Update from Section Chief Naftali Kaminski, MD
The Section of Pulmonary, Critical Care, and Sleep Medicine (Yale-PCCSM) believes its strength comes from its people. The section’s mission is to provide compassionate and effective patient care; to perform cutting-edge and innovative clinical and translational research; and to provide rigorous but tailored training for future leaders in academic medicine and science.
Yale-PCCSM faculty aims to fulfill this mission in the best atmosphere possible with a focus on community, diversity, equity, engagement, and work-life balance, says Naftali Kaminski, MD, chief of the Section of Pulmonary, Critical Care & Sleep Medicine. He and other section faculty members discuss the culture of Yale-PCCSM in a video featured in a docuseries created by the American Thoracic Society in 2021. Watch the video at https://m.yale.edu/ypn7.
Yale-PCCSM has grown from about 38 faculty members in 2013 to 75 in 2021. The section has two professors emeritus, nine professors, 20 associate professors, 28 assistant professors, and 12 instructors. The section, which traditionally has benefitted from strong female leadership, has an equal number of men and women professors. Eleven associate professors are women, and nine are men; 46% of ladder faculty are female, 54% of senior faculty are female, and 55% of clinical educators are female. Of the ladder faculty, 13% are from groups that have been underrepresented in medicine.
A new cabinet of vice chiefs and directors reflects the section’s size and stature: Jonathan Siner, MD, clinical chief; Hilary Cain, MD, VA section chief; Charles Dela Cruz, MD, PhD, and Klar Yaggi, MD, MPH, vice chiefs of research, basic and translational; Margaret Pisani, MD, MPH, vice chief, faculty development and mentoring; Jennifer Possick, MD, director, ambulatory services; Shyoko Honiden, MD, director, critical care services; Lynn Tanoue, MD, MBA, senior strategic advisor; Vivian Asare, MD, vice chief, Diversity, Equity and Inclusion; and Carolyn D’Ambrosio, MD, vice chief for fellowship training and fellowship program director. New faculty include Samir Gautam, MD/PhD, Brett Gerstenhaber, MD; Zack Harris, MD; and Sandra Zaeh, MD, MS. Newly promoted faculty are Assistant Professor Denyse Lutchmansingh, MD, and Associate Professor Jose Gomez Villalobos, MD, MS. Pisani and Yaggi, both alumni of Yale-PCCSM fellowship programs, were promoted to full professor.
Kaminski says the pipeline is working, explaining that Gomez, like Pisani and Yaggi, trained at the section as a fellow. Another thing that tells us a lot about the section's appeal is that people like to stay here, Kaminski said, adding that 40% of early career faculty were Yale-PCCSM fellows.
In 2021, the National Institutes of Health awarded R01 grants to former fellows who are members of this new generation of physician-scientists: Gomez, and Maor Sauler, MD. Gomez will study neutrophilic asthma, while Sauler will investigate the pathobiology of COPD. Lauren Ferrante, MD, MHS, also a former fellow, received the 2021 American Geriatrics Society Outstanding Junior Investigator of the Year Award for her studies of geriatric factors in intensive care.
The COVID-19 pandemic required team cohesion and resilience, with faculty safety and wellness a priority. Through 2021, the section treated 1,500 COVID-positive patients who required critical care. Their average stay in the MICU was two days longer than for a non-COVID patient, although some required extended stays. Also, 49 patients received ECMO for respiratory indications, many of them young. Providing these services to the section's patients requires resources, time, and resiliency along with skill, knowledge, 24-hour stamina, and commitment, says Kaminski.
The section recruited D’Ambrosio from Brigham and Women’s Hospital to be vice chief for fellowship programs and program director for the Pulmonary, Critical Care Medicine (PCCM) Fellowship. Brian Clark, MD, is the fellowship director; Jon Koff, MD, is associate director, fellowship research. Kaminski noted the extremely strong pool of candidates in 2021; the Pulmonary and Critical Care fellowship alone had 400 applicants. In addition to PCCM, the section offers fellowships in Sleep Medicine, Interventional Pulmonary Medicine, and Critical Care.
Yale-PCCSM appointed Margaret Pisani, MD, MPH, as vice chief of Faculty Development and Mentoring. She will work with senior faculty who are devoted to providing mentorship and sponsorship to all Yale-PCCSM faculty. The section also developed a structured process for supporting mentors and mentees.
Pisani met with mentors about their mentees to identify successes and challenges. The mentees provide a written report that is presented to the section chief and the senior faculty committee to approve career plans and target academic metrics for the coming year, which allows the leadership to support the mentors in guiding the faculty and set a process in place to ensure faculty are getting appropriate mentorship. The current focus is on clinicians and clinician educators, as the metrics for researchers are relatively clear, says Pisani.
