Pulmonary and Critical Care Medicine

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Hurricane Irma

Jackson Health System has resumed normal operations at a majority of its facilities.

The UHealth Jackson Urgent Care at Cutler Bay is now open
The UHealth Jackson Urgent Care center at Keystone Point is now open
The UHealth Jackson Urgent Care center at Country Walk, as well as the Jefferson Reaves, Sr. Health Center and Prevention, Education & Treatment (PET) Center, remain closed due to power outages.

To reschedule an appointment, please call 305-585-6000. Updated information for UHealth Jackson Urgent Care centers is available at JacksonUrgentCare.com.

The Jackson Health System/Jackson Memorial Hospital Pulmonary, Critical Care Fellowship Training Program, in affiliation with the University of Miami Miller School of Medicine, is accredited and offers 14 approved positions. The program is accredited by the Association of Clinical Graduate Medical Education and integrated into the Medical Residency Program.

The overall objective of our program is to prepare trainees for a wide spectrum of career opportunities, including academic teaching and patient care in respiratory and critical care medicine and biomedical research. Typically, trainees spend three years in the Program consisting of rotations in clinical pulmonary medicine, critical care medicine, and basic and clinical research. Additional years of research training are available and supported by the faculty for selected trainees interested in careers as physician-scientists or basic researchers. 

The typical three-year program makes trainees eligible for certification by the American Board of Internal Medicine in Pulmonary Diseases and critical care. 

The program is conducted in several clinical facilities: Jackson Memorial Hospital, the Miami Veterans Affairs Hospital, the University of Miami Hospital, and The Sylvester Cancer Center.

ACGME Accredited: Yes
Fellows per year: 4
Duration: 3 years
Postgraduate Training Required: Yes
U.S. Citizenship Required: The program sponsors trainees on a J1Visa.  We do not sponsor those on a H1B Visa.

Teaching Hospitals
Jackson Memorial Hospital, Veterans Affairs Medical Center and the University of Miami Hospital

Requirements
Three years of internal medicine residency training at an accredited institution are required to qualify for entry into the fellowship program. 

Fellows are required to have a current and valid certification for BLS, ACLS, OSHA and other certification required by the Public Health Trust, the Veterans Affairs Medical Center and The University of Miami Hospital or state or federal agencies.

Application Deadline
Our Pulmonary, Critical Care Fellowship Program participates in the NRMP match.  We accept applications only through the ERAS system, a centralized application processing service-paper applications will not be accepted. The Pulmonary, Critical Care program follows the July application cycle as stated in the ERAS Timeline. Match dates for the Pulmonary, Critical Care Fellowship Program are listed at the Medical Specialties Matching Program (MSMP).

For more information about ERAS, NRMP, ACGME and ECFMG, please refer to the following sites:

  • ERAS 
  • NRMP
  • ECFMG
  • ACGME

Due to the large volume of applications we receive each year, the program will only contact candidates chosen for an interview.  Please do not contact our program coordinator regarding the status of your application.

Our overarching goal is to produce the next generation of leaders in Pulmonary and Critical Care Medicine.

In addition, the goals of the program are:

  • To provide fellows with an educational program that will prepare them for a lifelong practice of quality Pulmonary/Critical Care Medicine.
  • To graduate professionally skilled, knowledgeable, compassionate, scholarly, and scientifically oriented pulmonologists and critical care specialists.
  • To provide a framework of training such that the graduating fellows remain “lifelong learners” and retain their interest and professional competency in Pulmonary and Critical Care Medicine.
  • To reinforce the values of selfless care of patients, ethical conduct of research, respect for the public trust, and service to the scientific community.
  • To prepare fellows to successfully obtain certification and become diplomats of Pulmonary Diseases as well as Critical Care Medicine.

The majority of fellowship learning is experiential. Therefore, our program provides clinical rotations in a variety of different settings to establish a broad background from which to gain knowledge and supplement it with focused readings.  The fellowship also has a didactic program for more formulized instruction.  Finally each fellow will receive an extensive ambulatory clinical experience.

Pulmonary Consultation Services (Jackson Memorial Hospital, Veterans Affairs Medical Center, and University of Miami Hospital):  The pulmonary consultation service will develop the fellows’ skills to provide effective and proficient consultations based on scientific principles for patients with respiratory disorders to the requesting health care practitioner. Fellows will be exposed to a large spectrum of disease entities from commonly encountered to rare and unusual problems. This exposure will ultimately enable the fellows to effectively work as consultants in a variety of environments, such as private practice setting, as well as in a large hospital based practice, or in an academic center. The fellows will be exposed and learn the technical aspects of pulmonary procedures such as bronchoscopies, transbronchial biopsies and other procedures. They are expected to appreciate a consultation as both a patient oriented diagnostic and management tool as well as an educational experience for themselves and the requesting health care practitioner.

