Pulmonary and Critical Care In the Department of Medicine

Education

The Stanford PCCM Fellowship offers four tracks tailored to the individual’s career goals. We work closely with each incoming Fellow to help match him or her with the best track for their interests and career goals. There are two general tracks (Research and Clinical) that are in turn divided into two specific tracks. The Research Track is subdivided into Basic and Clinical Research Tracks and the Clinical Track is divided into Clinician Educator and Subspecialty Tracks. These pathways are summarized below:

1. Research Tracks. This pathway is recommended for those Fellows interested in Academic Medicine and is strongly tied to mentored-training with a view to K-series NIH development awards.

              a. Basic Research Track. This pathway is intended for those Fellows interested in bench and translational research; this course requires a close affiliation with an established science mentor . The target grant mechanism is the K08 award.

              b. Clinical Research Track. This pathway is appropriate for Fellows interested in clinical research as a principal career activity; it similarly entails close relationships with established mentor. The target grant mechanism is the K23 award.

 2. Clinical Tracks. This pathway is recommended for Fellows inclined towards patient care and/or administration as primary activities. This training is tailored to the Fellow’s preferences and is characterized by the development of strong clinical mentoring relationships.

              a. Clinician Educator Track. This pathway is ideal for Fellows seeking to be, first and foremost, outstanding clinicians; training is oriented towards optimizing clinical skills, usually with a special emphasis on a group of diseases as well as on teaching skills.

              b. Subspecialty Clinical Track. This pathway is designed to provide deep training in one of several key areas including lung transplantation, pulmonary hypertension, cystic fibrosis and interstitial lung disease; Fellows leaving training program are well-qualified to care for these complex patients and are well suited for leadership roles in these fields.

Fellowship Clinical Training:

Our three-year fellowship program provides excellent exposure to the broad range of clinical activities within PCCM, and does so with clinical rotations provided in the three hospitals in our program.  These are the Stanford University Medical Center, the VA Palo Alto Health Care System, and the Santa Clara Valley Medical Center.  The core clinical training blocks (see below) are typically front-loaded in the fellowship, providing appropriate core clinical training to precede advanced training in any of the fellowship tracks outlined above.  Clinical elective rotations are also available covering a broad scope of areas relevant to PCCM (see below).  An example mock schedule for the three years is provided in the Table below.  Note that the schedule allows options for the pursuit of either a Clinical Track or Research Track, with Track decision-making and divergence of training trajectory to be determined in the first year of training.

Table: Mock schedule (13 four-week blocks per year).

1st yr

SU Con

VM ICU

VA ICU

Txp

Vac/VM Con

VA Con

VA ICU

VA Sleep

SU Con

Vac/

E

VA Con

VA Sleep

VA ICU

2nd yr

SU ICU

VM Con

SU ICU

VM ICU

SU Con

R/E

R/E

R/E

R/E

R/E

R/E

R/E

R/E

3rd yr

R/E

R/E

R/E

R/E

SU ICU

R/E

R/E

R/E

VM Con

R/E

R/E

R/E

SU Con

Abbreviations:

Con:          pulmonary consult service

R/E:          research or elective

SU:            Stanford University Medical Center

Txp:          Lung Transplant

VA             Palo Alto VA Health Care System (PAVAHCS)

Vac:           vacation

VM:           Santa Clara Valley Medical Center

Core Clinical Rotations:

Our core clinical rotations cover the components of inpatient and outpatient exposure and training necessary for gaining clinical expertise in PCCM.  These Core Clinical blocks include the following:

Stanford University Medical Center blocks:

Palo Alto VA Health Care System (PAVAHCS) blocks:

Santa Clara Valley Medical Center (SCVMC) blocks:

Clinical Electives:

A broad array of clinical electives are available for fellows with interest in gaining added exposure and training in specified subset clinical aspects of PCCM.  The formal electives are based at the Stanford University Medical Center, and include the following:

Cardio-Thoracic ICU:

The Cardio-Thoracic ICU (CT-ICU) service is a multidisciplinary ICU service providing care for patients from the following surgical teams: Cardiac Surgery, Thoracic Surgery, Lung and Heart Transplantation, and Vascular Surgery.  Attending faculty come from Cardiac Anesthesiology and PCCM, and the trainee team includes fellows from PCCM, CCM, Cardiac Anesthesiology, as well as residents from Anesthesiology, CT Surgery, and Vascular Surgery.

Interventional Pulmonology:

              Our Interventional Pulmonology (IP) program is a recent addition to the Stanford PCCM Fellowship, and is headed by Dr. Authur Sung, a nationally regarded IP specialist.  The IP rotation provides exposure to the full scope of state-of-the-art clinical IP, and also includes clinical activities at the Palo Alto VA Hospital.  The IP program is also involved with the renowned Stanford Biodesign Program (http://biodesign.stanford.edu/bdn/index.jsp), providing opportunities for added medical device and medical process innovation training.

Outpatient Cystic Fibrosis and ILD Clinics:

              Our adult CF and ILD programs offer a rotation block of outpatient clinical exposure and training in these two important facets of PCCM.  The clinical block includes multiple weekly outpatient clinical sessions, as well as scheduled weekly Specialty conferences in these two disciplines.

Pulmonary Hypertension:

              The Pulmonary Hypertension (PH) clinical block provides focused exposure to the large and varied pulmonary hypertension patient population seen at Stanford University Medical Center.  This includes both inpatient as well as outpatient exposure, and is integrated with the clinical and basic research programs coordinated through and supported by the Vera Moulton Wall Center at Stanford (http://wallcenter.stanford.edu/).  Added PH sub-specialty training, with either clinical or basic/translational research focus, is available for interested fellows.

Thoracic Radiology:

              The Thoracic Radiology elective allows PCCM fellows a focused experience in improving their skills in thoracic imaging, including CT as well as routine radiology. The participating Radiology faculty come from the Thoracic Radiology section.

Thoracic Surgery:

              PCCM fellows have the opportunity to rotate on the Thoracic Surgery service.  This busy service provides clinical exposure to the breadth of patients seen at a regional referral medical center, and provides opportunity for broader clinical skills acquisition by fellows, including gaining expertise in chest tube placement.

Lung Transplantation:

              Our Lung Transplant Program provides added sub-specialty training for fellows.  The elective block includes outpatient clinic exposure as well as inpatient experience.  Added Lung Transplantation sub-specialty training, with either clinical or basic/translational research focus, is available for interested fellows.

References

Lane Medical Library
Society for Critical Care Medicine

Additional Websites of Interest

Stanford Center for Biomedical Ethics
Stanford University: Program on Genomics, Ethics and Society
American Thoracic Society
American College of Chest Physicians
Practical Pathology for Chest Disease
American Journal of Respiratory and Critical Care Medicine
New England Journal of Medicine
Annals of Internal Medicine
Centers for Disease Control
National Institutes of Health
The Radiology Assistant

Stanford Medicine Resources:

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