Clinical Training

Overview of Clinical Training Structure

The majority of clinical training occurs in the first 2 years of fellowship with the third year generally dedicated to scholarship and research training. The clinical experience is divided into rotations at each of our 3 main hospitals: Jacobs Medical Center (JMC), UC San Diego Medical Center-Hillcrest, and the VA San Diego Healthcare System. Our clinical rotations offer a broad range of experiences working with very unique and diverse patient populations. Fellows will spend time in both the inpatient and outpatient settings in order to develop expertise in managing a wide range of respiratory and critical care illnesses. Fellows receive significant procedural training in the simulation lab, the ICU, on the general pulmonary consultation services, and on the interventional pulmonary service. These core rotations provide comprehensive training in the areas of pulmonary and critical care medicine as well as sleep medicine. This strong clinical foundation prepares our fellows to become extraordinary Pulmonary & Critical Care physicians ready to serve their communities.

Clinical Training Rotations		JMC	Hillcrest	VA
Critical Care	Medical ICU	14 weeks	6–8 weeks	6–8 weeks
	Night float	8 weeks
	Anesthesia Critical Care	2 weeks
	Neurocritical Care	2 weeks
Pulmonary	General Consults	8 weeks	8 weeks	8 weeks
	Pulmonary Vascular Medicine	6–8 weeks
	Lung Transplant	6–8 weeks
	Interventional Pulmonology	4–6 weeks
	Outpatient Pulmonary*	4–6 weeks
	Sleep Medicine	4 weeks
Research Training		48–56 weeks
Vacation		12 weeks
	*_{Does not include Continuity Clinic}

Critical Care Training

Medical ICU

JMC ICU, housed in the state-of-the-art facility Jacobs Medical Center, is home to a unique patient population, many of whom have undergone bone marrow or solid organ transplantation. Therefore, our MICU team cares for a wide range of life-threatening diseases in BMT patients with immunocompromised infections and end-stage liver disease as a robust transplant center. Furthermore, UC San Diego has a rapidly-growing extracorporeal life support (ECLS) program , so our fellows also manage VV-ECMO patients transferred from hospitals around the region for this specialized care. This MICU is a training site for residents and fellows from several departments, including Emergency Medicine, Interventional Radiology, and Anesthesia Critical Care.
JMC Night Float is an opportunity for fellows to run the ICU at night with a little more autonomy. Our fellows manage critically ill patients in the ICU as well as run codes throughout the entire hospital, alongside an in-house intensivist.
Hillcrest ICUis one of our most beloved ICUs. The Hillcrest patient population is comprised of underserved medically-indigent patients who can present with advanced disease processes. Our fellows encounter a tremendous breadth and depth of critical care pathology. This MICU is structured with attendings, fellows, and housestaff. Our fellows act as "junior" attendings, overseeing the service under the supervision of PCCSM faculty members.
VA ICU provides exposure to “bread and butter” ICU cases such as DKA, COPD exacerbations, ARDS, gastrointestinal bleed, septic shock, etc. On this teaching MICU service, our fellows lead rounds, conduct daily teaching, and supervise medical students, interns, and residents while developing their leadership and teaching skills. Additionally, fellows receive training in pulmonary function tests and participate in their interpretation with the ICU attending.

Pulmonary Vascular ICU

UC San Diego is world-renowned for its pulmonary thromboendarterectomy (PTE) program, performing more PTE surgeries than any other institution in the world. Patients travel from all over the world to be evaluated and treated by our multidisciplinary team. During their fellowship, our fellows have the opportunity to work alongside this world-class team, following patients from their initial evaluation in clinic all the way through their hospital stay and discharge to home. As a part of the Pulmonary Vascular Medicine Service, our fellows are the primary caretaker of post-operative patients in the ICU after undergoing pulmonary thromboendarterectomy (PTE) for definitive management of chronic thromboembolic pulmonary hypertension (CTEPH). Each patient is admitted to the ICU following surgery on mechanical ventilation with a Swan-Ganz catheter, chest tubes, and cardiac pacing wires still in place. Critical management of post-cardiac surgery patients with a specific focus on right heart physiology is a mainstay of this rotation. For those patients who are not surgical candidates, UCSD is also one of the few centers in the country performing pulmonary balloon angioplasty as an alternative to surgical intervention for CTEPH.

