Clinical Training - Pulmonary and Critical Care Medicine Fellowship
The Pulmonary and Critical Care Medicine (PCCM) Fellowship at the University of Maryland offers comprehensive clinical training, fostering both personal and professional development.
Fellows gain expertise in diagnosing and treating a wide range of pulmonary and critical care diseases. The outline below gives a summary of our major clinical rotations.
Core Rotations
UMMC Medical Intensive Care Unit
The UMMC Medical Intensive Care Unit (MICU) is a 29-bed, state-of-the-art facility and a quaternary referral center, ranking among the highest acuity units in the United States. Fellows manage all MICU patients and perform procedures such as endotracheal intubation, bronchoscopy, pulmonary artery catheter placement and critical care ultrasound. They gain expertise in physiology, pathophysiology, diagnosis and treatment of critical illnesses and multi-system diseases, as well as triage. The unit is staffed 24/7 by attendings, fellows, residents, interns and APPs.
UMMC Pulmonary Medicine Consult Service
Fellows perform pulmonary consultations for various diseases and can expect to perform at least 100 bronchoscopies by the end of their fellowship. A thorough understanding and accurate interpretation of pulmonary function tests (PFTs) are essential. Fellows also supervise medical house staff and students and present at conferences.
UMMC Interventional Pulmonology
The interventional pulmonology (iPULM) program at UMMC is a key component of our division. Fellows evaluate and manage pleural and airway diseases, both benign and malignant. Procedural experiences include performing ultrasound-guided procedures—thoracenteses, pigtail and tunneled pleural catheters—endobronchial ultrasound and advanced diagnostic bronchoscopy. Fellows also participate in the VA Lung Mass Clinic and multidisciplinary thoracic oncology tumor boards.
UMMC Lung Transplant
Fellows engage in comprehensive care for lung transplant patients. They assist with inpatient post-transplant care and outpatient evaluations for potential transplant candidates. Performing bronchoscopies on post-transplant patients is a key component. A core curriculum ensures fellows learn the fundamentals of pre- and post-transplant care, including indications and contraindications, pathophysiology, complications and the use of specialized procedures.
VA MICU/Consults
During the combined VA MICU and consult service rotation, fellows manage all VA MICU patients and perform pulmonary consultations for those on general medical wards. Key tasks include bronchoscopy and PFT interpretation. Fellows also supervise residents and students and prepare for conferences.
Pulmonary Electives
Numerous pulmonary medicine electives are available for fellows. Typically, fellows have two elective months in their first year and complete two or three more electives in subsequent years to meet ACGME program requirements.
- Chest radiology (required during first year)
- Lung pathology
- Pediatric pulmonology
- Pulmonary hypertension
- Pulmonary medicine consult service at the NIH Clinical Center in Bethesda, MD
- This rotation provides exposure to rare diseases and various immunosuppressed conditions. Fellows participate in clinical research specialty clinics and inpatient rounds, enhancing their experience with these disorders.
- Pulmonary rehabilitation and ventilator weaning at UMMC–Midtown
- Fellows learn about chronic ventilator management, long-term tracheostomy care, and rehabilitation services. They gain understanding of how combining exercise training with behavioral and educational programs helps patients manage symptoms and improve daily activities. Fellows gain experience in an inter-professional team approach, collaborating with nurses, respiratory therapists, physical therapists, psychologists and dietitians.
- Sleep medicine
- Fellows engage in a multidisciplinary sleep disorders clinic, where they assess patients with diverse respiratory and non-respiratory sleep disorders. They acquire extensive clinical experience in managing sleep disorders and develop a thorough understanding of interpreting polysomnography (PSG).
- Thoracic surgery
- Additional lung transplant and interventional pulmonology rotations
Non-Medical Critical Care Rotations
In addition to caring for patients in standard MICUs, the ACGME requires that fellows complete three one-month rotations in non-medical critical care units.
At the University of Maryland, we are fortunate to have the Maryland Shock Trauma Center, which is the prototype trauma hospital in the United States.
These non-medical ICU rotations expose the fellows to a wide array of critical illnesses, which are often not seen in the medical ICUs, and provide a milieu to learn the principles of critical care within the respective disciplines.
- Critical care ultrasound (required during 1st year)
- Midtown anesthesia (required during 1st year).
- Fellows develop comprehensive airway management skills, typically performing >40 intubations during this rotation. This foundational proficiency serves as a base for further skill refinement throughout their fellowship. Fellows also provide inpatient pulmonary consultation.
- Cardiac surgery ICU
- Critical care resuscitation unit
- Multi-Trauma ICU, including VV-ECMO unit
- Neuro ICU
- Neuro-Trauma ICU
- Surgical ICU
Outpatient Clinics
The ambulatory experience in our Fellowship Program provides comprehensive training in pulmonary outpatient care. Fellows learn to integrate history, physical examination, imaging, laboratory and pulmonary function data to formulate coherent treatment plans. Patient care focuses on thorough evaluation of new respiratory issues and efficient management of chronic conditions. Fellows see new and established patients in various clinics.
- University of Maryland Center for Pulmonary Health, located at UMMC Midtown campus (faculty practice). Subspecialty clinics include:
- Asthma
- COPD
- Cough/dyspnea
- ILD
- Lung transplant
- Sarcoidosis
- Sleep
- Pulmonary hypertension
- Pulmonary nodules
- Baltimore VA
- Pulmonary clinic (fellows' clinic)
- Lung mass clinic
Nighttime and Weekend Call
Fellow call schedules during our fellowship program vary by clinical service and year of training.
At UMMC MICU, four fellows rotate night-time and weekend shifts monthly in a shift-work model, eliminating traditional 24-hour overnight calls or home calls. VA ICU nighttime call is home call.
Weekend call involves traditional weekend coverage, where fellows rotate covering the VA ICU, pulmonary consults and critical care consults. Each first-year fellow typically covers approximately six or seven weekends of traditional weekend call. In subsequent years of fellowship training, nighttime and weekend call occurs less frequently, averaging about three to five weekends per year.
We strictly adhere to ACGME duty hour rules and regulations.