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Clinical Rotations

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, NP, one IM resident

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, we offer 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 cardiothoracic 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
Five teams each with staff, fellow, two residents, PA and pharmacist

Average Team Census
10-18 patients

Typical Hours
7 a.m.–5 p.m., Monday–Friday and one weekend day. Night rotation includes 3-4 nights per week with 14 hour shifts.

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
Eight patients

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
Cardiothoracic Surgical Intensive Care Unit (CVICU)

Patient Population
Surgical patients with acute disease or instability requiring intensive monitoring and/or interventions

Team
CVICU staff, fellow and anesthesia/general surgery residents

Average Team Census
6-10 patients

Typical Hours
8 a.m.–5 p.m., Monday–Friday

Responsibilities

  • Manage post-op CT surgical patients 

Rotation Strengths

  • Exposure to cardiac surgical ICU management, including ECMO, LVAD, invasive monitoring, etc
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
  • Round with multi-disciplinary trauma team as respiratory care expert 

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
4-8 patients

Typical Hours
8 a.m.–5 p.m., Monday–Friday

Responsibilities

  • Supervise residents

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

  • Supervise residents

Rotation Strengths

  • Exposure to cardiac ICU procedures (e.g., balloon pumps and temporary pacemakers)
  • Experience in managing diverse cardiac diseases  
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

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