Clinical Training & Education
Most fellowship training takes place at three facilities: UC Health University Hospital, Cincinnati Department of Veterans Affairs (VA) Medical Center and Drake Center.
Our three facilities – University of Cincinnati Medical Center, Cincinnati VA Medical Center and the Daniel Drake Center for Post Acute Care - each play an integral and complementary role in the comprehensive clinical training and education that UC provides. Fellows are also extensively exposed to general outpatient pulmonary medicine during through their continuity clinic experiences at the University of Cincinnati Medical Center’s Hoxworth Clinic and the VAMC Chest clinic and to subspecialty clinics (such a pulmonary hypertension clinic, interstitial lung disease clinic, etc.) where they work with attending physicians who are experts in their field.
Fellows receive extensive, high-quality critical care training here at UC. This includes time in our Medical Intensive Care Unit (MICU) – the tertiary referral center for the Tri-State area comprising Southwest Ohio, Southeast Indiana and Northern Kentucky. Over the course of their training, fellows acquire cutting edge critical care skills, including airway management, advanced ventilator management, ECMO management, and the full repertoire of ICU procedural skills (central lines, arterial lines, chest tubes, bronchoscopy, dialysis catheter insertion etc.) while caring for the sickest patients in the region.
In addition to a solid foundation in medical critical care, fellows are also an integral part of the multidisciplinary critical care teams in the Neuro-Surgical ICU, Surgical ICU and Cardiovascular ICU.
Finally, fellows rotate in the VA MICU where they supervise interns and often run rounds and serve as junior attendings. Upon completion of training at UC, fellows are well prepared for a versatile career in critical care medicine.
The pulmonary consult service at UCMC exposes fellows to the full spectrum of pulmonary pathologies and facilitates development of the diagnostic, and procedural skills necessary to care for hospitalized patients with pulmonary disease. Fellows work with the medical residents and students under the supervision of a pulmonary faculty team member. A typical day may start off with a bronchoscopy in the endoscopy suite, followed by rounds on patients with a variety of pulmonary disease processes including pulmonary arterial hypertension (PAH), COPD, pulmonary infiltrates in immunosuppressed patients and multifactorial hypoxia. The day might end by placing a chest tube for a patient with a complicated parapneumonic effusion.
The VA experience complements the University Hospital experience by providing high volume exposure to the diagnostic evaluation and treatment of lung masses, pulmonary nodules and pleural effusions. In addition to providing consultation services to our inpatient veterans, the VA consult fellow sees urgent outpatient consults. During this rotation, fellows gain extensive experience in advanced diagnostic bronchoscopy, including endobronchial ultrasounds (EBUS), endobronchial and transbronchial biopsies and brushings, navigational bronchoscopy and pleural disease management including thoracentesis and chest tube placement.
Fellows gain additional procedural experience on our interventional pulmonary service where there is ample opportunity to refine skills in advanced diagnostic bronchoscopy (EBUS and navigational bronchoscopy) and therapeutic bronchoscopy including rigid bronchoscopy with endobronchial stent placement and tumor debulking. Fellows also gain experience in advanced pleural procedures such as medical thoracoscopy in addition to performing percutaneous tracheostomy for ICU patients who are unable to wean from mechanical ventilation.
The Daniel Drake Center for Post Acute Care is a long term acute care (LTAC) center located about 7 miles from the Clifton campus. There fellows receive training in long-term ventilator weaning, tracheostomy management and evaluation of upper airway disorders. A typical day at Drake may find the fellow and attending rounding and making ventilator management/weaning plans on 10-15 patients, performing an endoscopic evaluation of the upper airway in a patient who fails to wean, or a tracheobronchoscopy to evaluate hemoptysis, and reviewing ventilator management in a one on one session. Over the course of their 2 or 3 rotations at Drake, fellows develop valuable skills that will assist them throughout their career, including tracheostomy management and clinical management of chronic respiratory failure. Perhaps most importantly, experiences spanning the University of Cincinnati MICU and the Drake Hospital provide fellows with an appreciation for the capacity of their care to return patients from life threatening critical illness to productive lives.
Fellows rotate with our sleep specialists and in the Holmes and VA sleep clinics, and gain a basic understanding of polysomnography, including interpretation of sleep studies. These training experiences provide fellows with a basic level of competence in the management of positive airway pressure therapies for sleep disordered breathing (both CPAP and non-invasive positive pressure ventilation or BiPap).
Recently developed based on feedback from fellows, the Pulmonary Physiology Elective (PPE) provides protected time and dedicated training in the pulmonary function laboratory required for true mastery of the discipline. As first year fellows, trainees gain an appreciation for the basics of pulmonary function test (PFT) interpretation, as well as rigorous approaches to measuring airflow, lung volumes and diffusing capacity in a modern laboratory. Second and third year fellows focus their time on advanced pulmonary physiology testing including cardiopulmonary exercise testing and methacholine challenge testing, as well as learning the principles of quality control for a pulmonary function lab. Our goal is for fellows to graduate with the skills required to become a future PFT lab director, if they so choose.
Fellows rotate on the radiology service, and receive dedicated teaching from expert chest radiologists on interpretation of chest film and high-resolution chest CT (HRCT) scans.
Thoracic Surgery Elective
Fellows round with the thoracic surgery team for first-hand experience with the preoperative evaluation of lung resection candidates, video assisted thoracoscopic thoracic surgery (VATS) wedge resections and lobectomies, pleurodeses and decortications, and post-operative care.
Fellows participate in general pulmonary continuity clinics at two sites where they function as the primary pulmonologist for inner city patients under supervision of the division faculty. Fellows spend 18 months of their ambulatory training at the University of Cincinnati Hoxworth Pulmonary Clinic and 18 months at the Cincinnati VA Medical Center. During their time at the VA, fellows gain extensive experience in the diagnosis and management of COPD, lung nodules and masses and the evaluation of dyspnea. Additionally, as a referral center for interstitial lung diseases (ILD), the Cincinnati VA provides fellows with the opportunity to evaluate and manage a variety of ILD etiologies. The Hoxworth clinic sees a variety of pulmonary diseases including asthma, sarcoidosis, ILD and pulmonary nodules.
The clinic experience at UC introduces fellows to comprehensive approaches to the full spectrum of pulmonary disease, with progression to total proficiency in the practice of outpatient pulmonary medicine upon completion of training.
Rotating in our pulmonary specialty clinics exposes fellows to common pulmonary pathologies as well as to rare, complex and refractory pulmonary diseases. These experiences provide the opportunity to learn directly from recognized experts in a variety of fields. On our specialty clinics elective, fellows will see patients from all over the world with lymphangioleiomyomatosis (LAM) and other cystic lung diseases who are referred to the Rare Lung Disease Clinic at the University of Cincinnati. Fellows will see multiple patients with ILD of unclear etiology referred from the community to our Pulmonary Fibrosis Foundation-accredited ILD clinic. At our Adult Cystic Fibrosis (CF) Center, accredited by the National CF Foundation, fellows will see adult CF patients with our dedicated CF team. Dr. Peter Lenz conducted a dedicated asthma clinic where fellows gain experience in managing severe refractory asthma. Fellows round with Dr. Jean Elwing in the Pulmonary Hypertension Association accredited UC Pulmonary Hypertension Center and gain valuable experience with the diagnosis and management of pulmonary vascular disease . Fellows can also attend the Hamilton County TB clinic for a full immersion experience in mycobacterial disease. Altogether, our specialty pulmonary clinics provide fellows with an in-depth training in the expert management of select pulmonary diseases.