As a pulmonary and critical care medicine fellow at the Cleveland Clinic Respiratory Institute, you will complete clinical rotations in pulmonary and critical care medicine.
Pulmonary Clinical Rotations
The Respiratory Institute manages two main in-patient services (advanced lung disease and primary pulmonary), an in-patient consultation service and the bronchoscopy suites, which comprise the majority of your pulmonary rotations.
Advanced Lung Disease Service»
Patient Population
Lung transplant and advanced airway diseases, post-lung volume reduction surgery
Team
Staff, fellow, PA, NP, anesthesia residents
Average Team Census
15-30 patients
Typical Hours
7:30 a.m.–5 p.m., Monday–Friday and one half weekend day
Responsibilities
- Run clinical service
- Serve as team leader
- Supervise residents
- Complete progress notes
- Perform procedures (e.g., bronchoscopy and thoracentesis)
Rotation Strengths
- Manage lung transplant patients immediately post-operation in CVICU and on non-ICU wards
- Work closely with consultants in infectious disease & nephrology who specialize in transplantation
- Perform pre-lung transplant evaluation
- Become familiar with advance airway disease issues (e.g., stents)
Primary Pulmonary Service»
Patient Population
General pulmonary and pulmonary HTN patients
Team
Staff, fellow and NP
Average Team Census
10-20 patients
Typical Hours
7:30 a.m.–5 p.m., Monday–Friday and one half weekend day
Responsibilities
- Run clinical service
- Serve as team leader
- Complete progress notes
- Perform procedures (e.g., bronchoscopy and thoracentesis)
Rotation Strengths
- Learn how to manage pulmonary hypertension
- Exposure to diverse pulmonary diseases
Consults»
Patient Population
Non-intubated hospital patients (including ICU)
Team
Staff, fellow and internal medicine resident
Average Team Census
5-10 patients; daily consults: 2-10
Typical Hours
8 a.m.–5 p.m., Monday–Friday and one half weekend day
Responsibilities
- Run consult service
- See consults
- Perform procedures (e.g., bronchoscopy and thoracentesis)
Rotation Strengths
- Exposure to diverse pulmonary diseases and pre-operation evaluations
- Learn how to work with hospital services requesting sub-specialist consultant input
Bronchoscopy/Pulmonary Function Testing»
Patient Population
Outpatients (including clinic and lung transplant patients)
Team
Staff, fellow and bronchoscopy nurses
Average Bronchoscopies
5-8 bronchoscopies per day
Average Bronchoscopies During Three-year Fellowship
300-400
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
- Outpatient procedures (e.g., bronchoscopy and thoracentesis)
- Interpretation of all outpatient PFTs (approximately 50 per day)
Rotation Strengths
- Large volume of procedures
- Exposure to diverse pulmonary diseases
- Experience with advanced diagnostics (e.g., EBUS and magnetic navigation)
- Exposure to advanced therapeutics (e.g., stents, cryo and dilatations) if interested
- State-of-the-art bronchoscopy suites
Electives and Other Core Rotations
In addition to the primary pulmonary rotations, you also may choose from elective rotations in the following areas:
- Pathology
- Pulmonary rehabilitation
- Pulmonary function testing
- Pediatric ICU
- Ultrasound
- Sleep medicine
Fellows organize these electives with guidance from staff.
Outpatient Longitudinal Clinic
Pulmonary and critical care trainees will spend a half day each week for the duration of their fellowship at the outpatient longitudinal clinic. The longitudinal clinic provides experience in the diagnosis and management of pulmonary conditions in an outpatient setting. With a different staff preceptor weekly, fellows also benefit from a diverse staffing experience.
Critical Care Clinical Rotations
The Cleveland Clinic Respiratory Institute manages the Medical ICU and ReSCU weaning unit, which comprise the majority of your critical care medicine rotation. You also will rotate through other intensive care units, such as surgical ICU, trauma ICU, neurology ICU and more.
Medical Intensive Care Unit (MICU)»
Patient Population
General medical and transplant (e.g., lung, liver, kidney and bone marrow) patients
Team
Three teams each with staff, fellow, two residents, NP and pharmacist
Average Team Census
10-18 patients
Typical Hours
7 a.m.–5 p.m., Monday–Friday and one weekend day
Responsibilities
- Run clinical service
- Serve as team leader
- Supervise residents
- Serve as designated procedure fellow
- Perform critical care consults
Rotation Strengths
- Diverse patient population
- Exposure to severely ill patients (top percentile of acuity nationally)
- High proportion of hospital transfers
- Develop high comfort with managing very ill patients
- Perform several procedures (e.g., central lines, thoracentesis, PA catheter placement, intubations, bronchoscopy and chest tubes)
- Leadership role for fellows on MICU teams
Respiratory Special Care Unit (ReSCU)»
Patient Population
Tracheostomy patients in the weaning unit
Team
Staff, fellow, anesthesia residents and respiratory therapist
Average Team Census
Six patients (expanding to 12)
Typical Hours
8 a.m.–5 p.m., Monday–Friday and one weekend day
Responsibilities
- Run clinical service
- Serve as team leader
- Supervise residents
Rotation Strengths
- Gain experience with difficult-to-wean patients
Surgical Intensive Care Unit (SICU)»
Patient Population
Surgical patients with acute disease or instability requiring intensive monitoring and/or interventions
Team
SICU staff, fellow and anesthesia/general surgery residents
Average Team Census
6-10 patients
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
Rotation Strengths
- Exposure to surgical ICU management
Trauma»
Patient Population
Critically ill trauma patients
Team
MetroHealth Medical Center trauma staff, fellow and residents
Average Team Census
6-10 patients
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
- Supervise residents and procedures
Rotation Strengths
- Exposure to trauma ICU management
Neurological Intensive Care Unit (NICU)»
Patient Population
Neurological patients with acute or unstable conditions
Team
NICU staff, fellow and neurological residents
Average Team Census
6-10 patients
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
Rotation Strengths
- Exposure to neurological ICU management
- Working in a specialized, dedicated NICU
Cardiac Intensive Care Unit (CICU)»
Patient Population
Cardiac patients
Team
CICU staff, CICU fellow and medicine residents
Average Team Census
6-10 patients
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
Rotation Strengths
- Exposure to cardiac ICU procedures (e.g., balloon pumps and temporary pacemakers)
- Experience in managing diverse cardiac diseases
Cardiovascular Intensive Care Unit (CVICU)»
Patient Population
Post-lung transplant and cardiac surgery patients
Team
Anesthesia staff, fellow and residents, and surgical staff and fellows
Average Team Census
6-10 patients
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Responsibilities
Rotation Strengths
- Exposure to LVADs and ECMO
- Perform procedures (e.g., PA catheters)
Echocardiography»
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Rotation Strengths
- Work with ultrasound technicians performing echocardiograms
- Learn interpretation of echocardiograms with cardiology staff
Intubations»
Typical Hours
8 a.m.–5 p.m., Monday–Friday
Number of Intubations
5-8 per day
Rotation Strengths
- Intubations with anesthesia staff in OR
Reviewed: 12/10