Pulmonary Medicine Continuity Clinic Longitudinal Experience (Jackson Medical Center and VA Medical Center): The Pulmonary Medicine Continuity Clinic will develop and maintain the fellows’ skills necessary to provide effective continuity care for patients with pulmonary problems in the outpatient setting. Fellows will start to develop the skills necessary in the diagnosis and management of common ambulatory respiratory problems. They will be exposed to patients with more complex pulmonary problems and with proper supervision will learn how to address these problems. They will become aware of appropriate preventive health measures. They will begin to develop skill to effectively serve as outpatient consultants and convey their findings and solutions of patients’ problems to the requesting physicians. They will collaborate with other health care professionals and coordinate their patients’ management with ancillary health care entities such as home health care, durable medical equipment suppliers, social services and community support services.

Critical Care Services: The critical care rotation is designed to provide fellows with a well rounded education in the management of critically ill patients. While focused on medical patients, trainees completing the program will have sufficient experience to competently provide critical care for surgical and trauma patients as well. A modern intensive care unit does not exist in isolation, but functions as an integral part of the hospital setting, coexisting and coordinating with other services, including medical, ancillary, quality management, and administrative. Fellows will be trained in the necessary skill sufficient to permit competent administration of an intensive care unit.

Clinical training in critical care medicine takes place at all three teaching hospitals, Jackson Memorial Hospital, Veterans Affairs Medical Center and the University Of Miami Hospital.  Fellows will spend a minimum of nine months and not more than fifteen months in a critical care unit.

The program incorporates three months of training in a non-medical intensive care unit, i.e. Surgical Intensive Care Unit, Trauma Intensive Care Unit, Neurosurgical Intensive Care Unit, or Chest Surgical (Transplant) Intensive Care Unit. 

Fellows will gain an understanding of the pathophysiology of a broad range of critical illnesses including respiratory failure of various causes, sepsis and septic shock, hemorrhage and hemorrhagic shock, renal failure, hepatic failure, status epileptics, acute stroke, acute cardiac events including myocardial infarction and cardiogenic shock and many other conditions. Fellows will learn and master therapeutic techniques including invasive and noninvasive ventilatory support, resuscitation, invasive monitoring and bedside diagnostic techniques, intubation, pacemaker insertion, tube thoracostomy, use of vasoactive agents conscious sedation and therapeutic sedation, and nutrition support in the critically ill.

These rotations are also designed to instruct the fellows in aspects of intensive care unit administration. Fellows will be intimately involved in evaluating patients for appropriateness of intensive care. They will become familiar with anticipated staff loads based on patient acuity, thus learning how to utilize an intermediate care setting. Fellows will participate in quality management activities of the intensive care unit under the direct supervision of the attending. They will become familiar with the intricacies of explaining critical illness to families of patient, with associated issues such as advance directives. Autopsy and Morbidity/mortality conferences will be attended when relevant

Bone Marrow Transplant Rotation: The BMT rotation provides care for cancer patients with acute pulmonary disease and critical illness.  Fellows will encounter patients with opportunistic respiratory infections, ARDS, and other types of respiratory failure, gastrointestinal bleeding, NS emergencies, tumor lysis syndrome, sepsis, etc.  Many of these patients will be recovering from bone marrow transplantation and will be critically ill from infection or complications of the therapy.  The fellow and supervising attending will act as critical care physicians for these patients.  There will also be in-patient and out-patient experiences in non-critical care respiratory medicine including immune-suppressed patients with pulmonary infiltrates, the diagnosis and management of obstructed airways, and the management of malignant effusions.

Specialty Clinics Rotation: The Specialty Clinics Rotation gives the fellows the opportunity to work in a selection of clinics that are dedicated to the treatment of specific diseases.  For the most part, these clinics manage unique patients with rare diseases.  The clinics vary in their structure and function with some providing short-term consultation for referring physicians and others providing longitudinal care over longer periods.  All bring together clinicians, basic scientists, nurses, case managers, research coordinators and other personal devoted to the understanding the pathogenesis, finding new treatments, and delivering the finest care to the patients under their wings.  Fellows will be given a weekly schedule and rotate through specified clinics throughout the week.  The clinics involve patients with cystic fibrosis, non-CF bronchiectasis, interstitial lung diseases, lung transplantation, sleep medicine and Pulmonary Hypertension

VA Physiology, Pulmonary Function Testing, and Rehabilitation Rotation:  A clinical physiology rotation is a unique opportunity to learn the foundations of pulmonary function testing as well as the principle of pulmonary physiology under expert supervision.  We provide our fellows with this exposure because we believe a solid understanding of pulmonary physiology remains essential to understand the effects of disease, and that pathophysiology is the bridge between cellular events and the patient’s experience. This rotation requires extensive reading on the part of the fellow in addition to providing hands-on training in the pulmonary function, exercise testing, laboratory management, and quality control. The fellows will also meet individually with attending who have extensive background in physiology and pulmonary function testing.  At this meeting we will review pulmonary function testing and will provide an opportunity to discuss a variety of physiology topics.

