The mission of the fellowship training program is to provide an environment that produces outstanding physicians trained in pulmonary and critical care medicine who are fully prepared to pursue careers in academic medicine.

 

Critical-care medicine is an integral part of our fellowship training and, at the end of the three-year training period, the fellows are eligible for dual certification in pulmonary and critical-care medicine. The American Board of Internal Medicine requires a total of 18 months of clinical training for board certification in both of these disciplines.

 

One of the goals of our program is to teach outstanding and compassionate interdisciplinary patient care in pulmonary and critical care medicine. The faculty who participate in this program are leaders both at Duke and internationally in pulmonary and critical-care medicine.

 

Fellows receive daily guidance by these physicians through bedside rounds, patient conferences, and didactic sessions. The breadth of patient experience at Duke is large and encompasses all aspects of pulmonary and critical care medicine. Formal didactic sessions in respiratory physiology, hemodynamic monitoring, mechanical ventilation, respiratory infections, and shock are a standard part of our curriculum.

 

An equally important goal of our program is to provide the type of mentorship and research opportunities that stimulate our trainees to pursue careers in academic pulmonary and critical-care medicine, and provide them with the necessary experience to be qualified for the very best positions in our field.

 

Mentored research is required in our fellowship training program. Much of the basic research being pursued in the pulmonary division laboratories involves lung injury and repair, genetics, and environmental lung disease.

 

Clinical research is also encouraged and these opportunities include ongoing programs in critical-care medicine, pulmonary hypertension, lung mechanics, ventilator management, and lung transplantation.

 

Though we believe our fellowship combines the best of clinical and research opportunities, we realize that all fellowships are not the same. The American Thoracic Society's fellowship page provides a nice overview of the process of selecting the specialty of pulmonary and critical care, applying, and finding a suitable fellowship to match your interests and goals.

 

To apply, our program only accepts applications through the Electronic Residency Application Service (ERAS) system. We will begin reviewing the applications in December and will interview applicants February - April.

 

In general, we do not accept H1-B and J1 visas because they are not supported by our training grant. However, please submit your application for review if you feel it is exceptional.

 

Our fellowship program is a three-year program with a fourth year optional for research. We accept five new fellows each year.

 

Please be sure to include the following items in your application:

 

During this period, each trainee is given comprehensive training in pulmonary and critical-care medicine that will meet board requirements.

 

A single subspecialty board certification in Pulmonary Medicine requires 12 months of clinical training while dual-board certification in Pulmonary and Critical Care Medicine requires a total of 18 months of clinical training, which may be assigned at any time during the three-year program.

 

In general, we schedule two-thirds of the clinical rotations during the first year and the remaining portion of the clinical responsibilities during the second and third years. The following rotations are the primary clinical training opportunities for the fellows, though special electives can be arranged for those with particular interests.

 

As MICU fellow, you will assume the lead role in the overall function and flow of the unit.

 

This will be one of the busiest months on service and one of the most gratifying. You will:

 

When you start the MICU, familiarize yourself with the latest policies (available from MICU Director Dr. Joe Govert) regarding triage, bed control, and MICU overflow.

 

Although many attendings provide formal lectures and informal teaching on rounds, fellow accessibility and continued presence in the ICU mean the house staff and students look to the fellow for guidance regarding medical decision-making.

 

Fellows take a major role in teaching the house staff and medical students while on service. In addition to clinical teaching, you will:

 

At their judgment, fellows defer procedures to the house staff. This rotation is consistently rated as one of the most popular by the house staff, and close interactions between the house staff and the pulmonary critical-care fellow are necessary for its continued success.

 

Fellows serve as bridge between the attending and the families of critically ill patients. Fellows develop and maintain relationships with appropriate family members and provide information, empathy, and direction regarding difficult end-of-life decisions.

 

You should become aware of the experienced nurses and clergy in the MICU with expertise in grief counseling and other resources available to help you in these family discussions. Fellows will work closely with the attending physicians in all of these areas and take on responsibilities and independence as the fellow's comfort level and experience grows.

 

The Duke MICU serves as a resource for recruitment of patients into a number of clinical trials. These trials primarily involve patients with sepsis and acute lung injury. Fellows should be aware of these trials and actively work to enroll patients when it is appropriate to do so.

 

There are excellent clinical research nurses on our staff that are dedicated identifying patients for clinical trials and assisting our attendings, fellows, and house staff in providing and obtaining informed consent from eligible patients.

 

The service is a general pulmonary service and a step-down service.

 

The general service will consist of 10-20 patients with a mix of common and uncommon lung diseases, including:

The fellow will:

The fellow rounds daily with the pulmonary attending. The inpatient pulmonary fellow will round with the general pulmonary service (one attending, one intern). Depending on the background of the interns, the complexity and severity of illness on the general pulmonary service can be quite overwhelming to the new intern. In addition, a small number of step-down beds that include ventilator-dependent patients are followed by the general pulmonary team.

