Clinical Training Program
Our fellows complete at least 18 months of clinical training during their fellowship. The first year of fellowship is all clinical and the remaining 6 months of clinical training are scattered through the second and third year. Throughout the 36 months of PCCM fellowship, fellows participate in a continuity clinic.
Five hospitals participate in the clinical training of PCCM fellows including: Yale New Haven Hospital (Y-NHH), a tertiary care hospital, The West Haven Veteran's Administration Hospital (WHVAMC), Hospital of St. Raphael a private community hospital, Bridgeport Hospital, a community hospital with specialty burn unit, and the Hospital for Special Care, a comprehensive rehabilitation hospital specializing in ventilator dependence, weaning and respiratory rehabilitation.
Medical Intensive Care Unit
The Medical Intensive Care Unit (MICU) at Yale New Haven Hospital (Y-NHH) under the directorship of Dr. Jonathan Siner, is regarded as one of the region's elite ICUs. As a PCCM fellow you will spend four months in the MICU. The MICU is currently housed in the new state-of-the-art facility on two floors in the Smilow Cancer Hospital, which offers 40 MICU beds alongside 16 step-down beds. The MICU team cares for an average daily census of 26-34 critically ill patients with a wide range of life threatening disorders, such as septic shock, acute respiratory distress syndrome, and fulminate hepatic failure. Four teams cover the MICU, each led by a PCCM faculty member supported by fellows, residents, and midlevel practitioners. In addition to PCCM fellows and Internal Medicine residents, the MICU is a major training site for medical students, as well as residents and fellows from several departments, including Surgery, Emergency Medicine, and Obstetrics-Gynecology. Yale faculty spend an average of 10 hours per day in the MICU, leading work rounds and conducting teaching conferences. The MICU is a haven for clinical research, with multiple faculty conducting studies in acute lung injury, sepsis, cognitive impairment, diabetes, liver failure, and end-of-life care.
Coronary Care Unit (CCU)
Senior fellows rotate for 2 weeks through the Coronary Care Unit (CCU) at Yale New Haven Hospital. This rotation allows PCCM fellows to gain experience and competence in managing critically ill patients in the unique environment of the CCU. The CCU at Yale New Haven Hospital is a 14-bed adult ICU which provides care to patients with life-threatening cardiovascular illness such as acute myocardial infarction, heart failure, cardiomyopathies, and arrhythmias. As a regional referral center, the unit supports patients as they undergo advanced diagnostic procedures such as cardiac catheterization and electrophysiology studies, as well as invasive procedures such as pacemakers, intra-aortic balloon pumps and left ventricular assist devices, coronary stents and brachytherapy. The PCCM fellows have a comprehensive and unique opportunity to experience and participate in state of the art intensive coronary care. As a heart transplant center, fellows will additionally be exposed to the complex and multidisciplinary care of the patient pre and post-transplant.
During this rotation, PCCM fellows are expected to gain experience and knowledge in procedures such as Swan Ganz catheter placement, temporary venous pacemaker placement, and pericardiocentesis. They additionally spend time in the interventional catheterization laboratory to understand the technical aspects of catheter-based advanced therapies (e.g. stenting, valvuloplasty, intra-aortic balloon placement) and to understand how this relates to the care of the critically ill patient.
Neurosciences Intensive Care Unit (NICU)
PCCM fellows rotate through the Neurological Intensive Care Unit (NICU) at Yale-New Haven Hospital, typically for 4 weeks, during their first year of fellowship. The goals of this rotation are broad and include learning all of the skills required to evaluate and manage critically ill patients with neurologic and neurosurgical diseases, including but not limited to subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, Guillain-Barre Syndrome, post-op neurosurgical patients and status epilepticus. Fellows are expected to attend neurology and neurosurgical conferences and are afforded the opportunity to join Neurosurgeons in the operating room. NICU work rounds are conducted with highly skilled neurointensivists. Dr. David Greer is the medical director, and Dr. Emily Gilmore, Dr. Evie Marcolini, and Dr. David Hwang are the other faculty. In addition to rounding in the NICU, fellows also provide consultative services during this rotation to patients in other intensive care units at YNHH (such as CTICU, SICU, CCU), providing them with a unique opportunity to serve as a critical care consultant in ICUs outside of the MICU.
Thoracic Interventional Pulmonary Rotation (TIP)
The TIP service at Yale-New Haven Hospital is under the directorship of Dr. Jonathan Puchalski and performs a wide variety of interventional procedures. Our fellows spend one month on the TIP service during their fellowship where they get exposure to advanced bronchscopic procedures, pleural procedures and percutaneous tracheostomies.
Pulmonary Consult Service
The pulmonary consult service at Yale-New Haven Hospital is run by our PCCM faculty and is an active consultative service where our fellows see patients on the medical and surgical floors as well as in the surgical ICU’s. PCCM fellows spend two to three months on the consult service during their training. They gain tremendous experience in diagnosing and managing all the common pulmonary diseases as well as many uncommon presentations of pulmonary disease. They see a wide variety of pulmonary disease including lung nodules, interstitial lung disease, pulmonary hypertension, pulmonary infections, cystic fibrosis and rheumatologic manifestations in the lung. They also gain experience with bronchoscopy during this rotation. While on the consult service they also round in the Progressive Pulmonary Care Unit which is comprised of 6 beds where stable ventilated patients are managed. Here they learn about long-term ventilator weaning. Fellows also participate in performing Cardiopulmonary Exercise Testing (CPET) on this rotation.
