPET) is now done at our VAMC facility. A pulmonary staff physician reviews the interpretation of the pulmonary fellow on a daily basis.

Pulmonary Clinic

The fellow obtains longitudinal experience in longitudinal ambulatory care of pulmonary patients in weekly clinics at both the VA Medical Center and Rhode Island Hospital. An attending physician is available to provide on-site consultation while the fellow is seeing his or her patients. All cases are reviewed with an attending physician. At the VA Medical Center, a pulmonary nurse practitioner works with fellows and staff to facilitate outpatient care.

Case Management Conferences

These weekly conferences are held by the pulmonary staff for all fellows. Difficult current cases are presented. The diagnosis and management of a variety of topics are discussed.

Pulmonary Grand Rounds

This weekly teaching conference is held on the Warren Alpert Medical School of Brown University campus with the entire faculty and with pulmonary specialists in the practicing community. This conference begins in September and is preceded during the summer by an introductory lecture series for the clinical fellows. The conference focuses on important topics in clinical pulmonary medicine through a case presentation format. Annotated bibliographies are distributed to provide an updated reference base.

Brown Pulmonary Research Seminar Series

This weekly conference is designed to allow pulmonary fellows, Brown faculty and visiting speakers to present their research to an audience that includes clinicians and researchers, both clinical and basic science. These conferences serve as an excellent forum for work-in-progress seminars.

Combined Medical/Surgical/Trauma Teaching Rounds

This conference is held twice a month at Rhode Island Hospital. The management of a variety of diseases encountered in Medical, Surgical and Trauma ICUs is discussed.

Pulmonary Oncology Conference

This multidisciplinary conference is held twice a month at Rhode Island Hospital and attracts faculty from the Divisions of Hematology/Oncology, Radiation Oncology, Thoracic Surgery, Radiology, Pathology and Pulmonary/Critical Care Medicine. Discussions focus on the management of patients with thoracic tumors.

Journal Club

Held monthly, this evidence-based medicine journal club is intended to teach fellows to evaluate critically the current literature in Pulmonary and Critical Care Medicine and assess the likelihood of it changing clinical practice.

Pediatric Pulmonary Disease

Electives can be arranged with Dr. Karen Daigle, Director of the Pediatric Pulmonary Division of Rhode Island Hospital, to familiarize fellows with lung problems unique to children. In addition, pediatric cases are reviewed during Pulmonary Grand Rounds.

Teaching Experience

It is our philosophy that teaching itself is an important educational experience. Each fellow, therefore, is encouraged to participate in the training of Internal Medicine residents and medical students in a variety of ways. Fellows present informal conferences to residents and medical students rotating on the pulmonary elective and the ICU. Our fellows organize and teach a third-year medical student course in reading chest x-rays. Additionally, many of our fellows participate in the small group teaching sections of the medical school Pulmonary Pathophysiology course.

Non medical Critical Care Training

In addition to the Medical ICU training that our fellows receive, they also spend time in dedicated rotations in a Surgical/Trauma ICU and Neuro ICU. These units are staffed by full time surgical critical care physicians or neuro intensivists and the fellows have the opportunity to fully participate in the care of these patients. Additionally, fellows may add additional experiences to their training by doing extra rotations in these units or rotating through the Emergency Room Critical Care Department or the Cardiac Care Unit. Fellows may also do a dedicated elective month in critical care nutrition with the Surgical Nutrition team.

Stipends and Benefits
It is expected that all first year fellows will enter the program at the PGY 4 level. Salaries for fellows are concomitant with their post graduate level. Funding is arranged for fellows to attend educational conferences.

Application Information
The Pulmonary and Critical Care Medicine program accepts applications through the ERAS electronic application service. We will not be processing independent applications by mail through our office.

We have included a link to the Lifespan Graduate Medical Education website, which will give you additional information about our programs. http://www.lifespan.org/services/graduate-medical-education/

For more information, please contact Charleen Pysz, Fellowship Coordinator, 401-444-8410, cpysz@lifespan.org.

Patient Services

Members of the Department of Medicine provide both Primary Care Clinical services and Subspecialty Clinical services. Locations include community-based private physician offices, Foundation-owned group practices and the hospitals listed below.

Rhode Island Hospital, a large academic medical center.

The Miriam Hospital, a community based teaching hospital.

Memorial Hospital of Rhode Island, a community based teaching hospital.

Women & Infants Hospital of RI, the 10th largest OB/GYN hospital in the U.S.

Providence VA Medical Center, serving a unique patient population & spectrum of illness.