Clinical Training

Fellows staff this 32-bed MICU 24 hours a day 7 days a week. In this busy unit fellows work closely with attending physicians, medical residents, and advanced practice providers to care for critically ill and medically complex patients. Fellows gain significant experience in endotracheal intubation and mechanical ventilation, V-V extracorporeal membrane oxygenation, and invasive hemodynamic monitoring. Fellows lead multidisciplinary rounds, triage admissions, and provide critical care consultative services to other ICUs throughout the hospital. 

Fellows care for patients admitted to the pulmonary ward. Typical patients include those with advanced interstitial lung disease, cystic fibrosis, pulmonary hypertension on parenteral therapy, and those patients undergoing evaluation for lung transplantation. In addition fellows interpret pulmonary function testing with faculty guidance and perform inpatient consultation for patients with respiratory diseases for other services within the hospital.

Working closely with our interventional pulmonary faculty, fellows gain experience with core pulmonary medicine procedures including bronchoscopy, transbronchial lung biopsy, endobronchial ultrasound guided transbronchial needle aspiration, tunneled pleural catheter insertion, chest tube insertion, and thoracic ultrasound. Fellows are also exposed to more advanced procedures such as rigid bronchoscopy, airway stenting, management of benign and malignant central airways obstruction, pleuroscopy, percutaneous tracheostomy, and navigational and robotic bronchoscopy.

In this 22-bed mixed medical and surgical ICU, fellows work with an attending physician and advanced practice providers to care for a variety of critical care conditions in a community hospital setting. Fellows have an opportunity to take a more supervisory role during this rotation as they gain experience through the course of their training.

Fellows provide pulmonary consultative services for the medical and surgical services at the Durham VA, perform diagnostic and therapeutic procedures, and interpret pulmonary function tests and cardiopulmonary exercise tests while on this rotation. With the VA's strong lung cancer screening and diagnostic program, this is a high volume procedural rotation in which fellows gain ample exposure to bronchoscopic diagnosis and staging of lung cancer and participate in the VA's multidisciplinary thoracic oncology conference.  

Fellows assume a supervisory role for this primarily resident run intensive care unit. Commonly encountered clinical scenarios include management of the patient with advanced, chronic respiratory failure, sepsis, and critical care of the patient with malignancy. 

Fellows work with a multidisciplinary team to manage lung transplantation patients following their initial post-operative care. Fellows gain in-depth experience with management of complex immunosuppression regimens, treatment of unusual opportunistic infections, as well as the late onset complications of lung transplantation.

Fellows round with surgeons and anesthesiologists to care for critically ill surgical and post-operative patients at Duke University Hospital.  

Fellows rotate on the inpatient pulmonary vascular disease service, seeing patients with high-risk acute pulmonary embolism as part of the PE Response Team, new evaluations for pulmonary hypertension including performing right heart catheterizations, and managing patients with PH on parenteral pulmonary vasodilators. 

Fellows join attending subspecialty pulmonologists to see patients in advanced lung disease clinics, including interstitial lung disease, pulmonary hypertension, asthma, lung transplantation, and sleep/chronic ventilator clinics.

Additional clinical elective opportunities include spending time in the Neuro ICU, Cardiothoracic ICU, or Cardiac Intensive Care Unit. Fellows also frequently pursue additional intubation training in the OR or attend longitudinal outpatient clinics with pulmonary faculty. 

Fellows attend a half day of continuity clinic weekly, alternating between the Durham VA and the Duke Asthma, Allergy, and Airway Center. In these clinics fellows see their own patients and discuss evaluation and management plans with core faculty preceptors.