The fellowship program consists of 18 months of clinical exposure, the majority of which occurs during the first year. We have a large and diverse patient population and currently have 5 “core” clinical rotations that all first year fellows rotate through. In addition to these rotations, F2’s rotate for one month in the surgical critical care unit and F3’s rotate for one month on cardiothoracic/thoracic surgical critical care units.  F2s and F3s and also have an elective month each year.  We have a full array of sub-subspecialty programs (both patient care and research components) including:  allergy, asthma, COPD, cystic fibrosis, interstitial lung disease, interventional pulmonology, lung cancer, pulmonary hypertension, pulmonary transplantation, sarcoidosis and sleep medicine.

First Year

The clinical, or 1st year, fellow is exposed to the entire spectrum of pulmonary and critical care illnesses through time spent at OSU University Hospital on the Medical Intensive Care Unit (MICU) service; at University Hospital, James Cancer Hospital and Ross Heart Hospital on the Pulmonary Consult services; and at OSU East Hospital on the pulmonary consult service. The fellow will rotate among the “core” service rotations in an ordered fashion and each fellow will spend approximately the same amount of time on the various rotations. First year fellows also do one month of a combination of various sub-subspecialty clinics, which is a no call month.  All F1’s also participate and obtain certification in ATLS, funded by the division.

A unique feature of our fellowship is that we have a month long orientation program in July of F1 year developed by our Program Director, which we call "Pulmonary Medical School." No first year fellow takes any call in July and they are not formally assigned to a service. First year fellows spend July reviewing the basics of pulmonary physiology, learning basics of pulmonary/critical care medicine, spending time in our simulator lab with interactive sessions aimed at mastering the basics of bronchoscopy, airway management, chest tubes, and other essential procedures. When not in class or in the simulator lab (1/2 day per most days), F1’s spend time on all of the core rotations learning the specific requirements of each rotation and fully participating in the care of the patients. The goal of this month is to allow the first year fellows to review the basics of pulmonary/critical care physiology and clinical medicine, begin to learn the essential procedural skills required of a pulmonologist, and get acclimated to the hospital/program before being placed on service or on call.

MICU

While on the MICU service, the fellow will assist in managing the care of critically ill patients in the 25-bed MICU. There are 2 independent MICU teams consisting of a faculty, a fellow with housestaff and students, each of whom cares for approximately 12 patients. Responsibilities of the fellow include overseeing housestaff patient care and guiding ventilator management, performing and supervising critical care procedures, such as intubation, bronchoscopy, venous access and arterial line placement, pulmonary artery catheter placement and interpretation, tube thoracostomy and chest tube management.

Pulmonary Consults

The pulmonary consult services see approximately 800-900 consults per year and includes all aspects of pulmonary and critical care medicine. There are two consult teams each with a faculty, fellow and 0-2 residents/students.  One team is based in the James Cancer Hospital and the other team is based in the Ross Heart Hospital. The two teams alternate days of accepting new admissions from the University Hospital. The majority of the patients are pulmonary in nature, but there are critical care consults for and ventilator management for patients requiring mechanical ventilation on cardiology services, in the Bone Marrow Transplant Unit and in the Surgical Intensive Care Unit. Through these experiences the fellow will be exposed to the entire spectrum of pulmonary procedures including chest tube placement and management, pleural catheter placement, pleurodesis and bronchoscopic procedures, such as bronchoalveolar lavage, transbronchial and needle biopsies, cryotherapy, stent placement and brachytherapy. 

Over the last several years, first year fellows perform approximately 200-300 bronchoscopic procedures during their clinical year. Additionally, the consult fellow is responsible for interpreting inpatient and outpatient pulmonary function tests, bronchoprovocation studies and pulmonary exercise tests performed during the consult months.

OSU East Pulmonary/Critical Care Consults

The pulmonary/cc consult service at OSU East provides consults on a wide spectrum of pulmonary patients. There are also consults in the multi-facet ICU which includes medical, cardiac and surgical patients. OSU East is a secondary hospital with a combination of private practice services and traditional academic services. This experience exposes the fellow to a different patient population and health care system than OSU University Hospital. 

Outpatient Clinics

It is also during the first year that fellows begin their outpatient clinic by seeing patients one-half day per week. Fellows will have a continuity clinic in general pulmonary medicine for 24 months. The final 12 months of clinic will be done in six month blocks in a variety of the sub-subspecialty clinics. Fellows will choose which 3 sub-subspecialty clinics they wish to rotate through.

Second and Third Years

During the second and third years, fellows complete the remaining six months of their clinical requirements. This will include core rotations as described above, as well as rotations in surgical critical care, cardiothoracic and thoracic critical care and elective rotations. Clinical elective options available during the second and third years include but are not limited to the following:

Ambulatory subspecialty clinics	Thoracic Surgery
Adult CF Care (Children’s Hospital)	Chest Radiology
Pulmonary Transplant/Pulmonary Hypertension	Pediatric Pulmonology
Pulmonary Rehabilitation & Exercise Testing	CCU
Surgical ICU/Trauma/Burn	Asthma/Allergy
Lung Cancer	Interventional Pulmology
Sleep Medicine	Pulmonary Pathology