Fellows complete inpatient training at Carilion's flagship hospital, Carilion Roanoke Memorial Hospital, including training within a closed medical ICU.
Acceptance into the Virginia Tech Carilion Pulmonary/Critical Care Medicine Fellowship Program requires the applicant to be either board eligible or board certified by the American Board of Internal Medicine or American Osteopathic Board of Internal Medicine.
It is expected that fellows will become Board Certified in Internal Medicine at the earliest possible test date, and will go on to sit for the pulmonary medicine and critical care boards.
After acceptance into the training program, fellows will have the following responsibilities:
- Provide inpatient consultations and general pulmonary services for suspected and/or known pulmonary diseases at Carilion Roanoke Memorial Hospital (CRMH) and at Salem Veteran Affairs Medical Center (SVAMC) (pulmonary and critical care consult services).
- Provide care to patients in medical, trauma, neurologic cardiothoracic, and cardiac intensive care units.
- Supervise and teach medical students or residents (under the direction of an attending physician) rotating on any of the various pulmonary teams.
- One half-day per week is devoted to pulmonary outpatient continuity clinic. New patients are not preselected by disease type, but consist of a mix of pulmonary conditions, such as asthma, COPD, sleep disorders, lung cancer, interstitial lung disease, pulmonary vascular disease, etc. Fellows are assigned new patients and expected to follow these patients during the entire training period. Additionally, fellows will follow patients whom they have seen as inpatient while on the pulmonary consult service. The program will make sure that at least 25 percent of fellow’s clinic patients are from each gender.
- Attendance and participation is required of each fellow in the weekly clinical conferences, the monthly journal club, the monthly critical care morbidity and mortality conference, the monthly research conference, and the weekly core curriculum didactic conferences of the section. In addition, attendance at the weekly Internal Medicine Grand Rounds is recommended. Additional supplemental conferences in sleep medicine, ethics, etc are also available monthly.
- Pulmonary/Critial Care Medicine clinicians perform a variety of procedures as part of daily practice. Some of these are procedures for which the trainee is already certified as competent in Medicine training, such as central line insertion and lumbar puncture. However, there are many procedures which require direct attending supervision and/or teaching, including, but not limited to, bronchoscopy, Swan-Ganz insertion, chest tube placement, endotracheal intubation, and tracheostomy. Trainees are expected to perform and/or review biopsy specimens, cytology, and pertinent radiographs of the patients they are managing. They are expected to follow the department’s procedure protocols in performing those procedures (see attached protocols).
- Trainees take call from home with a faculty member as a back up also on call. Trainees and staff are expected to respond to pages within 15 minutes unless exceptional circumstances prevail. All trainees have at least one day in seven free from clinical duties at present. Adjustments will be made in the time off policy to comply with future changes in duty hour regulations.
- Participation in research is expected for each trainee. The section expects preparation of at least one manuscript suitable for publication, and submission of at least one abstract to a regional, national, or international meeting prior to completion of the three-year training period. Each fellow will have a minimum of seven 4-week blocks of protected research time throughout the three year training period.
- Communication regarding patient care between faculty and fellows is essential. When complex decisions are addressed, fellows are required to contact faculty at once personally or by phone. Faculty supervision occurs continuously. During the first year of training, fellows review all changes in therapy or recommendations for invasive procedures with the faculty attending prior to making the recommendation to another physician.
- During the second year, assuming that the trainee has made satisfactory progress, trainees are given more freedom to make recommendations if he/she is comfortable and confident in the recommendation. Invasive procedures can be performed without attending notification if the need arises and the fellow has been deemed competent. In the second year, trainee recommendations must be reviewed by the supervising faculty within 24-hours. Trainees are encouraged to contact the attending physician, at any time day or night. This type of supervision applies to inpatient and outpatient care, home health care management, phone calls from outside physicians or family members.