Program Graduate Dr. Kristen Fless with Resident Dr. Phung in the Uinversity Hospital Medical Intensive Care Uint
The information below is provided for informational purposes only to present an overview of our program. While it provides an accurate description of the program at the present time, it is not intended to constitute a contract or guarantee regarding our program.
The program received full accreditation from the ACGME in May 2005 for five years. Our program is also certified by the American Board of Internal Medicine to provide subspecialty training in Pulmonary Diseases and in Critical Care Medicine. Typically, our fellows are eligible for and take the Board examination in Pulmonary Diseases during the third year of training. Fellows achieve eligibility for the Board examination in Critical Care Medicine at the time of their graduation. Due to recent changes in the certification requirements in sleep medicine, additional year of training is required after the completion of the fellowship in Pulmonary and Critical Care Medicine (PCCM). Graduates of our fellowship program, interested in achievement of board certification in sleep medicine, typically continue their training at the sleep laboratory at Hackensack University Medical Center .
Candidates for our program have usually completed training in internal medicine and are eligible to take the American Board of Internal Medicine certification examination in Internal Medicine. By the time of completion of their training, fellows will fulfill the requirements for certification by the ABIM in Pulmonary Diseases and in Critical Care Medicine. To meet these goals, fellows usually spend 12 months of pulmonary consultation and 12 months of MICU service throughout the fellowship, split between the teaching hospitals of New Jersey Medical School (NJMS), i.e. University Hospital, Hackensack University Medical Center and the New Jersey Veterans Administration Hospitals (East Orange VA). The training emphasis at each of these hospitals is dictated by the major teaching strengths of the individual programs (see below) and, in sum, will include pulmonary consultation, intensive care medicine, pulmonary function testing, evaluation of sleep disorders, and all relevant pulmonary/critical care medicine procedures. The first year of training is typically spent on clinical services, such as pulmonary consultation and MICU. The scheduling for the second and third years will depend upon the specific career interests of the trainee. During the 3 years of training leading to certification in both Pulmonary Diseases and Critical Care Medicine a fellow is offered approximately 9 months of research/elective time. Research is considered of great importance in our program and every trainee is required to devote a portion of time in the latter years of the program to this activity
A. University Hospital
The primary teaching hospital of NJMS is University Hospital . This 466-bed general hospital located in Newark , New Jersey , was constructed in the mid-1970's. It is designated as a Level 1 Trauma Center and has special units for diagnosis and treatment of diseases in each of the subspecialties in internal medicine, surgery, neurology, psychiatry, pediatrics, obstetrics-gynecology, radiology, pathology, and rehabilitative medicine.
1. Pulmonary Consultation Service
The Pulmonary and Critical Care Medicine Division at University Hospital consists of both full-time and part-time members. We maintain an active inpatient consultation service. Our patients encompass a broad spectrum of clinical problems. Trainees are responsible for the evaluation and for provision of management recommendations for these patients. We make daily teaching and service rounds.
We have well-equipped pulmonary physiology laboratories at the University Hospital . During the first year of training while at University Hospital , the trainees evaluate the patients referred to this laboratory. Each day the laboratory work is presented to one of the staff physicians. During the rotation through the consultation Pulmonary Service, the trainee learns theory, techniques, and maintenance of pulmonary function equipment including, computerized spirometry, diffusion testing, inhalational challenge, and exercise testing.
University Hospital has a procedure room for performing fiberoptic bronchoscopy. Bronchoscopic techniques generally include bronchoalveolar lavage, brush biopsies, transbronchial forceps biopsies and Wang needle transbronchial biopsies of mediastinal lymph nodes. This equipment can be moved to the bedside or to the fluoroscopy suite, if necessary, to monitor transbronchial biopsies. Fellows perform bronchoscopy under the direction of the Pulmonary and Critical Care staff physicians. Fellows also gain experience in other special procedures such as pleural biopsies, lung needle aspiration, Swan-Ganz catheterization, chest tube insertion, intubation, and brachyradiotherapy.