Anesthesia Critical Care Service

Second year fellows rotate for two weeks on the Anesthesia Critical Care Service at the Jacobs Medical Center. During this rotation, fellows learn about post-operative surgical ICU care including advanced cardiac device management such as LVADs. Under the direct supervision of anesthesia critical care faculty, our fellows are first call on emergent airways in the hospital during this time period.

Neurocritical Care Service

Second year fellows rotate for two weeks on the Neurocritical Care Service at the Jacobs Medical Center. The goal of this rotation is to master the skills required to care for critically ill patients with neurologic diseases including cerebral hemorrhage, ischemic stroke, status epilepticus, increased intracranial pressure, etc. Furthermore, our fellows also learn how to manage neurosurgical patients post-operatively.

Pulmonary Training

JMC Pulmonary and Cystic Fibrosis Consultation Service

The JMC Pulmonary and CF Consultation Service at the Jacobs Medical Center offers the opportunity to care for a variety of specific patient populations, namely a large oncologic population, advanced lung disease patients and adults with cystic fibrosis.

Jacobs Medical Center is home to the Moore’s Cancer Center, the only National Cancer Institute-designated Comprehensive Cancer Center in the region. The Pulmonary Consultation Service plays an integral role in both the diagnostic evaluation and treatment of a large immunocompromised patient population, including patients with blood cancers, solid organ tumors, and patients who are part of the largest bone marrow transplant program in San Diego. Fellows are exposed to unique diseases processes encountered by these immunosuppressed individuals. As a result, there exists a close collaborative relationship with both the oncologic as well as the infectious disease division.

UC San Diego is also home to one of the few Cystic Fibrosis Foundation-accredited care centers in the San Diego region with adult cystic fibrosis patients traveling long distances for our world-class care. Fellows participate in the care of the CF patients during their hospital stays and learn about management of acute CF exacerbations and the importance of health maintenance in this patient population.

Hillcrest Pulmonary Consultation Service

UC San Diego-Hillcrest serves as the region’s county-like hospital to provide care for the underserved population in the area, and it also cares for a large HIV patient population plugged into the Owen Clinic; therefore, there is an emphasis on infectious pulmonary diseases, COPD, asthma, and acute thromboembolism care. This service manages inpatient pulmonary consults as well as the interventional pulmonary service, which includes both outpatient pulmonary consults and advanced pulmonary procedures. Fellows gain experience in thoracentesis, chest tube placement, Pleurx catheter placement, endobronchial ultrasound, and transbronchial biopsy. Overall, this rotation is well-reviewed due to its high volume of bronchoscopic and pleural training under the direct supervision of the interventional pulmonary group at UCSD Hillcrest.

VA Pulmonary Consultation Service

The VA Pulmonary Consultation Service is divided into two different rotations in which fellows assist in the management of both inpatient and outpatient pulmonary needs for veterans in the San Diego region. The VA Pulmonary Consult rotation alternates between an inpatient and an outpatient component. Fellows work alongside subspecialty faculty to evaluate new inpatient pulmonary consults and urgent outpatient pulmonary consults. The VA Lung Cancer rotation is focused on teaching fellows how to evaluate pulmonary nodules and masses concerning for malignancy. One of the most rewarding parts of this rotation is that our fellows lead Tumor Board. In this multidisciplinary conference attended by departments of oncology, radiology, pathology, cardiothoracic surgery, and therapeutic radiation oncology, our fellows lead a case-based discussion on challenging thoracic oncologic cases and play an instrumental role in the diagnosis, staging, and management of thoracic cancers. Fellows also gain additional procedural training in bronchoscopy and endobronchial ultrasound.

Pulmonary Vascular Medicine Service

The pulmonary vascular medicine service is divided into two main components: management of post-operative pulmonary thromboendarterectomy (PTE) patients and management of pulmonary arterial hypertension (PAH) patients on advanced therapies. The PTE aspect of this rotation is described in more detail above in the “Critical Care Training” section of the website. Our fellows learn how to perform right heart catheterizations, manage right heart failure, and are exposed to advanced pulmonary hypertension therapies.