 

Thus, your role is essential to educate and assist the interns in dealing with the complex clinical problems, to help them focus and develop successful time management strategies, and to be available to assess patients with them when ventilator or other serious acute problems develop in patients on the service. The medical director of the Inpatient Pulmonary Service is Harvey Marshall, MD.

 

The Inpatient Pulmonary Service fellow is also responsible for interpretation of all PFTs under the tutelage of Dr. MacIntyre (who is on the ATS committee for PFT guidelines).

 

Exercise studies (two to four per week) are interpreted from the Duke Pulmonary Rehabilitation Program located at the Duke Center for Living (Neil MacIntyre, MD, Medical Director), and there are 20 PFTs per day to read.

 

The fellow also interprets cardiopulmonary exercise stress tests (two to three per week) with Dr. MacIntyre. Furthermore, due to the proximity of the 7800 service to the Bone Marrow Transplant Unit, the Consult Pulmonary Service Fellow is responsible for evaluating all BMT consults with the consult attending.

 

The Duke University Medical Center Lung Transplant Program provides comprehensive health care service to lung transplant candidates and recipients from the time of their initial referral to the program and after their lung transplantation.

 

The program has an international reputation for its ability to manage the most complex of patients while maintaining survival outcomes that are consistently above the national average. The lung transplant team is a group of highly specialized professionals that includes:

The program is supported by Duke University Hospital's outstanding inpatient and outpatient facilities, radiology, and laboratory services. The transplant service will be pre-transplant care of end-stage lung disease and post-transplant care.

 

The pulmonary transplant fellow will round with the transplant team (a transplant attending, transplant fellow, and intern) both on 7800 (general inpatient transplant patients) and in the Cardiothoracic Intensive Care Unit (post-transplant ICU patients). The fellow should be aware of the transplant patients, available to assist the transplant intern with procedures and acute problems, and will assist the transplant attending with all bronchoscopies (10 - 15 per month). Dr. David Zaas is the medical director of the Duke Lung Transplantation Program.

 

The Duke pulmonary consultation fellow is responsible for all inpatient, non-critical-care pulmonary medicine consultations. The pulmonary consultation fellow is also responsible for both inpatient and outpatient bronchoscopies performed on the consult service and for all interventional pulmonary consultations/procedures evaluated by Dr. Momen Wahidi, director of the Invasive Pulmonary Service.

 

The Duke pulmonary consultation service consists of the fellow, medical students, and a senior medical resident. During this rotation, an average of 50 consultations and 50 bronchoscopy procedures are performed.

 

The fellow will also learn:

 

The fellow will be responsible for weekly case presentations at a multidisciplinary thoracic conference and will supervise and teach the medical residents and students rotating through the pulmonary consult rotation.

 

The Pulmonary Section at the Durham VA Medical Center has the responsibility for providing pulmonary consultations to all inpatients and outpatients with pulmonary and critical care related problems.

 

The fellow is responsible for:

 

The pulmonary consult fellow and VA MICU fellows are also responsible for the presentation of interesting topics and cases during the weekly Interdisciplinary Pulmonary Chest Conference. The consult attending is responsible in guiding the fellow in his/her preparation.

 

The conference is attended by fellows and faculty from Pulmonary Medicine, Radiology, and Pathology. The consult and MICU fellows share responsibilities to provide the bi-monthly in-services on relevant topics of respiratory and critical care medicine for the respiratory care therapists and critical care nursing staff.

 

The Durham VA MICU is a closed, eight-bed intensive care unit and the only tertiary MICU for the Veterans Health Administration in North Carolina.

 

Senior Assistant medical residents, Pulmonary and Critical-Care fellows, and Pulmonary/Critical Care attendings staff the unit.

 

The VA MICU had 370 admissions last year -- approximately 30 per month. The fellow and the MICU attending will provide teaching on relevant aspects of critical care management for the residents. The fellow will interact very closely with the MICU residents and provide supervision and guidance.

 

Approximately three to five "portable" bronchoscopies are performed per month in the MICU and a variable number of PA catheter placements. The pulmonary fellow is encouraged to take an active role in airway management and chest tube placement. The MICU fellow will also provide the requested consultations on patients in other critical care unit (CCU) areas, as well as round each morning with the SICU staff.

 

The objectives of this rotation are to:

 

The fellows will spend three to four weeks on this service per year. During this period, fellows will also participate in the evaluation of non-medical ICU consults. Responsibilities include:

 

The fellows will be supervised and evaluated by the ICU attending on service.

 

The objectives of this rotation are to learn:

 

The fellows will spend three to four weeks on this service per year. During this period, fellows will:

 

The fellows will be supervised and evaluated by Dr. Ambrose Chiang, our sleep specialist.

 

The goal of the Research Training Program is to train physicians to conduct independent investigation relevant to the etiology, basic mechanisms, and treatment of lung diseases.