Diversity, Equity, and Inclusion
As part of the section’s mission to focus on community, diversity, equity, and inclusion, Vivian Asare, MD, vice chief for DEI, together with the section’s DEI committee, set up a series of events that included multiple DEI-related Yale-PCCSM Grand Rounds; a screening of Black Men in White Coats with the documentary’s creator; and Pride events in June. The commitment to recruit fellows from diverse backgrounds has led to such initiatives as participation in the Yale GME office-sponsored inaugural Under-represented in Medicine recruitment fellowship dinner. The section also organized several events benefiting local foodbanks, including virtual 5K and a Thanksgiving food drive for a community soup kitchen.
Yale-PCCSM clinical programs are committed to providing the best, most compassionate, and up-to-date clinical care to patients with lung disease in inpatient or outpatient settings. They also provide cutting-edge clinical research, and rigorous education with the goal for both faculty and trainees to be national and international leaders in their subspecialties.
The Critical Care program includes the inpatient Medical Intensive Care and Step Down Units, the Tele-ICU and access to outpatient consultations. Shyoko Honiden, MD, MS, recently was named director of Yale-PCCSM Critical Care Services, replacing Jonathan Siner, MD. In addition to Siner’s role as the section’s clinical chief, he was named Yale New Haven Health ICU director in 2021. The team managed the Medical Intensive Care Unit on two campuses through an unprecedented period of growth from 24 beds to 60; expansion of the step-down unit; and creation of first Tele-ICU unit in the EPIC environment that allows remote treatment of critically ill patients. During COVID surges, the number of beds increased to as many as 130, and Tele-ICU was expanded.
The Winchester Center for Lung Disease, (WCLD), a multidisciplinary center for the diagnosis and care of patients with lung disease, opened in 2021. Jennifer Possick, MD, is its medical director; Denyse Lutchmansingh, MD, is the associate director. WCLD is a partnership with Yale New Haven Hospital (YNHH), Yale Medicine, and Yale-PCCSM. Negative-pressure exam rooms prevent the spread of contagious illnesses from one area to another. The new space triples the capacity to treat patients with asthma, COPD, pulmonary fibrosis, sarcoidosis, pulmonary hypertension, cystic fibrosis, bronchiectasis, and tuberculosis; and houses all the outpatient services of Yale-PCCSM centers and programs. The Post-COVID-19 Recovery Program, which saw 692 post-COVID patients in 2021, is also located at WCLD.
Centers of Excellence
Center for Asthma and Airway Disease
A national and regional leader in asthma care, YCAAD is led by Geoffrey Chupp, MD, and Lauren Cohn, MD, who were able to minimize the impact of COVID-19 on their patients. Chupp recently described how new data show that people with asthma at YNHH were relatively protected from severe COVID-19.
The Yale-ILD Center has a nationally recognized multidisciplinary team. Erica Herzog, MD, PhD, is the director, and Danielle Antin-Ozerkis, MD, is the medical director. Interstitial lung diseases are difficult to diagnose and treat, and often require referral from community physicians, including pulmonologists. The center has world-renowned experts in pulmonary fibrosis, connective tissue-associated ILD, hypersensitivity pneumonitis, sarcoidosis and other ILDs; and is actively recruiting patients to participate in clinical trials of novel therapeutics.
Adult Cystic Fibrosis
Yale-PCCSM has one of the top cystic fibrosis programs in the country, specializing in the diagnosis, management, treatment and research of cystic fibrosis. Jon Koff, MD, is the director. Koff is also the medical director of the Yale Center for Phage Biology and Therapy, which aims to use phages to combat the increasing prevalence of antibiotic-resistant bacteria in cystic fibrosis and other conditions.
Yale Sleep Centers
The Centers for Sleep Medicine is led by Klar Yaggi, MD, MPH, and Christine Won, MD, MSc. It has three locations in North Haven, Madison, and at the VA Connecticut Healthcare System location in West Haven, and 21 beds for sleep testing, as well as renowned experts in obstructive sleep apnea, insomnia, narcolepsy, and other sleep disorders.
Comprehensive Pulmonary Care Program at WCLD
As described earlier under outpatient services, Yale-PCCSM master clinicians evaluate and treat patients with a wide range of lung disorders as well as undiagnosed respiratory complaints. They provide the best current diagnosis and treatment based on their vast experience. The team is led by Jennifer Possick, MD.
Pulmonary Vascular Disease Program
Led by Director Inderjit Singh, MBChB, and Associate Director Philip Joseph, MD, the Pulmonary Vascular Disease Program (PVDP) is a comprehensive center for the evaluation and treatment of pulmonary hypertension, acute and chronic pulmonary embolism, and unexplained shortness of breath. The PVDP has ongoing research studies as well as such clinical and diagnostic services as right-heart catheterization, and highly specialized services that are offered in only a few sites nationwide. These services include advanced cardiopulmonary testing that allows evaluation of shortness of breath not otherwise explained by such routine tests as pulmonary function tests, echocardiogram, chest imaging, or standard exercise tests. In collaboration with cardiothoracic surgery, the PVDP also offers pulmonary thromboendarterectomy for the treatment of chronic thromboembolic disease. This is a specialized and complex surgery with few expert practitioners nationwide.