Lung Transplant Service

During this rotation, our fellows are exposed to the entire scope of the transplantation process. This rotation includes a mix of advanced lung disease patients with end-stage lung pathology awaiting lung transplantation and lung transplant recipients. One of the most exciting opportunities is participation in the weekly Lung Transplant Selection Meeting where our fellows learn how to properly evaluate a patient for lung transplantation and determine the best candidates for pursuit of transplant. While on the inpatient side, fellows learn to manage lung transplant patients immediately post-surgery and to manage complications in those with a history of lung transplant. Fellows become quite experienced with managing immunosuppression at various stages of the lung transplant process and master transbronchial lung biopsies.

Interventional Pulmonary Service

This rotation is procedure-based with the majority of the time spent at the Jacobs Medical Center. It focuses on challenging pulmonary procedures with the interventional pulmonary group. It offers exposure to the most advanced diagnostic and therapeutic approaches to various disease processes in the chest. In addition to the general pulmonary procedures described above, fellows have the opportunity to participate in percutaneous tracheostomy placement, rigid bronchoscopy with airway interventions (such as ablation, dilation), navigational bronchoscopy with fluorosocpy, and pleuroscopy.

Outpatient Pulmonary Rotation

Fellows spend four to six weeks of dedicated time in various subspecialty clinics in pulmonary medicine. This rotation is designed to provide exposure to these various areas with an opportunity to return in the future if more experience is desired. A broad range of pulmonary clinics are offered including severe asthma/eosinophilic lung disease, ILD/advanced lung disease, hypoventilation/neuromuscular disease, mycobacterial disease, cystic fibrosis, lung transplant, pulmonary hypertension, and venous thromboembolism.

Sleep Training

Fellows spend two weeks each in the first and second year on the Sleep Medicine Rotation. This rotation is split between the Sleep Center at UCSD and the Sleep Medicine Clinic at the VA Hospital. During this time, fellows see patients and learn how to interpret PSGs. Sleep medicine lectures are incorporated into the conference schedule on a regular basis. At the VA, sleep medicine patients are also commonly seen in the general pulmonary continuity clinic. Furthermore, there are numerous scholarship opportunities in the area of sleep, given our strong collaboration with the Sleep Research Laboratory run by the same outstanding sleep medicine faculty.

Continuity Clinic

Continuity clinics occur in three locations: Chancellors Park in La Jolla near the Jacobs Medical Center, UCSD-Hillcrest, and the VA Hospital. All fellows maintain two continuity clinics throughout their three years of fellowship. All fellows have one clinic at UCSD, at either the Chancellors Park or UCSD-Hillcrest location, and all have their own VA continuity clinic. Each fellow alternates between their UCSD and VA continuity clinic on a weekly basis. On average, the fellows see between four to six patients per clinic session. Each of the clinics is staffed by a dedicated group of pulmonary faculty who are experts in general pulmonary medicine.

Additional Elective Opportunities

Elective weeks, scattered throughout the first two years of training, can be utilized to spend time on advancing scholarship projects or to gain additional clinical experience in any particular area of interest. Exposure to many of these rotations are included in the core curriculum that every fellow will go through, so that a fellow can choose to spend additional time in a specific area of interest. Otherwise, they may choose to spend time on a rotation not otherwise included in the core rotations. Their elective time is used to augment their education in an individualized manner.

Outpatient Pulmonary Clinics

Pulmonary Function Tests
Pulmonary Rehabilitation
Severe Asthma/Eosinophilic Lung Disease Clinic
Advanced Lung Disease/Interstitial Lung Disease Clinic
Cystic Fibrosis Clinic
Lung Transplant Clinic
Pulmonary Vascular Disease Clinic /li>
Sleep Medicine Clinic
Thoracic Oncology Clinic
Mycobacterial Pulmonary Infection Clinic
Neuromuscular Disease and Assisted Ventilation Clinic
Interventional Pulmonary Clinic
ICU Recovery Clinic

Other Elective Rotations

Introduction to Anesthesiology
Thoracic Radiology
Telemedicine
Burn ICU Service
Trauma ICU Service
Anesthesia Critical Care Service
Neurocritical Care Service
Critical Care Ultrasound
Medicine Subspecialties including ID, Nephrology, Palliative Care