 

As a research trainee, you will develop investigative skills to work at the interface of clinical and basic research and translate emerging knowledge in lung biology and genetics into clinically relevant concepts.

 

This program builds on a long history of training in pulmonary medicine at Duke University Medical Center. The Division is fortunate to have highly successful investigators that are capable of providing a broad array of research opportunities for trainees. The fellows also have the option of choosing mentors outside the Division and even outside Duke University at the National Institute of Environmental Health Sciences or the Environmental Protection Agency.

 

At least 18 months of mentored research training is a requirement of the fellowship program. During their second year of fellowship, all eligible fellows will be supported by the T32 Training Grant that provides their salary support, tuition, and travel expenses to national meetings.

 

As fellows embark upon their research careers, they are required to select an advisory committee that consists of their primary research mentor and two to three other advisors from related fields (see discussion below).

 

Furthermore, fellows are expected to apply for individual NIH-sponsored grant support during their second year (NRSA) and third year (KO8/K23; Clinician Scientist Award) of fellowship. A fourth fellowship year will be offered to those trainees who have successfully progressed during their research training and need further time for development.

 

Below is a very brief listing of areas of specialized interest, followed by focused areas of expertise among our faculty.

           

Cell and molecular biology studies are a major focus in this division. An NIH program project grant and multiple R01 grants support this research effort. The goals of the various programs reflect the diverse interests of the principal investigators, but all share physical resources, common technique, and a focus on understanding the molecular basic of lung disease.

 

Environmental Lung Disease

 

The biologic and genetic determinants of environmental lung disease are a major focus of the research in this division. An NIH program project and multiple RO1 grants support these studies in asthma and pulmonary fibrosis. The division has recently established an NIH-supported Environmental Health Sciences Center to develop the infrastructure (microarray, proteomics, inhalation toxicology, and bioinformatics facilities) to support research in environmental lung disease. Ongoing studies focus on innate immunity, environmental asthma, pulmonary fibrosis, and comparative genomic responses to common inhalational toxins.

 

Clinical Studies

 

A number of active human clinical study protocols are being conducted by this group of investigators. All fellows contribute to parts of this clinical research during their clinical year of training. We find their participation in human study protocols useful for developing an appreciation for the different problems and unusual complexities involved in human studies. While rotating on the appropriate clinical services, most fellows participate in patient recruitment as well as in clinical study protocols.

 

Center for Hypo- and Hyperbaric Medicine

 

The hypobaric and hyperbaric facilities at Duke University constitute a center supporting interdisciplinary clinical and research programs through the Departments of Medicine, Surgery, and Anesthesiology. An NIH Program grant supports core research facilities, provides a stable environment for maintenance of these complex facilities for regulation of high- and low-pressure environments, and supports basic research. The Pulmonary Division offers research training in this area primarily through the Oxygen Transport Laboratory under the direction of Dr. Claude Piantadosi.

 

Medical Genetics Training

 

Duke University has recently made strong initiatives to be at the forefront of genome technologies and medical genetics. Fellows can work within the division as well as other modern facilities such as the Institute of Genome Sciences and Policy, Center for Human Genetics, and the Center for Bioinformatics and Computational Biology. Some of our fellows are taking adjunct coursework leading to a Masters degree in Medical Genomics through the Medical Genomics Training Program.

 

We have developed several levels of oversight to ensure the successful research experience for all trainees.

 

The Pulmonary and Critical Care division chief meets with each of the fellows individually at least three times each year. During these meetings, he or she reviews progress, discusses plans, considers alternative approaches, and helps to identify and rectify potential problems.

 

For firs- year pulmonary fellows, the discussion focuses these discussions on how to choose a research project/mentor, focusing on research interests, identifying faculty members that could serve as mentors, reviewing the research opportunities identified, and helping to finalize a research/mentorship plan.

 

All trainees supported by the institutional T32 award meet with the division chief three times each year; these discussions focus on research accomplishments/plans, evaluation of and by mentors, and grant/career development opportunities.

 

Once the trainee has decided with whom they will train, a research Mentorship Committee is established. This committee consists of the research mentor and two to three individuals with related scientific interests at Duke University.

 

This committee meets semi-annually to review the progress, discuss the plans, formally establish expectations, and help guide career development. After each meeting, the trainee is expected to write up a summary of the meeting and present this to the Mentorship Committee members and the division chief and Dr. Que, the training program director.

 

All research trainees are expected to participate in appropriate formal courses relevant to their research goals, to present their work before national meetings on an annual basis, and to give a work-in-progress seminar before the division faculty on an annual basis. Progress in each of these areas is systematically considered as part of the internal review process.

 

Twice a year, the preceptors are asked to fill out a confidential Research Performance Form. The purpose of this review is to identify problems, weaknesses, or opportunities early in each trainee's program. Critiques are constructive and are used to provide additional support in areas of deficiency.

 

For more information about this training program, please select one of the Fellowship Program links to the right.