Fellows undergo intense clinical training during the first year. Experience in the intensive care units, consult services, and ambulatory clinics is balanced by various lecture series on bronchoscopy, pulmonary pathophysiology, and critical care medicine. By the end of the first year the expectation will be that fellows will have gained sufficient knowledge, experience, and leadership skills to direct pulmonary and critical care units in a tertiary care center.
We maintain an active inpatient consultation service at Strong Memorial Hospital. Our patients encompass a broad spectrum of clinical problems. Trainees are responsible for evaluation and providing management recommendations for these patients. We make daily teaching and service rounds. Generally, first-year fellows will spend 4 months on this service.
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Ambulatory Chest Medicine Clinic
Throughout their training, fellows participate in a weekly outpatient clinic which accepts referrals from physicians throughout the upstate New York area. The clinic is held at Strong Memorial Hospital in an area adjacent to the Pulmonary Function Laboratory, so that necessary tests such as spirometry and blood gases can be done at the time of the patient's visit. Many of the second and third year fellows will continue their continuity clinic at the Mary Parkes Asthma Center. Emphasis at either clinic is placed on teaching rather than providing primary care for a large number of patients. Fellows also use the clinics to follow selected inpatients after discharge from the hospital. This design lets the fellows have the opportunity to see unusual cases, as well as gain experience in the long-term management of selected patients with chronic respiratory diseases. Fellows manage their clinic patients under the direct supervision of a faculty member.
At least one-half day per week, each of the faculty members see patients who are referred to them. Additionally, faculty see patients with obstructive lung diseases at the new Mary Parkes Asthma Center, and an Occupational and Environmental Lung Diseases Clinic meets once a month. After the first year of training, fellows may also elect to participate in subspecialty clinics in pulmonary hypertension , or thoracic oncology.
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Intensive Care Units: Strong Memorial Hospital
The Strong Memorial Hospital Adult Intensive Care Units are major resources for teaching critical care medicine and pulmonary disease in critically ill patients. They offer Pulmonary and Critical Care fellows exposure to a wide range of critical illness, patient care challenges, and high technology medicine in an environment with an educational emphasis. One of our faculty members, Dr. Michael J. Apostolakos, is Director of Adult Critical Care at Strong Memorial Hospital.
The Medical Intensive Care Unit is under the direction of Dr. Apostolakos. Other members of the Pulmonary and Critical Care Unit participating in this Unit include Drs. Michael Larj, Joseph Modrak, Carol-Lynn Petronaci, David Trawick, Irene Perillo, Anthony Pietropaoli, and Jim White. Drs. Caroline Jones and Thomas Watson provide thoracic surgery consultation. This Unit has state-of-the-art monitoring facilities, ventilators, and a nurse-to-patient ratio of 1-2:1. The staff of the Pulmonary and Critical Care Unit is a major contributor to the general teaching and management of this facility. First-year fellows function as consultants for the house staff assigned to this Unit. Fellows also participate in resident teaching and have direct involvement with central line placement, pulmonary artery catheter placement and interpretation of data, endotracheal intubations, chest tube insertion, and therapeutic and diagnostic bronchoscopies. In the initial year of training, fellows spend 3 months in this Unit; they may elect further training on this Unit in subsequent years.
The Progressive Care Unit, under the leadership of one of the Pulmonary and Critical Care Faculty, Dr. David Trawick, opened in the fall of 1997. This 14-bed unit has the capability of caring for 10 ventilator-dependent patients and 4 ICU patients. This Unit emphasizes approaches for weaning patients from mechanical ventilation and encompasses a multidisciplinary approach to patient care. Fellows rotate on this unit during the pulmonary rehabilitation elective and learn the finer points of weaning, tracheotomy management, a care for the chronic critically ill patient. A separate 20-bed unit for chronically ventilator-dependent patients is located a few miles from Strong Memorial Hospital.
A 14-bed Surgical Intensive Care Unit and a 15-bed Burn-Trauma Unit at Strong Memorial Hospital are the major teaching facilities for our associated Critical Care Fellowship Programs . Drs. David Kaufman and Julius Cheng of General Surgery, and Drs. Peter Papadakos and Joseph Dooley from the Department of Anesthesiology direct these units. The Units serve patients who have had extensive subspecialty or general surgery, burns, or trauma. During the initial year of fellowship, trainees may elect time in these Units. Pulmonary/Critical Care Fellows generally elect time in both of these units during their third year of training.
A 14-bed combined Cardiology and Cardiothoracic Intensive Care Unit is under the direction of Dr. Joseph Delehanty from the Department of Medicine. This Unit serves open heart surgery patients as well as patients with complicated myocardial infarction and heart failure requiring mechanical ventilation. The heart transplantation program and heart failure center bring many patients to this unit. Fellows may choose an elective in this Unit during their second and third years of fellowship.
