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Division of Pulmonary, Allergy &

Critical Care Medicine

COLUMBIA UNIVERSITY
College of Physicians and Surgeons
Division of Pulmonary, Allergy and Critical Care Medicine
Department of Medicine

 

Clinical Centers

Pulmonary and Critical Care Fellowship Program

 

 

Charles A. Powell, M.D.,  Program Director

Columbia University, College of Physicians & Surgeons
Division of Pulmonary, Allergy & Critical Care Medicine
630 West 168th Street, PH 8-101
New York, NY 10032

 

Contact:  Fellowship Administrator (Mr. Brandon Murrell)

Phone: (212) 305-9817

Fax:    (212) 305-8464
E-Mail: bm2361@columbia.edu

 

 

 

How to Apply:

 

 

We participate in the Electronic Residency Application Service- ERAS. A complete application packet includes:

 

       ERAS application form

       3 letters of recommendation

       ECFMG Certification (for foreign medical graduates)

       USMLE Scores (for foreign medical graduates)

       Photo (optional)

 

The deadline for PACC fellowships beginning in July 2009 is February 15, 2008. 

 

Interviews are by invitation only. Tentative dates for Interviews are February 26, March 4, March 11, April 1, and April 15, 2008.

 

 

 

 

Columbia University does not discriminate on the basis of sex, race, color, national or ethnic origin.  It has a dedicated, enthusiastic, and successful affirmative action program.

 

Asthma Center

Cystic Fibrosis Program

Interventional Bronchoscopy and Endobronchial Therapy Center

Jo-Ann F. LeBuhn Center for Chest Disease & Respiratory Failure

John Edsall-John Wood Asthma Center

Lung Reduction

Lung Transplantation

Medical Intensive Care Unit

Pediatric Pulmonary Medicine

Pulmonary Clinic

Pulmonary Function Testing

Sleep Studies Unit

Stress Test

Tuberculosis Clinic

 

CPPNCPPN Physicians Network

 

 

 

 

 

General Description

 

The Division offers four positions each year to board eligible internists who wish to subspecialize in Pulmonary and Critical Care Medicine.  This three-year program is designed to meet the needs and interests of individuals preparing for an academic career as a practicing pulmonologist/intensivist who is also qualified to teach and/or to conduct research as a member of a medical school faculty.  The first two years offer a wide and closely mentored experience in the diagnosis and management of patients with respiratory disease and critical illness in both in-patient and ambulatory settings.  The third year is devoted to a laboratory-based or clinical investigation program that is determined by the fellow and program director.  An optional fourth year is available to facilitate continuation of promising research projects. 

 

Goals and Objectives

The goal of our program is to present an experience that will permit graduates to qualify as scholarly practitioners or investigators in an academic environment.  The graduate will acquire a clinical approach based upon a knowledge of the relationship between structural and functional respiratory abnormalities and their clinical manifestations; a critical analysis of the literature; and expert performance of invasive procedures as well as interpretation of a wide variety of non-invasive diagnostic examinations.  The fellowship also provides experience and management of the diverse clinical problems seen in the Medical Intensive Care Unit setting.  By the end of the training program, the graduate should be equipped to provide superior care to critically ill patients.  In addition, the graduate should be familiar with the instrumentation and data acquisition systems used in the ICU setting and should be able to recognize the indications, the benefits and the complications of the invasive procedures utilized in the ICU setting.

 

Pulmonary Medicine

During the first two clinical years, the fellow encounters a broad spectrum of disease entities as a consequence of the wide geographic referrals to this tertiary care center and of the interests of the Divisional and Departmental faculty.  The fellow is afforded an armamentarium of modern and innovative diagnostic techniques such as spiral and thin section CT, PET scanning, and gated MRI, as well as an unusual mix of therapies, including lung transplantation, lung volume reduction surgery for emphysema, and novel treatments for primary pulmonary hypertension. During year one, each fellow is encouraged to familiarize him/herself with the research programs being conducted within the program.

