Clinical training takes place on the medical campus of the University of North Carolina at Chapel Hill, and in outpatient specialty clinics of the UNC Health Care System. The UNC system includes North Carolina Children's Hospital, North Carolina Memorial Hospital, North Carolina Neurosciences Hospital, North Carolina Women's Hospital and the North Carolina Cancer Hospital. It is a public, academic institution operated by and for the people of North Carolina. The system’s mission is to provide high quality patient care, to educate health care professionals, to advance research and to provide community service.
People from all 100 North Carolina counties and throughout the Southeast are patients at the 803-bed hospital facility - more than 37,000 each year. Additionally, more than 800,000 people are cared for at UNC outpatient practices and clinics each year. Training within this large and dynamic health care system provides our fellows with robust clinical exposure to a diverse patient population, a wide range of common and uncommon pulmonary diseases, and breadth of critical illness.
The first year of fellowship is dedicated exclusively to clinical training. During the latter years of fellowship, 75% of the time is dedicated to a research training program tailored to the specific career interests of the individual fellow, and 25% of the time for continued clinical training during which time clinical skills are advanced, solidified, and fine-tuned.
Clinical training during the first year of fellowship is divided equally among 3 rotations: Outpatient Pulmonary Service, Inpatient Pulmonary Service, and the Medical Intensive Care Unit. Fellows rotate on each service in one month blocks during the first year of training. During years 2 and 3, each fellow spends 2 months per year in the MICU and completes 3 months of non-MICU critical care electives over both years. Additional electives can be arranged on an individual basis based upon fellow preferences and interests.
Inpatient Pulmonary Medicine
It is on this service that the Fellow acquires skills in diagnosing and managing hospitalized patients with lung disease who do not require intensive care. These skills are acquired through running the inpatient pulmonary medicine ward service (Med G), and the inpatient pulmonary consultation service with guidance and supervision by attending physicians. Bronchoscopies on patients on the inpatient pulmonary service and pulmonary consultation service are performed by the inpatient pulmonary medicine fellow. The conduction of Pulmonary function testing (PFT) and the operation of a PFT lab is observed during this rotation, and the fellows becomes highly skilled in interpretation of spirometry, lung volumes, diffusion, and cardio-pulmonary exercise testing (CPET).
Outpatient Pulmonary Medicine
During this rotation the fellow participates in a number of pulmonary subspecialty clinics including Sleep Clinic, Allergy and Immunology clinic, Multi-disciplinary Thoracic Oncology Program (MTOP) clinic, Lung Transplant clinic, Pulmonary Hypertension clinic, and their own continuity clinic. One day each week during this rotation the fellow performs bronchoscopies on patients seen in the thoracic oncology clinic and outpatient lung transplant patients needing surveillance bronchoscopy.
Medical Intensive Care Unit
During the first year, fellows participate in the care of all patients in our 18 bed medical ICU, and provide consultative care to patients in the surgical ICUs. The first year fellow guides the resident team in the evaluation and management a wide spectrum of diseases including hemorrhagic shock from gastrointestinal bleeding, septic shock, cardiogenic shock from massive pulmonary emboli, respiratory failure, liver failure, renal failure, metabolic emergencies, and drug overdose. Management of respiratory failure and the mechanical ventilator is a primary focus of MICU rotation. The first year fellow performs all bronchoscopies in ICU patients, learns airway management/intubation, and assists the housestaff with the placement of central lines, arterial lines, paracenteses, and thoracenteses. The first year fellow places all pulmonary artery catheters in the MICU, and gains skill in pulmonary artery catheterization one day per week in the cardiac catheterization laboratory under the direct supervision of our pulmonary hypertension faculty. Skills in bedside ultrasound imaging of central veins, the pleural space, the heart and the abdomen are acquired. Fellows also have the opportunity to acquire skills in chest tube placement during this rotation, during rotations on the surgical service, and through opportunities to participate in thoracic surgery cases in the operating room.
Second and third year fellows act as the Attending physician for ½ of the MICU beds, directing teaching rounds with the housestaff and supervising patient care.
Non-medical Critical Care
During the 2nd and 3rd years of fellowship, the fellow participates in 2-4 week rotations on the surgical services caring for critically ill surgery patients at UNC Hospitals. These rotations permit the fellow to gain experience with critically ill patients in the surgery/trauma ICU, cardiothoracic ICU, neurosurgery ICU, burn unit, and cardiac intensive care unit.
Fiberoptic bronchoscopy is the dominant procedure of the pulmonologist. Skills in bronchoscopy are obtained at orientation and on each rotation during the first year of training. Training begins with a 1-day bronchoscopy course with our colleagues at Duke University Medical Center, and with simulation in the UNC Procedural Simulation Laboratory. The Fellow becomes skilled in airway inspection, bronchoalveolar lavage, endobronchial biopsy, and transthoracic needle biopsy using endobronchial ultrasound (EBUS). Fellows also have the opportunity to acquire skills in electromagnetic navigation bronchoscopy. Bronchoscopies are performed in our state-of-the art bronchoscopy suite, OR 17 which is reserved for EBUS bronchoscopies 1 day each week, and in the intensive care units of UNC Hospitals. Each fellow in our program performs over 100 bronchoscopies during their first year.
Fellows maintain a weekly continuity clinic throughout all three years of fellowship training. In continuity clinic each week, fellows evaluate new referrals, often from other pulmonologists, and maintain their own panel of follow-up patients with a wide variety of respiratory diseases. The clinic is staffed by faculty from the division with a 3:1 or 2:1 Fellow:Attending ratio. After three years of training in this longitudinal pulmonary clinic, fellows are well-prepared to practice outpatient pulmonology in an academic or clinical setting.
To complement the hands-on training, a number of didactic and interactive conferences are available. Clinical conferences are attended by fellows during their research and clinical years. Clinical conferences include:
- Clinical Case Conference
- Core curriculum conference
- Critical Care Boot Camp
- Journal club
- Lung transplant conference
- Multidisciplinary Thoracic Oncology Program conference