Finally, this rotation will provide time for fellows to be introduced to pulmonary rehabilitation.  Pulmonary rehabilitation is getting more recognition for its impact on the quality of life and function status of patients with chronic lung disease especially chronic obstructive lung disease.  Fellows will participate in twice weekly sessions with patients undergoing pulmonary rehabilitation.  They will provide initial assessments, aid in completing quality of life questionnaires and conduct education sessions.  This will occur at the VA Medical Center.

Research
As part of the academic environment a research component is included in the three year pulmonary/critical care fellowship program. The division is engaged in many grant supported basic science oriented and clinical research projects. All fellows are expected to participate in one or more of these projects. During their first year of training fellows will have an opportunity to obtain information about ongoing research through formal divisional research conferences, discussion with the program director and with individual faculty.

After eight months of their first year of fellowship (in March of the following year after beginning of their fellowship in July) fellows will submit a research protocol signed by their tutors/mentor to the Chairman of the Research Committee.  All fellows will get mandatory and protected time for research each academic year.

Fellows will be assigned according to their preference to a faculty member as tutor/mentor, who will closely supervise the fellow to assure a productive learning experience. Fellows are expected to present their research results at national meetings and achieve publication of their work in peer reviewed journals. Fellows will learn study design and interpretation of research data, learn research methods and will receive instruction about critical assessment of basic and clinical research.

Board Exam Requirements
Three years of internal medicine residency training at an accredited institution are required to qualify for entry into the fellowship program. 

Educational & Other Experience
Didactic Conferences:  Formal educational instruction is provided throughout the year in several formats including the following:

1. Summer Lecture Series:  Intensive 2 month conference schedule on the most important clinical problems encountered by the novice pulmonary consultant or critical care fellow.  This includes a Mini-Ventilator course” to discuss the principles and different modes of mechanical ventilation and an overview of statistics.

2. Board Review Series:  Biweekly one hour lectures in September and October.  These lectures are created and run by the senior fellows who are undergoing board preparation.

3. Core Lecture Series:  weekly conference from November to June of fellow determined topics.  Lecture topics are typically rotated every 18 months.

4. Weekly Pulmonary Rounds:  Fellows present interesting cases or topics encountered during their clinical rotations.  In additional the final week of each month is reserved for a basic science presentation  by the faculty.

5. Critical Care Journal Club:  Twice monthly the Critical Care Faculty at the VA Medical Center has an hourly discussion of the most recent trials in critical care medicine with an emphasis on trial design and statistical analysis.

6. Tumor Board:  During the BMT rotation, fellows participate in the weekly Multidisciplinary Thoracic-Oncology Tumor Board, held weekly on Thursday afternoon between 2:30 and 4pm in the radiation oncology conference room at UMHC.  The principle objective is to provide an open forum for the presentation of newly diagnosed or complex thoracic oncology cases, the majority of which will be primary bronchogenic carcinomas (lung cancers).  The fellow will have the opportunity to present cases and to learn the up-to-date approaches to the diagnosis, staging, and multi-modality management of thoracic malignancies.

Research: As part of the academic environment a research component is included in the three year pulmonary/critical care fellowship program. The division is engaged in many grant supported basic science oriented and clinical research projects. All fellows are expected to participate in one or more of these projects. During their first year of training fellows will have an opportunity to obtain information about ongoing research through formal divisional research conferences, discussion with the program director and with individual faculty.

After eight months of their first year of fellowship (in March of the following year after beginning of their fellowship in July) fellows will submit a research protocol signed by their tutors/mentor to the Chairman of the Research Committee.  All fellows will get mandatory and protected time for research each academic year.

Fellows will be assigned according to their preference to a faculty member as tutor/mentor, who will closely supervise the fellow to assure a productive learning experience. Fellows are expected to present their research results at national meetings and achieve publication of their work in peer reviewed journals. Fellows will learn study design and interpretation of research data, learn research methods and will receive instruction about critical assessment of basic and clinical research.

Call
Depending on the service on-call schedule will vary.

Dr. Horst J. Baier, M.D, JD
Professor of Medicine, Physiology and Biomedical Engineering
Program Director - Pulmonary, Critical Care Medicine Training Program

Dr. David J. De La Zerda, MD
Assistant Professor of Medicine
Associate Program Director – Pulmonary, Critical Care Medicine Training Program

Cary Menendez
Senior Program Coordinator
(Office) 305-585-5215, ext. 2
(Fax) 305-585-8137

Prospective Residents

Physicians Services / Housestaff Office
Jackson Memorial Hospital
East Tower Room 1004
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-355-1122
Fax: 305-355-1123

Graduate Medical Education Office
Jackson Memorial Hospital
Institute 118B
1611 NW 12th Avenue, Miami, Florida 33136
Phone: 305-585-4310
Fax: 305-585-4309

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