Division of Pulmonary, Critical Care & Sleep Medicine

Curriculum

The PCCM fellowship training program is designed to train academic physicians. In keeping with ACGME requirements, we offer 2 years of clinical training in pulmonary and critical care medicine, and 1 year of protected, mentored research training. In addition to the core rotations at our three hospitals (UCSD Medical Center – Hillcrest, Thornton Hospital – La Jolla, and VA San Diego Healthcare System – La Jolla), we offer 6 months of clinical or research electives during the first 2 years. Trainees may select from a wide range of established electives listed below. At the conclusion of their training, fellows will be eligible to sit for ABIM subspecialty boards in Pulmonary Disease and Critical Care Medicine.

UCSD Medical Center – Hillcrest

The UCSD Medical Center is a 386 bed facility located near downtown San Diego which also serves as the regional trauma and burn center. This busy tertiary care hospital will expose our trainees to a diverse patient population with respiratory, infectious, and critical care disorders. It is also home base for our Pulmonary Special Procedures Unit. This dedicated procedural service offers a unique opportunity for our trainees to perform and participate in a comprehensive array of diagnostic and therapeutic interventional procedures including, but not limited to, flexible and rigid bronchoscopy, endobronchial ultrasound, airway stent placement, laser applications, percutaneous tracheostomy, thoracentesis, chest tube placement, pleural biopsy, medical pleuroscopy, and diagnostic/therapeutic bronchoscopies for the burn and trauma units. It is not uncommon for our fellows to have nearly 200 supervised bronchoscopies during a month rotation. Another rotation is through the medical ICU (MICU) – a 13 bed unit that serves a diverse population of critically ill patients. Fellows rotating in the MICU will gain experience in the procedural and patient management skills necessary for competency in critical care medicine. The fellows will gain experience in coordinating a multidisciplinary team involving students, house staff, nurses, nurse practitioners, respiratory therapists, physical therapists, pharmacists, nutritional services, and consultants. Fellows will also gain experience in ethical issues related to critical care medicine, including end of life care and regular family discussions. The following is a list of subspecialty clinical and research activities at our Hillcrest campus:

  • Acute Venous Thromboembolism
  • Advanced Lung Disease
  • Chronic Pulmonary Infection
  • HIV Program
  • Hyperbaric Program
  • Lung Transplantation
  • Occupational Medicine
  • Pulmonary Physiology
  • Pulmonary Rehabilitation
  • Pulmonary Special Procedures Unit
  • Sleep Medicine

Thornton Hospital – La Jolla

The UCSD Thornton Hospital is a 119 bed facility located in La Jolla. Although smaller in capacity, this is a bustling hospital with a highly active Cancer Center, Sulpizio Cardiovascular Center, and several sub-specialized surgical programs. Thornton Hospital is home to our Pulmonary Circulation Program – dedicated to clinical and research activities in Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension (PAH). This is also the site for our Pulmonary Thromboendarterectomy (PTE) program, lung transplantation surgery, and Adult Cystic Fibrosis program. The fellows will gain unique and dedicated experience in the management of patients with pulmonary vascular disorders during the PTE rotation. Fellows will learn to diagnose, evaluate, and manage patients with PAH, including experience with right heart catheterization. Preoperative evaluation of patients with suspected chronic thromboembolic disease and postoperative management of patients undergoing PTE surgery are covered in depth, as UCSD is a world referral center for these disorders. The ICU is a 12 bed open unit serving both medical and surgical patients. Fellows rotating through the combined ICU and consult service at Thornton Hospital will gain experience assessing and treating complications of cancer and/or bone marrow transplantation, as well as critical care management of sub-specialized surgical patients. The following is a list of subspecialty clinical and research activities at our Thornton campus:

  • Adult Cystic Fibrosis
  • Bone Marrow Transplantation
  • Cancer Center
  • Cardiovascular Center
  • Chronic Thromboembolic Pulmonary Hypertension
  • ICU Outcomes
  • Lung Transplantation
  • Pulmonary Arterial Hypertension
  • Pulmonary Thromboendarterectomy

