Introduction

The Pulmonary and Critical Care Fellowship Program at MetroHealth Medical Center is an AGCME accredited three-year program designed to achieve certification in both Pulmonary and Critical Care Medicine. During training, Fellows gain exposure to the complete spectrum of pulmonary diseases and critical care illnesses. Education is a priority, and the Faculty enthusiastically embraces teaching. Learning occurs throughout the year at the bedside, on rounds, in the ambulatory area and through interdisciplinary conferences.

The Fellowship Program consists of two years of core clinical rotations and electives and one year of research. The critical care experience provides the opportunity to manage adult patients with a wide variety of serious illnesses requiring treatment in a critical care setting. The majority of the intensive care unit rotations are in the Medical Intensive Care Unit (MICU).  Because critical care is multidisciplinary in nature, Fellows also rotate for a minimum of three months in additional specialties, which may include Surgical (Trauma) Intensive Care Unit, Pediatric Intensive Care Unit, Cardiac Intensive Care Unit, Burn Unit, Anesthesia Service, and high-risk Obstetrics. As the only Level I Trauma Center in northeast Ohio, rotation on these electives offers a unique experience that is not available with many other programs. The Fellow assumes responsibility, under appropriate supervision, for the care of patients throughout their stay in the critical care unit.

Other core rotations include the Pulmonary Consult Service and the Physiology Service.   On consults, fellows can expect to see a wide variety of pulmonary diseases on this service. The experience is enhanced by MetroHealth’s Tuberculosis Clinic (serving all of northeast Ohio) and the Physical Medicine and Rehabilitation Unit, which cares for a number of patients with chronic respiratory failure. Fellows follow their patients from hospital discharge to the outpatient arena, providing for continuity of care. Fellows spend a half-day per week in the clinic during the three-year Fellowship on the physiology service.

While on clinical rotations, the Fellow learns decision making and performs all indicated diagnostic procedures, such as fiberoptic bronchoscopy, pulmonary artery catheters, pleural biopsies, chest tubes and intubations. The fellow also learns to interpret pulmonary function tests and how to conduct and interpret cardiopulmonary exercise studies. There is significant exposure to Sleep Medicine as well.  MetroHealth is a primary training site of the Case Western Reserve University Sleep Fellowship. 

Research is an integral part of our Fellowship Program. Under the guidance of a Faculty member, the Fellow develops an individualized program and carries it out in one of our research facilities. This provides in-depth exposure to a given area of pulmonary science. The opportunity to develop the skills and insight necessary to initiate a career path towards independent research is available.

Areas of active research at our institution include sleep-disordered breathing, airway disease and asthma, health disparities, and health outcomes research. Courses in the basic aspects of epidemiology and clinical decision-making, respiratory control, immunology, airway function and sleep are provided to foster an integrated approach to answering questions now and in the future.