A 17-bed Pediatric Intensive Care Unit at Strong Memorial Hospital has a wide variety of both medical and surgical patients. Trainees may elect to spend time in this Unit during their third year.
The Neonatology Division at Strong Memorial Hospital is responsible for a 52-bed Neonatal Intensive Care Unit, a tertiary referral center. This group works closely with us in areas of research that include surfactant replacement for acute lung injury, aerosolization of antiviral agents, and specialized techniques for ventilatory support such as high-frequency ventilation. Fellows acquire experience in handling infant ventilators during this rotation. Opportunities are available for elective time with this Division as well.
The Hematology Division manages a 12-bed Bone Marrow Transplant Unit. The Pulmonary/Critical Care Service frequently helps in the management of these immunocompromised patients with respect to infections, respiratory failure following transplant, and ventilator management.
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Other Intensive Care Units
During their initial year, fellows usually spend two to three months at Highland Hospital, in the combined Medical/Surgical/Coronary Intensive Care Unit (14 beds) under the direction of Dr. Irene Perillo. This Unit permits added direct experience in pulmonary and critical care in a community hospital setting. This is an opportunity for gaining experience in the management of patients following thoracic surgery, extensive general surgery, and trauma.
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Pulmonary Function Laboratory
Well-equipped pulmonary function laboratories are in operation at Strong Memorial and Highland Hospitals. During the rotation through the Pulmonary Consult Service, trainees learn theory, techniques, and maintenance of equipment including blood gas apparatus, computerized spirometry, diffusion testing, body plethysmography, assessment of control of ventilation, and exercise testing.
The Mary Parkes Asthma Center was established in 1995 by the Parkes family in honor of their daughter Mary, an intensive care nurse whose long battle with asthma ended with her death in 1991. Since its inception, the mission of the Center has been to promote diagnosis, treatment and research of acute asthma, allergies and other pulmonary diseases. The center has been supported generously by Walter Parkes, father of the Center’s namesake. His most recent donation has made it possible to double the size of the center, relocate it to a brand new facility, and expand the services offered by the Center. Current services include two full PFT labs, a skin testing lab, and facilities for other outpatient pulmonary procedures.
The Center is now affiliated with the University of Rochester Medical Center, combining the Medical Center’s pulmonary division with the services already offered by the Parkes’ program. Twenty adult and pediatric pulmonary and allergy clinicians and researchers will eventually work out of the Mary Parkes Asthma Center, caring for both adult and pediatric patients.
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Strong Sleep Disorders Center
All fellows will have exposure to the evaluation of sleep disorders. The Strong Sleep Disorders Center is a 14 bed, state of the art, fully accredited facility performing over 2500 sleep studies a year. Dr. Donald Greenblatt is the medical director, and Dr. Joe Modrak is the associate director and the director of post graduate education at the sleep center. All fellows spend a minimum of 2 weeks (longer if desired by the fellow) rotating at the Strong Sleep Disorders Center in both their 2nd and 3rd years of the fellowship, during which time they are exposed to all facets of sleep medicine. The Strong Sleep Disorders Center is primarily a clinical facility, but also participates in a number of research projects. These research projects include a study of a new medicine for treatment of narcolepsy as well as several studies looking at pediatric obstructive sleep apnea.
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General and Interventional Bronchoscopy
The Pulmonary Division has procedure rooms for performing video-assisted fiberoptic bronchoscopy at both Strong Memorial and Highland Hospitals. Bronchoscopic techniques generally include bronchoalveolar lavage, brush biopsies, transbronchial forceps biopsies, and Wang needle transbronchial biopsies of mediastinal lymph nodes. Fellows perform bronchoscopy under the direction of the Pulmonary and Critical Care staff physicians. During the first year, Drs. Michael Nead and Gary Dudak will provide the fellows with a lecture series and demonstrations regarding bronchoscopic indications, skills and emergencies. Second and third year fellows continue in-depth training in cryotherapy, laser therapy, brachytherapy and other techniques in interventional bronchoscopy. Most fellows perform a minimum of 80 fiberoptic bronchoscopies during their initial year of fellowship training.
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Related Subspecialty Services
The flexibility of the program permits fellows to arrange for elective rotations on Cardiology (including the catheterization laboratory), Infectious Diseases, Immunology and Allergy or other medical subspecialties. Also, rotations can be arranged with the Cardiothoracic Surgery Division, the Pediatric Pulmonology Division, the Cystic Fibrosis Service, Pediatric Allergy, and the Neonatology Division.
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