Curriculum

Pulmonary Disease Curriculum

Duration: 24 months

Ambulatory care:

Each fellow is assigned to a continuity clinic for one half-day per week throughout the two years in Pulmonary Medicine. The majority of assignments are to the Chest Clinic at KCHC. This clinic provides broad experience in thoracic diseases; it also affords training in the treatment and prevention of tuberculosis. Fellows also attend general pulmonary clinics while rotating at three affiliate hospitals. Sleep-related breathing disorders are managed in these clinics.

Procedures:

Fellows gain "hands-on" experience in all standard respiratory function tests, polysomnography, comprehensive exercise testing, ultrasonography, Fiberoptic Bronchoscopy and in the invasive procedures routinely practiced in pulmonary and critical care medicine. An exposure to some specialized interventions, such as EBUS, Navigational Bronchoscopy, Airway stent placement, is also available.

 

Critical Care Medicine Curriculum

Duration: 12 months

Usually follows 2 years of Pulmonary Medicine subspecialty training.

Ambulatory care:

CCM fellows spend one afternoon per week in the KCHC Chest Clinic during their rotations at the DMC campus.

 

Academic Component

Conferences:

The division offers formal conferences at the main campus, which are mandatory for fellows in all three years of training. There are additional conferences available at the affiliated institutions. Please see Teaching Conferences for details.

Research:

All fellows are expected to complete at least one scholarly project leading to peer-reviewed publication or abstract. Usually this involves participation in a research project (mostly clinical), with presentation of data at a national meeting (usually ATS or ACCP). Fellows are encouraged to develop their own studies, but they may also join research projects initiated by faculty members. Expert guidance in study design and statistical analysis is available through the Scientific Computing Center at DMC; an introductory course on these topics is available. Fellows' research areas in recent years have included obstructive sleep apnea, acute lung injury, pulmonary function tests, tuberculosis, and asthma. Basic science research opportunities on the molecular mechanisms of acute lung injury (Patrick Geraghty, PhD – DMC, Raj Wadgaonkar, PhD – DMC & VA), lipid biology in lung diseases (Itsaso Garcia-Arcos, PhD – DMC) and phosphatase/kinase signaling in COPD (Robert Foronjy, MD – DMC) are offered.

Additional research opportunities are available through other clinical and basic science departments at the medical school.

The program includes monthly faculty grand rounds, often with visiting professors, updating fellows and faculty on developing trends and techniques in pulmonary disease and critical care medicine in addition to the weekly fellows' journal club presentations. As mentioned, all fellows execute a research project, and mentorships are established in the first year of fellowship training. Other special program features include interventional procedures at the Brooklyn VA and collaborative Interventional Pulmonary electives with Memorial Sloan Kettering Cancer Center (MSKCC) as well as the subspecialty divisions like Cardiology and Cardiothoracic surgery at UHB.

Strengths of the overall fellowship program include the extensive exposure to trauma cases, and well-structured rotations through programs at the affiliated hospitals. Fellows get off to a positive start through experience with varied patient populations and pathologies at the different clinical sites. Another outstanding aspect of the SUNY Downstate education program is the opportunity to work and learn in state-of-the-art facilities, where the most sophisticated equipment permits conducting very advanced procedures. Fellows often praise the enthusiasm of the faculty and the program's emphasis on research accomplishment.

Many fellows go on to private practice and to a lesser extent academic position. More recently, a number of our fellows have applied to Interventional Pulmonology and Sleep Medicine fellowships. Nonetheless, our fellows are equipped to go directly into practice and perform extremely well once they graduate from our program. Over the last decade, there has been a marked increase in the quality of applicants for our fellowship program openings, attracted by the division's growing national reputation. At its most recent review by the ACGME, the division has received full accreditation.