 

The fellows’ responsibilities lie in the consult service, the pulmonary function laboratory, the sleep laboratory, the cardiopulmonary exercise laboratory, the lung transplant service, the Medical Intensive Care Unit and the outpatient Chest and Asthma Clinics.  There are also rotations through non-medical critical care units.  The fellows respond to all adult service consultation requests throughout the Medical Center.  They evaluate the problem, outline the diagnostic evaluation, and guide the house staff concerning management.  Within 24 hours, the patient is presented to the attending consult service pulmonologist for discussion and critique.  The fellow performs all invasive diagnostic procedures under direct supervision.

 

Because the in-patient service of the Department of Medicine is not organized on a subspecialty basis, the consultative component of the pulmonary program serves as a major bedside input for house staff and clinical clerks with respect to diagnosis, management and prognosis of respiratory disease, in addition to patient management.  This interaction includes a scholarly component of notes in the case record citing the relevant literature for each condition.  In addition, the program accepts up to two fourth year students per month in a pulmonary medicine elective and house officers at the PGY1 to PGY3 level for elective periods from one to three months.  The fellows act as mentors to these individuals.

 

Under faculty supervision, fellows interpret all evaluations of pulmonary function and sleep disordered breathing daily.  The fellows attend Chest Clinic once a week during each year of the program.  In-patients are referred by the house staff or the fellows themselves, while out-patients may be referred by Emergency Services, other Subspecialty or General Medicine Clinics as well as the various community based clinics organized by the Medical Center.

 

Critical Care Medicine

The Columbia-Presbyterian Medical Center has 70 Intensive Care Unit beds, not including Pediatric and Neonatal ICUs.  The major allocation of the fellow’s time is devoted to the Medical Intensive Care Units (6 months), which are comprised of two active 14-bed units (MICU-A and MICU-B).  The fellow will participate as a member of the ICU team, which includes the ICU attending physicians, first and second year medical residents (MICU-A) and Nurse Practitioners and Critical Care Physician Assistants (MICU-B).  Fellows are expected to work closely with the house officers, nurse practitioners, and physician assistants to guide them in the process of clinical information gathering and participating in discussion related to the appropriate ordering of additional specialized tests and interventions.

 

Rotations are also scheduled in the Cardiac Intensive Care Unit.  The fellow participates in the evaluation and management of patients with acute cardiac disease including acute myocardial ischemia and infarction, malignant arrhythmias, acute cardiogenic pulmonary edema, decompensated chronic heart failure, and aortic dissection.  The fellow will gain experience in the management of patients undergoing evaluation for various angioplasty procedures, for cardiac valve replacement, for coronary bypass surgery, and for heart and lung transplantation. In addition rotations are scheduled in the Surgical-Anesthesia Intensive Care Unit and the Neurological-Neurosurgical Intensive Care Unit.  Rotations can also be arranged in the Cardio Thoracic Surgical Intensive Care Unit.

 

Research

During the third research year, the fellow has access to a wide range of investigative problems and technologies in clinical investigation, cell and molecular biology, and immunology in ongoing programs throughout the Medical Center.  The project and mentor are chosen with the advice of the most senior members of the Division during the first two years, and the entire third year is devoted to acquiring the necessary technology and pursuing the project.  The fellow is expected to present his or her investigation results at a national meeting and to prepare a manuscript for publication.  During this period, the fellow will also continue to attend Chest Clinic and will be required to rotate through the Lung Transplantation Program and Lung Volume Reduction Program for two weeks each.  The following laboratories are currently available to this program:

 

Dr. Robert Basner (sleep disorders)

Dr. Jahar Bhattacharya (endothelial mechanisms of lung injury)
Dr. Kathryn Calame (transcription factors)
Dr. Raphael Clynes (FC receptors and inflammation)
Dr. Jeanine D'Armiento (role of collagenase in emphysema)
Dr. Phillip Factor (acute lung injury, gene therapy)
Dr. Emily DiMango (cystic fibrosis)
Dr. Steven Goff (problems in virology)
Dr. Steven Greenberg (control of macrophage phagocytosis)
Dr. Rachel Miller (allergic diseases in utero)
Dr. Alessandra Pernis (B Cell Development)
Dr. Alfred Neugut (epidemiology of cancer)
Dr. Charles Powell (lung cancer, functional genomics)

Dr. Boris Reizis (immune system development)
Dr. Regina Santella (genes/environment moleuclar epidemiology)
Dr. Neil Schluger (tuberculosis, clinical trials in lung disease)
Dr. Christian Schindler (JAK-STAT signal transduction)

 

Additional Years

Additional research experience is often needed both to qualify for faculty appointment and to bring interesting projects to fruition. When the quality of performance during the second year suggests special aptitude for development in this direction, we will offer further post-doctoral experience and resources while supervising the fellow's application for independent support.