2. Medical Intensive Care Unit (MICU) Service
The Medical Intensive Care Unit of University Hospital consists of 15 beds with a companion Coronary Care Unit of 15 beds. These combined units have a total of about 1800 admissions per year. The MICU provides a major resource for teaching critical care medicine and pulmonary disease in critically ill patients. The MICU as a “closed” unit and the MICU team consists of the critical care attending, PCCM fellow, 3 senior residents, 3 interns and variable number of medical students. The faculty rotates on a weekly basis, whereas the fellows and residents rotate on a monthly basis. Fellows participate in all clinical and academic activities within the unit. This unit has state-of-the-art monitoring facilities, ventilators, and a nurse-to-patient ratio of between 1:3 and 1:1.
3. Outpatient Clinical Service
Throughout their training, fellows participate in a weekly outpatient clinic. Emphasis in this clinic is placed on teaching rather than providing primary care for a large number of patients. Fellows also use this clinic to follow selected inpatients after discharge from the hospital. This design provides fellows with the opportunity to see unusual cases, as well as the chance to gain experience in the long-term management of selected patients with chronic respiratory diseases.
4. Other Clinical Opportunities
The division maintains a close association with the New Jersey Medical School National Tuberculosis Center , directed by Dr. Lee Reichman. This nationally recognized facility provides a unique opportunity for the fellow to learn about the diagnosis, treatment, and research related to Mycobacterium tuberculosis. The flexibility of the program permits fellows to arrange for elective rotations on Cardiology (including the catheterization laboratory), Infectious Diseases, Immunology and Allergy, other medical subspecialties, the Cardiothoracic Surgery Division, the Cystic Fibrosis Service, Pediatric Allergy, and the Neonatology Division.
5. Conferences at University Hospital
Our conference schedule is listed below. In addition to didactic teaching, these conferences provide an opportunity for fellows to learn the techniques of effective scientific communication, including public speaking and the proper use of audio-visual aids.
a. NJMS-Wide Clinical Pulmonary and Critical Care Conference (weekly on Wednesdays, 7-9AM):
This conference consists of two sections, approximately 1 hour each. The fellows are excused from the non-emergency patient care during the conference and are expected to be present. Majority of the faculty from the UH, VA and the HUMC, as well as some private physicians from the community are also often present.
The first hour is usually a didactic lecture by the PCCM faculty. Occasionally, distinguished speakers both within and outside of the New Jersey Medical School present topics related to Pulmonary and Critical Care Medicine. We have monthly journal club every second week of the month, as well as research conference every third week of the month.
The second hour is the clinical case conference. Fellows select and present interesting, unusual or challenging clinical cases they have encountered during their clinical rotations. This is rather informal part of the conference and usually leads to a lively discussion.
During the summer months (between the Independence Day and the Labor Day), this format is replaced by the “Summer Lecture Series”. Both hours of the conference are replaced by didactic lectures on the core topics of pulmonary and critical care medicine. This serves as the introduction for the first year fellows as well as repetition for the third year fellows gearing up for the pulmonary board examination.
b. Tuberculosis Conference (weekly on Tuesdays 4-5PM):
This conference is held in conjunction with the Global Tuberculosis Institute. Cases, topics, and research related to tuberculosis are presented.
c. Clinical Pulmonary Function Laboratory Review (each week day):
Patients evaluated in the Pulmonary Laboratory are reviewed in this conference with one of the staff physicians.
d. Pulmonary/Thoracic Surgery/Oncology Conference (weekly on Tuesdays, 12-1PM):
This interdisciplinary clinical conference reviews management of oncological diseases involving the thorax and the lungs. Challenging clinical cases are presented and discussed by the numerous faculty members from pulmonary, medical oncology, radiation oncology, radiology and thoracic surgery departments.
B. Department of Veteran Affairs Medical Center , East Orange and Lyons Campuses
The Department of Veterans Affairs New Jersey Health Care System (VANJHCS) consists of two medical centers, East Orange and Lyons . The East Orange VA Medical Center is a 500-bed tertiary referral facility within the Department of Veterans Affairs. VA hospitals and outpatient facilities from eastern Pennsylvania , New York and New Jersey utilize the cardiac catheterization, medical and surgical oncology and radiation therapy services of the East Orange VA Medical Center in care of their patients. In addition, the East Orange VA Medical Center serves as a referral center for a variety of medical and surgical problems. The Lyons VA Medical Center is a general medical and neuropsychiatric facility.