A growing number of patients are treated to prevent repeat hospitalizations and deteriorations, including the most complex COPD patients. The COPD sleep clinic for the management of COPD-related sleep disordered breathing and chronic respiratory failure opened in July 2021. The program is led by Carolyn Rochester, MD.
Nontuberculous Mycobacterium (NTM) Pulmonary Infections and Bronchiectasis Program
This program evaluates and manages patients with bronchiectasis and chronic infections, including nontuberculous mycobacteria (NTM) as part of the Yale Chronic Pulmonary Infection and Non-Cystic Fibrosis Bronchiectasis Program. The interdisciplinary group provides workup and non-antibiotic and antibiotic management of difficult-to-treat chronic lung infections, patient support and education and access to research. It is led by Charles Dela Cruz, MD, PhD, and Ashley Losier, MD.
Among the procedures performed are advanced diagnostic and therapeutic bronchoscopy. The first bronchoscopic lung volume reduction surgery at Yale was performed in 2021; it involved an endobronchial valve placement on a patient for treatment of COPD.
The Yale Cancer Center Thoracic Oncology Program (TOP) is a multidisciplinary program for the evaluation and treatment of patients with thoracic malignancies, and for advancing scientific discovery in lung cancer biology and treatment. It is led by Lynn Tanoue, MD, MBA, and Jennifer Possick, MD.
Tuberculosis (TB) Clinic
Directed by Tanoue, the Tuberculosis Clinic is the regional referral center for tuberculosis and non-tuberculous mycobacterial diseases. Its faculty are engaged in outreach in adult education centers in the Greater New Haven area, screening and treating high-risk people who often have limited access to health care.
VA Connecticut Healthcare System
Yale-PCCSM at VA Connecticut Healthcare System, directed by Hilary Cain, MD, has clinical, educational, and research programs. Six faculty members spend most of their clinical and academic efforts at the VA campus, while other section faculty make additional contributions to the program. The Sleep Medicine Program is shared equally between the Yale and VA campuses.
The section’s clinical programs translate into significant scientific productivity. Annual research publications averaged around 20 to 50 until 2014, and then doubled in 2015. Over 230 papers were published per year in 2020 and 2021 by Yale-PCCSM physician-scientists, clinician educators, trainees and PhD investigators. Kaminski notes that these publications showcase high-quality multidisciplinary research and clinical observations, and are published in high-impact journals.
The section published several manuscripts describing single-cell profiling of IPF, COPD, cystic fibrosis, COVID-19, as well as the largest and most detailed characterization of normal lung endothelial cells. All the papers are accompanied by data sharing, mining, and dissemination portals that allow free exploration of the data without the for expertise in bioinformatics or computational biology. Yale-PCCSM cell atlases can be accessed at https://medicine.yale.edu/lab/kaminski/research/atlas/.
Yale Center for Pulmonary Infection Research
Led by Charles Dela Cruz, MD, PhD, the Center for Pulmonary Infection Research (CPRIT) and Treatment advances cutting-edge basic, translational, and clinical research that will lead to improved understanding of pulmonary infections and more effective diagnoses and treatments, while providing enhanced preparedness for future outbreaks of such respiratory infections as COVID-19. Faculty in the newly established comprehensive multidisciplinary Yale Chronic Pulmonary Infection and Non-Cystic Fibrosis Bronchiectasis (CPNB) Center have significant expertise in the treatment of complex lung diseases. CPNB houses clinical and translational studies and offers experimental therapy and a comprehensive approach to disease management.
Precision Pulmonary Medicine (P2MED)
This center facilitates the application of precision medicine approaches to pulmonary, critical care, and sleep medicine. It applies technologies to improve the diagnosis and management of human lung disease, with a focus on identifying a patient’s molecular characteristics. The center provides access to cutting-edge RNA and protein profiling technologies. Gomez is the center director. P2Med has a dedicated analytic team that provides quantitative approaches, from traditional statistics to robotic-assisted technology. Xiting Yan, PhD, is director of its data analysis and bioinformatics hub.
The section’s research funding has doubled from eight years ago. The section makes a major effort to train their researchers and their clinician-educators in submitting grants and supporting them, Kaminski says. The increase in funding is reflected in research productivity as mentioned above, as well in the quality and impact of research published. Section members published in the top medical and scientific journals in areas as diverse as single-cell multi-omics in nearly every lung disease; geriatric outcomes in the MICU; the contributions of socioeconomic status to mortality; novel mechanisms of infection; sleep disordered breathing phenotyping; palliative care; novel therapies and mechanisms in sarcoidosis; and women physicians' perceptions of breastfeeding and pumping.
Three Lakes Foundation selected Yale School of Medicine and the University of Pittsburgh School of Medicine to join the Three Lakes Consortium for Pulmonary Fibrosis. The researchers will focus on advancing disease understanding with the goal to speed new treatments and find a cure for this devastating lung condition. The section’s work in pulmonary fibrosis is showcased in a new video by the American Thoracic Society, “Mapping Technology Supports Pulmonary Fibrosis Patients.”
To learn more about the Section of Pulmonary, Critical Care, and Sleep Medicine, visit medicine.yale.edu/intmed/pulmonary/.