West Haven VA Connecticut Health Care System
The Section of Pulmonary and Critical Care Medicine at the WHVA is directed by Dr. Hilary Cain. The WHVA has a six bed medical ICU, a pulmonary consultation service, pulmonary function lab and outpatient pulmonary clinics. Our fellows spend two months of their inpatient training at the WHVA where they round with faculty and housestaff in the ICU, see pulmonary consult patients, perform bronchoscopies and read PFTs. The WHVA also has an active sleep program under the directorship of Dr. Klar Yaggi and a pulmonary rehabilitation program under the directorship of Dr. Carolyn Rochester and our fellows also rotate on these services during their fellowship.
Dr. Carly Rochester directs the pulmonary rehabilitation program for our fellows. The fellows spend two to four weeks during their training receiving didactics on the science behind pulmonary rehabilitation, learning how to assess patient suitability for pulmonary rehabilitation, observing rehabilitation in both inpatient and outpatient settings and learning to manage tracheostomies.
Hospital of St. Raphael (HSR)
The Hospital of Saint Raphael is a 500-bed community hospital located in New Haven about 5 minutes from Yale-New Haven Hospital. It is the 4th largest hospital in Connecticut and has a ten bed ICU. PCCM fellows spend two months during their training at HSR. Three PCCM faculty who are based there: Dr. Herbert Knight, Dr. Roger Elias, and Dr. Aydin Uzunipar. In addition there are several private pulmonary groups that care for patients in the medical intensive care unit and on the medical floors. PCCM fellows can interact with both faculty and private physicians during their rotation at HSR. During this rotation fellows round with housestaff in the ICU and see pulmonary consult patients on the medical and surgical floors. They also get frequent opportunities to learn bronchoscopic techniques.
Training in Sleep Medicine occurs during rotations through the Yale Center for Sleep Medicine and the VACHCS sleep laboratory. Our fellows spend two to four weeks on the sleep medicine rotation. The curriculum for this sleep rotation includes: fundamentals of the neurobiology and structure of sleep, fundamentals of the effects of sleep on organ system physiology, pharmacology of drugs affecting sleep and wakefulness, classification of sleep disorders, basics of polysomnography, knowledge about ambulatory techniques for the monitoring of sleep disordered breathing, obstructive sleep apnea syndrome and related conditions, nocturnal hypoventilation management, and the basics of the differential diagnosis of excessive daytime sleepiness. Fellows who are interested in a career in sleep medicine can apply to our ACGME accredited Sleep Medicine Fellowship.
Pulmonary and Critical Care Electives
Hospital for Special Care
Hospital for Special Care has 200 beds and is licensed as a Long-Term Acute Care Hospital (LTAC). The Hospital services patients with chronic respiratory diseases from spinal cord/neuromuscular disorders, COPD, chronic ventilator dependency and long term weaning from mechanical ventilation. Acute rehabilitation is also provided. Our fellows have the option to spend time at HSC as an elective during their training.
Bridgeport Shriner's Burn unit/SICU
The burn unit is a unique and highly specialized care environment and is the only burn center in the state of Connecticut The burn center is an outstanding model of interdisciplinary care including occupational & physical therapy, dietary, respiratory & pulmonary services, social work and chaplain services. Thermal injuries with inhalation injuries, electrical, chemical and exfoliative skin disorders are what is typically seen here.
Chest and Critical Care Radiology
As radiographic studies are a critical part of our pulmonary and critical care medicine, learning how to interpret radiographic studies of the thorax is critical. Fellows meet on a daily basis in the thoracic radiology suite and read films with the thoracic radiology service.
Fellows can rotate through the operating room with anesthesiology either at Yale-New Haven Hospital or the West Haven VA and learn the technical skills of intubation, vascular access and difficult airway management.
Our fellows have the opportunity to spend a month doing an away elective in a field of their choosing Our previous fellows have spent time learning lung transplant at specialized centers, learning about bronchiectasis and MAI, spending time in an underserved location as part of the Johnson and Johnson Global Health program.
All of our first year fellows have weekly continuity clinic at the West Haven VA under the guidance of our faculty (Hilary Cain, Carly Rochester, Kathleen Akgun, Charles Dela Cruz, Christine Won, Klar Yaggi and Meir Kryger). The VA clinic population includes a large amount of COPD, asthma, lung nodules and obstructive sleep apnea.
During their second and third years the fellows alternate their weekly clinic between the West Haven VA and Winchester Chest Clinic at Yale-New Haven Hospital. Winchester Chest Clinic serves the local community as well as a wide referral population. The addition of Winchester Chest Clinic in the second and third year of fellowship not only gives the fellows exposure to a wider range of pulmonary disease but also teaches them the art of outpatient consultative medicine. The faculty who supervise in Winchester include Jennifer Possick, Richard Matthay, Jonathan Puchalski and Patty Lee.
Our fellows have a wide variety of subspecialty clinics to choose from including TB, cystic fibrosis, ILD, asthma, thoracic oncology, pulmonary hypertension and sleep. Our fellows spend 6 months doing ½ day/week in subspecialty clinics during the course of their fellowship.