 

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Pulmonary and Critical Care Curriculum

 

The curriculum for the Pulmonary and Critical Care fellows is based on a strong foundation of clinical and academic exposure to the following following subjects:

 

Clinical Curriculum
• Pathology of Airway Diseases
• Emphysema: clinical manifestations, diagnosis, prognosis, management
• Cystic Fibrosis: genetics, pathophysiology, management
• Chronic Bronchitis: clinical manifestations, course, complications, management
• Bronchiectasis: diagnosis, treatment, management of massive hemopytsis
• Asthma I: cell biology and immunology
• Asthma II: diagnosis, prognosis and management
• Complications of steroid therapy
• Pathology of Parenchymal Inflammatory Disease
• Interstitial Lung Diseases: functional disturbances, clinical course
• Sarcoidosis
• Collagen Vascular Diseases
• Environmental Lung Disease
• Wegeners's Granulomatosis
• Lymphoma
• Alveolar Hemorrhagic Disease
• Pulmonary Hypertension I: The congested lung
• Pulmonary Hypertension II: Pulmonary arterial hypertension
• Pulmonary Thromboembolism
• Anticoagulants and Thrombolytics
• Pulmonary Tuberculosis
• Community Acquired Pneumonia
• Opportunistic Pulmonary Infections
• Fungal Infections of the Lung
• Acute Respiratory Failure: Courses and management
• Respiratory Muscle Function
• Pulmonary Rehabilitation
• Pathology of Pulmonary Neoplasms
• Management and Prognosis in Lung neoplasia
• Paraneoplastic syndromes
• Morbid Obesity: respiratory and hemodynamic abnormalities
• Pulmonary Function/Complications of Pregnancy
• Congenital Pulmonary Abnormalities
• Pleural Effusions: evaluation and management
• Structural Imaging of the Lung

 

Pathophysiology Curriculum
Respiratory System Mechanics
• Abnormalities in lung and chest wall elastic properties
• Disturbances in airflow
• Work of breathing and oxygen cost of breathing
• Respiratory muscle dysfunction


Respiratory Gas Exchange
• Hypoxemia
• Perfusion of capillaries in non-ventilated areas of the lung
• Perfusion of capillaries in poorly ventilated areas
• Impairment of diffusion
• Reduction in minute ventilation
• Hypercapnea
• Reduction in minute ventilation or in tidal volume
• Ventilation perfusion abnormality
• The A-a gradient
• Physiologic consequences of hypoxia, hypoxemia, and hypercapnea

 

Pulmonary Circulatory Abnormalities induced by Respiratory Disturbances
• Consequences of disturbed gas exchange
• Anatomic reduction in the size of the pulmonary vascular size
• The diagnosis of pulmonary arterial hypertension


Ventilatory Control
• Respiratory control center
• Afferent traffic
• Peripheral chemoreceptors
• Central chemoreceptors
• Cortical signals
• Proprioceptive signals
• Parenchymal and airway signals
• Measurement of ventilatory response

 

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Pulmonary and Critical Care Weekly Conference Schedule

 

Monday

7:30 am

Transplant Conference

 

Tuesday*

8:00 am

Chest Conference*

 

Wednesday

12:00 pm

1:00 pm

Medical Grand Rounds

Critical Care Seminar Series

Thursday

8:00 am

 

8:00 am

 

  1:00pm

3:00 pm

Thoracic Oncology Tumor Board (every 2 weeks)

Interstitial Lung Disease Conference (every 2 weeks)

Pulmonary/CCM Didactic Series

Critical Care Grand Rounds

 

Friday

8:00 am

12:00pm

Pulmonary Grand Rounds

Journal Club

 

                                                          

* Case presentations with basic science correlation, pathology reviews, monthly joint conference with Pediatric Pulmonary Group.

 

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