| Fellowship Goals and Objectives 
| General Description 
| Pulmonary Consult Service 
| Internal Medicine Residents and Medical Students 
| Medical Intensive Care Unit Service 
| Fellowship Electives 
| Fellowship Research Activities 
| Pulmonary/Critical Care Division Schedule 
| Fellowship in Critical Care Medicine 
| Application for Fellowship 
| Top of this page 

The Pulmonary/Critical Care fellowship training program at Virginia Commonwealth University is fully accredited by the Residency Review Committee of the American Council on Graduate Medical Education. The Medical College of Virginia Hospitals (MCVH) is a 700 bed tertiary care level facility with a level 1 trauma center. The McGuire Veterans Administration Hospital (MVAH) is a 900 bed tertiary care facility. The Pulmonary/Critical Care Division at Virginia Commonwealth University offers one to two positions yearly to board- eligible internists desiring subspecialty training in Pulmonary and Critical Care Medicine. The program is three years in length and is designed to meet the needs and interests of individuals preparing for careers in Pulmonary and Critical Care medicine. Fellowship trainees receive a broad experience in the diagnosis and management of patients with respiratory diseases and critical illness in both in-patient and ambulatory care venues.

The goal of the program at Virginia Commonwealth University is to provide an experience that enables graduates to become scholarly practitioners who possess advanced diagnostic and interventional skills in respiratory disease and critical illness. By the completion of the program, the graduate will have acquired a significant new knowledge base and will have learned a clinical approach to problems that is based on an intimate familiarity with the relationship between structural and functional respiratory abnormalities and their clinical manifestations. The trainee will become an expert in the performance of invasive procedures as well as the interpretation of a non-invasive diagnostic tests. Finally, the trainee will also have acquired the ability to critically analyze and assimilate new knowledge from the medical literature

Wide regional geographic referrals to Divisional and Departmental faculty and to the tertiary care centers: Medical College of Virginia Hospitals and McGuire Veterans Administration Hospital afford the fellowship trainee an exposure to a broad spectrum of disease entities. As a consequence of the advanced technologies in place at both MCV Hospitals and McGuire Veterans Administration Hospital, the fellow is armed with modern and innovative diagnostic techniques such as spiral and high resolution chest CT, PET scanning, and gated magnetic resonance imaging. Fellows gain unique knowledge and skills by working directly with Division faculty members who provide therapies for patients with advanced lung disease. These innovative activities include the Critical Care Units, the MCV/McGuire lung transplant program, the interventional fiberoptic bronchoscopy service, and interventional therapies for patients with pulmonary hypertension such as nitric oxide administration and prostacyclin infusion therapy.

The pulmonary fellow can elect a research year and receive exposure to investigative problems and new technologies in both clinical investigation and in cell and molecular biology within the Division or within other Departments.

P/CCM fellows are assigned responsibilities and rotate on a monthly basis onto services at either MCV Hospitals or McGuire Veterans Administration Hospital. The areas of duty are: the Pulmonary consult service, the Medical Intensive Care Unit, the pulmonary function laboratory, and the Adult Chest Clinic.

Pulmonary Consult Service. On the pulmonary consult service, fellows respond to all adult service consults requested throughout the medical center to which they are assigned. Fellows first evaluate the patient’s problem, outline a diagnostic evaluation and then guide house staff management efforts. Consults are presented later the same day to the Pulmonary attending assigned to the consult service where discussion of the problem occurs along with critique and fellow feedback. Invasive diagnostic procedures such as fiberoptic bronchoscopy, thoracentesis, pleural biopsy, or etc. are performed by that fellow under direct supervision of the assigned faculty member. In- patient services within the Department of Medicine at Virginia Commonwealth University are organized both as large general internal medicine services as well as by subspecialties (e.g., general oncology, bone marrow transplantation, subspecialty faculty attending services). As a consequence, the consultative component of the pulmonary program, in addition to its patient management function, serves as a major bedside input for house staff, clinical clerks, and non-pulmonary Departmental faculty with respect to diagnosis, management and prognosis of respiratory disease. The pulmonary consult service also receives many in-patient consult requests from non-Internal Medicine services such as: Surgery (general and subspecialty surgical ward services, surgical-trauma ICU, Cardiac Surgical ICU, Neuroscience ICU, Burn ICU), Obstetrics and Gynecology, and brain injury and general rehabilitation wards. Consult fellow-to-service interactions always include an academic component in consult notes, citing the relevant literature for each condition.