VA San Diego Healthcare System – La Jolla

The VA San Diego Healthcare System (VASDHS) is located adjacent to the UCSD main campus in La Jolla. VASDHS is a state-of-the-art 336 bed facility offering comprehensive care to all VA patients within the catchment area south of Los Angeles and west of Las Vegas. The primary goal of the VA Pulmonary Consult/Procedure rotation is to provide the trainee with experience in the clinical and procedural aspects of consultative pulmonary medicine with an emphasis on chest nodule work-up and management. A unique and particularly rewarding aspect of this rotation is the fellow’s involvement with the multidisciplinary Chest Tumor Board. The fellow will present all cases of suspected or proven lung cancer at this weekly conference attended by specialists from pulmonary, radiology, thoracic surgery, pathology, oncology, radiation oncology, and their trainees. The fellow is responsible for running this conference and obtaining consensus from the group about the most appropriate diagnostic and therapeutic plan for each patient. During this rotation, the fellow will also become facile in all standard pulmonary diagnostic and therapeutic procedures, including bronchoscopy, transbronchial lung biopsy, transthoracic needle aspiration, thoracentesis, chest tube placement, pleural biopsy, and tracheostomy management. Fellows will also rotate separately through the ICU service. The 18 bed combined medical/surgical ICU provides fellows with experience in the management of a diverse group of critically ill medical and surgical patients. Fellows will gain experience in coordinating a multidisciplinary team involving house staff, nursing, respiratory therapists, physical therapists, pharmacists, nutritional services, social work, and chaplain services. The medical ICU team, under the supervision of the fellow and attending, assumes the primary care for surgical subspecialty patients requiring ICU care (urology, neurosurgery, orthopedics, ENT), while providing consultation to general surgery, vascular surgery, and cardiothoracic surgery patients receiving ICU care. The fellow will also gain experience in the interpretation of pulmonary function tests during this rotation. The following is a list of research and clinical activities at the VASDHS campus:

  • Adult Cystic Fibrosis
  • Allergy and Immunology
  • ARDS
  • Asthma
  • COPD
  • Lung Cancer
  • Pleural Diseases
  • Pulmonary Physiology
  • Sleep Medicine
  • Spinal Cord Injury Center

Electives

During the first two years of clinical training, our fellows will have the opportunity to take 6 months of clinical or research electives. Several of the electives may be combined to maximize elective time. Electives currently offered include the following:

  • Adult Cystic Fibrosis
  • Introducution to Anesthesiology
  • Chronic Pulmonary Infection
  • Lung Transplantation
  • Principles of Thoracic Oncology
  • Pulmonary Rehabilitation
  • Pulmonary Vascular Disease
  • Scholarly Activity 101
  • Scholarly Activity 201
  • Sleep Medicine for the Pulmonologist

Outpatient Clinic

Our fellows participate in one half day per week of outpatient clinic. The fellow will alternate weekly between Hillcrest and VASDHS. The clinic is supervised by an attending and serves as the ACGME mandated continuity clinic for the duration of the fellowship.

Scholarly Activity

The third year of the fellowship has been set aside as protected time to engage in scholarly activity with an approved mentor. All entering fellows will be assigned a faculty advisor. This advisor, together with the PCCM Education Committee, will facilitate the process of identifying a research mentor before the fellow’s third year. The “Scholarly Activity 101” and “Scholarly Activity 201” electives are designed as another option to allow fellows an opportunity to identify a mentor, become familiar with the mentor’s prior work and laboratory environment, and formulate big picture questions for further investigation. Fellows are encouraged to submit abstracts and attend the annual American Thoracic Society (ATS) conference throughout the fellowship. Travel stipends are available for fellows to attend the ATS conference.. Fellows are expected to prepare and compete for grants during their fellowship, with the goal of training independent investigators in academic careers. Opportunities will be available for a fourth year fellowship for those committed and engaged in scholarly activities and in need of additional time for career development. Our NIH funded training program Training in Respiratory Biology: Innovate, Integrate, and Translate provides one avenue for additional research training.

Divisional Conferences

The Division hosts a variety of regularly scheduled conferences during the academic year. The weekly Pulmonary Grand Rounds is a CME-accredited activity that hosts world class visiting speakers, as well as PCCM faculty. Pulmonary Grand Rounds is followed by the PCCM Case Conference, which is a CME-accredited activity that allows fellows the opportunity to present cases to stimulate discussion among their peers and the PCCM faculty. A clinical pathology conference as well as a journal club are presented once a month. Both of these conferences are presented by the fellows with discussion by their peers as well by faculty. The clinical pathology conference has a moderator and discussant from the faculty as well as having a radiologist and pathologist in attendance for their presentation of the case. The weekly Scholarly Activities Meeting (SAM) allows faculty and fellows to present their investigative work, and features a weekly summer series focusing on aspects of career development. The summer series also serves as a “grant sounding board” for faculty and fellows preparing grant proposals. Alternating with the SAM is our Core Lecture series – didactic sessions addressing a wide range of topics in pulmonary and critical care medicine given by faculty within PCCM and experts outside of the Division. Additionally, we have a monthly Journal Club open to all faculty and fellows.