The Unified Division of Pulmonary and Critical Care Medicine at the Albert Einstein College of Medicine - Montefiore Medial Center offers a three-year joint Fellowship training program centered at two campuses. Both campuses are located in the North Bronx, about 15 minutes apart by car, with frequent free shuttle service running between the sites. The campuses are easily reached from neighboring Westchester County, Long Island, or Manhattan.
The West campus consists of Montefiore Hospital, a private, not-for-profit Hospital with over 700 medical beds and over 40 intensive care beds. There are separate intensive care units for medicine, general surgery, cardiothoracic surgery, as well as neurosurgery. Almost completed is a new state of the art Sleep Lab, directed by a member of our faculty.
The east campus is the home of two facilities, the Jack D. Weiler Hospital and Jacobi Medical Center. The Jack D. Weiler Hospital of the Albert Einstein College of Medicine, is a large community hospital staffed by faculty of the medical school. Jacobi Hospital is a large city hospital with over 500 medical beds and 32 ICU beds, and includes a 36-bed Chest ward. Jacobi is also a level 1 trauma center and is home to the regional burn unit.
Each hospital has busy pulmonary consulting services, pulmonary function laboratories, bronchoscopy suites and chest clinics. The Pulmonary Division includes 10 full time physicians and several part time or voluntary attendings.
The Curriculum
The first year is devoted to clinical pulmonary medicine, medical intensive care, sleep medicine and pulmonary physiology. During the second year, fellows continue on the clinical services with time for electives and further emphasis on sleep and physiology training. In addition, for 6 months, fellows rotate through the sub-specialty intensive care units at Montefiore and Weiler Hospitals, including cardiothoracic surgery, neurosurgery, and general surgery intensive care units. There is also a Trauma rotation where fellows become active members of the Trauma Team at Jacobi Hospital. The third and final year, is divided between clinical work and research (described later). Fellows also rotate with the interventional pulmonologist during this year. Fellows have elective time to pursue such fields as sleep medicine, chest radiology, interventional radiology, allergy and immunology, thoracic surgery, echocardiology, and burn services. Fellows also have the opportunity to rotate on the Lung Transplant service at Columbia Presbyterian Hospital during this year.
Each year, there will be three or four positions open for pulmonary/critical care training. Fellows are chosen from the National Residency Matching Program and applications are received via the Electronic Residency Application System (ERAS).
Clinical training consists of practical learning on the pulmonary wards and consultation services where cases are seen and evaluated with a member of the pulmonary faculty. In addition, a pulmonary continuity clinic is maintained throughout the three years. There are also specialty clinics offered during specific rotations. Fellows learn to perform a wide range of pulmonary and critical care procedures including fiberoptic bronchoscopy and percutaneous pleural biopsy, interpretation of pulmonary function, exercise and sleep studies, insertion techniques and monitoring of central venous and swan-ganz catheters, and intubation, mechanical ventilation and percutaneous chest tube placement. In-services are established for bronchoscopic procedures, pigtail thoracentesis, and mechanical ventilators. Training with ultrasound guided procedures takes place with formal courses and as part of direct patient care. Exposure to interventional pulmonary procedures with such equipment as navigational bronchoscopy, endobronchial ultrasound, laser and photodynamic therapy take place on a case by case basis.
Conferences occur regularly throughout the year. Weekly conferences include clinical case conference, curriculum conference, thoracic tumor board, and radiology conference. There are also monthly Journal Clubs, research conferences, pathology conferences and sleep didactic conferences. An M&M/CPC is given quarterly. A combined pediatric and adult pulmonary conference also takes place quarterly. Lectures from faculty who are from Einstein/Montefiore, as well as from outside institutions, occur regularly.
Research is discussed and encouraged throughout the training period, though is mostly concentrated during the third year. Fellows are enrolled in a clinical epidemiology/research methodology course offered by the Albert Einstein College of Medicine in the start of the third year. Research mentors are chosen by the fellow. The full-time members of the Pulmonary/Critical Care Medicine Division are actively engaged in basic and/or clinical research ranging from studies of respiratory and vascular physiology to clinical studies on pathophysiology and treatment. Fellows have the opportunity to work in any of these laboratories as well as in a variety of basic science laboratories at the medical school.
We believe that the discipline and perspective from independent work in the study and evaluation of some aspect of chest medicine is an important ingredient in training pulmonary physicians. Accordingly, each fellow is expected to do a piece of original work that may range from laboratory to clinical research. It is expected that this will culminate in a written manuscript and regional and/or national presentation of the findings.
In addition, case studies of interesting patient presentations are constantly being written and submitted to the major medical journals. One or more additional years of research training are available to individuals with suitable background and interest.
The size and diversity of the program provides the opportunity for considerable flexibility so that an individual with strong research interests may arrange to spend time in laboratory or clinical research whereas others have the opportunity to do more intensive clinical work.
This fellowship provides an extensive experience in all aspects of pulmonary and critical care medicine based on the direct investigation and treatment of patients both in the outpatient department and in the hospital. The working experience leads to skill in the performance and interpretation of pulmonary function tests and of the diagnostic procedures used in chest medicine and to the acquisition of the complicated concepts of pulmonary science.