Internal Medicine Residents and Medical Students. Fourth year medical students and Internal Medicine residents (PGY1 - PGY3) are assigned to monthly Pulmonary consult rotations at both institutions. P/CCM fellows act as mentors for both students and residents during these experiences. All evaluations of pulmonary function are interpreted on a daily basis by the fellows under the supervision of the assigned Divisional faculty member.

Chest Clinic. P/CCM fellows attend Chest Clinic on Thursday mornings from 8:15 a.m. - 12:00 p.m. during each year of the program. Discharged in-patients are referred by the house staff or the fellows themselves, while out-patients may be referred by Emergency Services, other Subspecialty or General Medicine Clinics as well as the various community based clinics organized by the Medical Center.

Medical Intensive Care Unit Service. Virginia Commonwealth University has been recognized for over thirty years at regional and national levels for its excellence in the practice of critical care medicine. VCU’s expertise in critical care began in 1966 when The Medical College of Virginia established one of the first respiratory intensive care units in the United States. Today, critical care fellows receiving training at VCU benefit from the long-standing knowledge and skills possessed by Division faculty. The P/CCM fellow will serve monthly blocks of time in each year of training on the medical intensive care unit service. On this service, fellows are members of a designated ICU team that consists of internal residents, fourth year medical students and the assigned Pulmonary/Critical Care Division faculty member. Referrals for ICU admission originate hospital-wide from in- patient services and the emergency department. Referrals for admission also originate from area physicians and inter-hospital transfers from across the region. P/CCM fellows coordinate every ICU admission with members of the house staff team and the attending, performing patient assessments and directing both initial and subsequent management strategies. Fellows gain a vast experience in the performance of ICU invasive procedures such as: arterial and central line placement, tracheal intubation, right heart catheterization, ICU bronchoscopy, and etc. all under the direct supervision of the critical care attending. During training, the fellow is exposed to an intense learning environment where he/she gradually becomes skilled in a broad range of areas such as: respiratory failure with traditional and innovative mechanical ventilation techniques, shock states, gastrointestinal hemorrhage, acute renal failure, multi-system organ failure, endocrinological emergencies, overdose, post operative emergencies, myocardial infarction and etc.

Fellowship electives. Fellowship trainees have a diversity of choices for elective rotations. Electives are one month in duration and include: the MCV Sleep Center Laboratory, the Exercise Physiology Laboratory, Chest Radiology, MCVH or MVAH Cardiac Catheterization laboratory, MCV acute dialysis service, Surgical-Trauma ICU. The fellow may also elect to attend the comprehensive asthma management clinic each week or the attend by arrangement the tuberculosis management clinic.

Fellowship Research Activities. During training, each fellow is encouraged to familiarize him/herself with the research being conducted within the Division or by collaborators in other Divisions or Departments. The choice of research project or mentor is made in consultation with the director of the fellowship training program, Dr. Lisa Brath and other senior members of the Division. The second and third years of fellowship is devoted to acquiring the necessary technology and pursuing a project whether it be clinical or basic science research. Fellows will present the results of their investigations at both regional and national meetings such as the Virginia Thoracic Society and the American Thoracic Society. Fellows are expected to prepare a manuscript for publication prior to completion of fellowship. During research periods, fellows will continue to attend Chest Clinic and will be required to rotate ICU call nights and weekends. A full two years of basic research experience is available to the fellowship trainee wishing to obtain intensive training in cell and molecular biology.

| Fellowship Goals and Objectives 
| General Description 
| Pulmonary Consult Service 
| Internal Medicine Residents and Medical Students 
| Medical Intensive Care Unit Service 
| Fellowship Electives 
| Fellowship Research Activities 
| Pulmonary/Critical Care Division Schedule 
| Fellowship in Critical Care Medicine 
| Application for Fellowship 
| Top of this page