There are 7 rotations that compose the core training curriculum for the fellowship.
Fellows staff this 24 bed ICU 24 hours a day 7 days a week. In this extremely busy unit fellows will work closely with attending physicians and medical residents to care for these critically ill patients. Fellows will gain experience with high-frequency ventilation, extracorporeal membrane oxygenation, conventional ventilation, and invasive hemodynamic monitoring. In addition, fellows will have an opportunity to rotate through the Duke Cardiothoracic ICU to gain exposure to post-operative management of patients who have undergone a wide variety of cardiac and thoracic surgical procedures.
General Pulmonary Service and Pulmonary Consult Service
Fellows will care for patients admitted to the pulmonary ward. Typical patients include those with advanced lung disease, cystic fibrosis, pulmonary hypertension on parenteral therapy, and those patients undergoing evaluation for lung transplantation. In addition you will perform inpatient consultation for patients with respiratory diseases for other services within the hospital.
Lung Transplantation Service
Fellows will work with a multidisciplinary team to manage lung transplantation patients following their initial post-operative care. Fellows will gain in-depth experience with management of complex immunosuppression regimens, treatment of unusual opportunistic infections, as well as the long-term, and late onset complications of lung transplantation.
Working closely with our interventional pulmonary attendings, fellows will gain experience with the core procedures in pulmonary medicine including bronchoscopy, transbronchial lung biopsy, transthoracic needle aspiration using endobronchial ultrasound, tunneled pleural catheter insertion, chest tube insertion, and thoracic ultrasound. Fellows will also be exposed to more advanced procedures such are rigid bronchoscopy, airway stenting, management of benign and malignant central airways obstruction, pleuroscopy, and percutaneous tracheostomy.
Duke Regional ICU
This is a 22 bed mixed medical and surgical ICU. Fellows will work with an attending physician and mid-level providers to care for a variety of 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.
VA Consult Service
Fellows will provide consultative services for the medical and surgical services, perform diagnostic and therapeutic procedures, and interpret pulmonary function tests and cardiopulmonary exercise tests while on this rotation.
VA Medical ICU
Fellows will 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.
Quality Improvement Rotation
This is an inpatient/outpatient rotation available to fellows with an interest in a clinical/academic career. The goal of the rotation is improving hospital wide adherence to established treatment best practices. Areas of focus include management of COPD, pneumonia, asthma, sepsis, and ARDs. The fellow will design and implement focused projects for the inpatient setting to improve care, minimize hospitalizations, and reduce readmission rates. Fellows will be assigned for 6-month blocks to the Durham VA to carry out these projects working closely with a faculty member. In addition to inpatient duties, the fellow will participate in a weekly pulmonary follow-up clinic that will be available for patients recently discharged from the hospital or seen in urgent care with a primary respiratory complaint who need close follow-up to avoid hospitalizations.
Global Health Pathway
The Division of Pulmonary and Critical Care in conjunction with the Duke Hubert-Yeargan Center for Global Health have developed a combined fellowship for those interested in a career in global health and pulmonary medicine. In this pathway, the first two fellowship years are spent on clinical rotations and preparing an area of research for the fellows time abroad. The 3rd year is started with a 6-week rotation at the planned research location overseas and then initiation of coursework with completion of the classroom portion of the Masters in Global Health at the end of the 3rd year. In the 4th year of training, a minimum of 9 months is spent overseas working on research to complete the master’s degree.