1. Consultation and Inpatient Service
Four full-time attending physicians staff the Pulmonary/Critical Care Section. The division provides pulmonary consultation for the entire medical center, both on an inpatient and outpatient basis. Pulmonary malignancies, chronic obstructive lung disease, interstitial diseases, sarcoidosis, tuberculosis make up the majority of the referrals to this center. Fellows gain experience in the performance of fiberoptic bronchoscopy with transbronchial lung biopsy, thoracentesis with closed pleural biopsy, transbronchial lung aspiration and biopsy. The East Orange VA Medical Center performs about 180 bronchoscopies annually, all performed by pulmonary fellows with faculty supervision.
The Pulmonary Section supervises and works closely with the Respiratory Therapy Section. Pulmonary fellows are active in providing in-service programs on the operation of ventilators and in the basic aspects of respiratory therapy. A fully equipped Pulmonary Function Laboratory is available. Measurements of lung volumes, flow rates, diffusion capacity, body plethysmography, methacholine challenge and pulmonary exercise stress testing are all performed. There is also a sleep laboratory for the evaluation of sleep apnea. The ICU is a combined ten bed MICU/CCU. Chronic ventilator patients are managed on one of the wards and are followed by a pulmonary fellow.
The Sleep Laboratory is directed by the Pulmonary Section. It is a four bed sleep center. There is a weekly Sleep Disorder clinic which is attended by 2 faculty members trained in sleep medicine, as well as pulmonary fellows. Pulmonary fellows work closely with the Sleep Laboratory director and are instructed in all aspects of sleep medicine, including interpretation of polysomnography.
2. Outpatient Clinics
The Pulmonary Section conducts five outpatient clinics weekly, with an average census of 80 out patient visits per week. The Section provides sub-specialty and consultative care for the outpatients. This outpatient experience allows fellows to follow patients longitudinally who are being treated for tuberculosis, acute lung interstitial illnesses, as well as chronic respiratory problems.
3. Conferences
Pulmonary/Thoracic Surgery Conference - weekly review and discussion of potential surgical cases with thoracic surgeons
Pulmonary Pathology – monthly review of active pulmonary pathology
C. Hackensack University Medical Center (HUMC)
Hackensack University Medical Center has 718 beds. Recently, its pulmonary program was cited as one of the 50 best in the country by US News and World Report. It boasts the largest number of admissions in the State of New Jersey . The hospital provides a level II Trauma Center, cardiac surgery, bone marrow transplantation and a full range of acute medical, surgical, pediatric and obstetrical and gynecological services.
1. Consultation and Inpatient Service
The Pulmonary Section has 3 full time and 6 part time members. They provide a full range of Pulmonary and Critical Care services, including consultations, pulmonary function and cardio-pulmonary exercise testing, pulmonary rehabilitation, and a fully accredited sleep/wake disorders center. The bronchoscopy service averages 600 bronchoscopies per year. Transbronchial biopsies, Wang needle aspiration biopsies, and various procedures in interventional bronchoscopy are available. The Section also participates in providing Critical Care and Respiratory Care Services for the 10 medical, 7 respiratory, 14 surgical, 10 cardiac care and 18 cardiac surgery beds.
2. The Breath and Lung Institute
This is a regional outpatient multidisciplinary service for the diagnosis and treatment of disorders related to breathing or chest medicine. The team includes Pulmonary, Allergy, Otorhinolaryngology, Cardiology, and Gasteroenterology. Fellows have an opportunity to participate in the care of patients evaluated in the Institute. Also, available is an extensive pulmonary rehabilitation and smoking cessation program.
3. The Institute for Sleep-Wake Disorders
The Institute for Sleep-Wake Disorders at Hackensack University Medical Center is dedicated to the diagnosis and treatment of the full spectrum of sleep disorders. It is also a major site for teaching and research in sleep disorders. The institute is the only facility in 5 neighboring counties accredited by the American Sleep Disorders Association since 1994 and draws patients from a large referral area. PCCM fellows, rotating through HUMC are exposed to broad range of sleep disorders at the Institute. Many of our fellows interested in achieving credentialing in sleep medicine do so at the Institute under the supervision of Dr. Hormoz Ashtyani.
4. Conferences and Teaching Rounds
Faculty members of the Section make daily rounds with the Fellows on both the Pulmonary and Critical Care Services. In addition the following conferences take place:
a. Morning Report
The attendings, fellows and residents meet each morning to review active cases.
b. Journal Club
Fellows and faculty meet each week to review critically articles in the scientific literature, which are of relevance to Pulmonary and Critical Care Medicine.
c. Pulmonary Function Tests and Exercise Study Review
Fellows meet on a daily basis with faculty to review these tests.
d. Sleep Medicine Conference
Fellows meet on a weekly basis to review interesting patients with sleep/wake disorders. Interpretation of sleep studies is emphasized.
It is our feeling that both clinical and basic research activities are extremely important in developing critical thinking. Therefore, we require all fellows to participate in a research project. Skills acquired during research training are the fundamental tools for careers in academic medicine, as well as, clinical practice. Most fellows initially have insufficient background to know precisely what type of investigation they wish to do. We frequently suggest participation in ongoing projects. However, we also encourage fellows to develop well-conceived projects of their own which seem likely to lead to fruitful conclusions. We encourage our fellows present their original work at national meetings and publish their findings in peer-reviewed journals. We encourage interdisciplinary research that takes advantage of the extensive research resources available in other clinical departments, as well as basic science departments.
We believe fellows can receive valuable supplementary training from educational opportunities outside the University. Therefore, each fellow is provided with funds to attend at least one national thoracic meeting per year during their second and third years, as well as special conferences and meetings related to their research.
Our program is certified by the American Board of Internal Medicine to provide subspecialty training in Pulmonary Diseases and in Critical Care Medicine. With three years of training, fellows are then eligible to take both the Pulmonary and Critical Care board examinations. As described above, individuals seeking certification in sleep medicine will require additional training after the completion of the PCCM fellowship.
All of the participant hospitals are located in northern New Jersey , either in or adjacent to Newark . The northern New Jersey metropolitan area offers virtually unlimited opportunities to enjoy cultural, recreational and educational pursuits. Newark is an active business and industrial center with a population of approximately 350,000. It has two large educational complexes composed of several adjacent universities and schools of higher education. Smaller urban and suburban communities offering a full spectrum of suitable housing surround the city. New York City is only minutes away and is easily accessible by both public and private transportation. The area hosts major and minor sport teams. There is also a broad range of recreational areas within easy reach, including the shore areas of New Jersey , and the lake and mountain areas of northwestern New Jersey .
Director, Pulmonary Disease/Critical Care Training Program: Zaza Cohen, M.D., Assistant Professor, University Hospital (UH), Interim Director, Division of Pulmonary/Critical Care Medicine
Associate Director: Walter Strauss, Clinical Assistant Professor of Medicine. Veterans Administration New Jersey Health Care Services (VANJHCS)
Associate Director: Hormoz Ashtyani, M.D. Clinical Assistant Professor of Medicine. Hackensack Medical Center (HUMC)
Claiborne-Hodge, Felicia. Training Program Coordinator, UH.
Blaivas, Allen , D.O., Staff Attending, VANJHCS
Bolanowski, Paul, M.D., Associate Professor of Surgery, UH
Carilli, Albert, M.D., Clinical Professor of Medicine, HUMC
Chang, Steven, M.D. Assistant Professor of Medicine, MICU Director, UH.
Connell, Rebecca, M.D., Staff Attending, VANJHCS
Kim, Jenny, M.D., Staff Attending, VANJHCS
Lardizabal, Alfred, M.D., Assistant Professor of Medicine, UH
Lavietes, Marc, M.D., Associate Professor of Medicine, UH
McDonald, Reynard, M.D., Professor of Medicine, UH
Patrawalla, Amee, M.D., Assistant Professor of Medicine, UH
Polkow, Melvin, Clinical Assistant Professor of Medicine, HUMC
Reichman, Lee B., M.D., Professor of Medicine, UH