Clinical Training
At Cleveland Clinic, education and mentorship are the cornerstones of fellowship. We have monthly protected “education days”, new simulation-based curricula introduced every year for the past several years, and a comprehensive orientation in July including hands-on training in bronchoscopy, ultrasound, and bedside ICU procedures. We have exceptional mentorship programs that help us become the specialist that we desire.
Procedural Training
(Number of Procedures in 2023)
1,907
Bedside Ultrasound
1,267
Intubations
211
Thoracenteses
83
Lumbar Punctures
1,822
Arterial Lines
504
Paracenteses
116
Electrical Cardioversions
16
Pericardiocenteses
1,552
Central Lines
483
ICU Bronchoscopies
106
Chest Tubes
Pulmonary
Critical Care
Medicine
Diverse Training Curriculum
The Pulmonary & Critical Care Fellowship at Cleveland Clinic is highly customizable based on fellows' interests. You will be trained and mentored by world experts in interstitial lung diseases, asthma, COPD/A1AT, pulmonary hypertension, lung cancer, lung transplant, interventional pulmonology and more.
Overview.
The Pulmonary & Critical Care Fellowship requires a 3-year commitment for most trainees. We offer dedicated 4-year tracks for those trainees interested in pursuing a Master’s or additional research in medical education, basic/translational science or clinical trials.
Education
First Year
The first year of fellowship focuses heavily on developing clinical expertise in pulmonary and critical care medicine. This year is rigorous, but it is here that fellows discover how to diagnose and manage the vast array of pulmonary diseases that we see at CCF. In this year, fellows also master skills specific to pulmonary/critical care including bronchoscopy, bedside ultrasonography/echo and intubation. The first year is a pivotal time for fellows to explore the multiple academic opportunities available and begin developing mentored relationships (a key aspect of our program) in preparation for the scholarship phase of fellowship in years two and three.
Second Year
The second year of fellowship focuses on two key elements; leadership and scholarship. The early portion of the year is geared towards refining the core skills learned in year one and providing each fellow with clinical leadership experience. Thereafter, fellows begin to set the cornerstone for future scholarship by crafting a personalized academic track. The scholarship track with emphasis on the mentorship experience follows each fellow into their third year and is key to our mission of graduating physicians equipped to be leaders in medicine.
Third Year
The third year focuses on continuing scholarship and applying this to a career in pulmonary/critical care medicine. In addition to continued research, education, and individualized clinical training in accordance with each fellow’s academic track plan, fellows should expect to publish, present work at national meetings, and network with national and international experts. These opportunities form the foundations for what our program strives to achieve; fellows who graduate with a passion for sustained scholarly pursuit who are recognized as emerging thought leaders in their respective area of interest.
Longitudinal Clinic
The outpatient clinic focuses on teaching evidence-based approaches to outpatient evaluation and management and on delivering world-class care to patients with a wide array of pulmonary diseases. During non-MICU months, fellows have ½ of clinic each week, continuing throughout their three years of fellowship. Fellows assume the role of the patients primary pulmonologist and also benefit from supervision by on-site faculty who do not have additional patient care responsibilities during the time they are with the fellows.
Specialty Clinics
During the second and third year of the fellowship, fellows may electively participate in specialty clinics as a rotation or in a longer-term, longitudinal fashion. Specialty clinics offer fellows a unique opportunity to see patients who have been referred to Cleveland Clinic from around the world for specialty care and to work alongside faculty who are leaders in their respective field. Specialty clinic opportunities exist in Interstitial Lung Disease, Sarcoidosis, Lung Cancer, Cystic Fibrosis, Interventional Bronchoscopy, Asthma, Lung Transplantation, Pulmonary Vascular Disease, Sleep and Neuromuscular Disease.
Procedural Training
(Number of Procedures in the Past Year)
Traditional Track
In the second and third year of fellowship, each fellow will have the opportunity to choose from one of several prespecified academic tracks. Each track allows a fellow to pursue a deeper focus on a specific area of pulmonary/critical care through academic inquiry and enhanced clinical training. Early in the second year, fellows choose a mentor whom they work alongside to define specific scholarly aims. These aims can vary depending on the long term career objectives of each fellow, but universally, the academic tracks serve to give fellows advanced training and expertise in a particular aspect of pulmonary and critical care medicine.
- Advanced Lung Disease/Transplant
- Pulmonary Vascular Disease
- Airways Disease (Asthma/COPD)
- Cystic Fibrosis/Bronchiectasis
- Lung Cancer/Advanced Bronchoscopy
- Critical Care
- Quality Improvement/Practice Management & Administration
- Focused Research: Basic/Translational/Outcomes
Academic Track Example
During their first year, fellows work closely with program directors to carefully select a faculty mentor and scholarship track. The mentor/fellow relationship is the foundation of our track system and starts with the mentor and fellow formulating a curriculum to optimize the use of elective blocks for research, education, and focused clinical training. Below is a sample curriculum for a fellow pursuing expertise in Quality Improvement.
Education Scholar Track
Fellows in this track will complete their clinical rotations similarly to those in the academic track, after which they will spend a 4th year as a clinical associate. During that time they will pursue a masters of education in health professions education. They will learn about adult learning theory, curriculum design and instruction, learner assessment, evaluation of educational programs, healthcare education research and technology in health professions education.
Research Scholar Track
After identifying mentors and submitting their T32 proposal during their first year of training, fellows in this track will then have the opportunity to spend 2 full years of dedicated research time. They will have the opportunity to attend didactics through the Lerner Research Institue. They are also eligible to purue a Masters in public health or clinical research as well as participate in our PRISM program. Their fourth year will consist of a mixture of clinical and research blocks. A fifth year where the fellows can continue their research and submit their K award while working as a clinical associate can be applied for.
Sample Rotation Schedule (PCCM)
Rotation | 1st Year | 2nd Year | 3rd Year | Total |
|---|---|---|---|---|
Orientation/Boot Camp | 0.5 | 0 | 0 | 0.5 |
Pulmonary Consult | 0.5 | 1 | 0 | 1.5 |
Primary Hospital Service | 2 | 0 | 0 | 2 |
Advance Lung Disease | 2 | 0 | 0 | 2 |
Bronchoscopy | 1 | 1 | 0.5 | 2.5 |
Pleural Service | 0.5 | 0 | 0.5 | 1 |
Sleep Medicine | 0 | 0.5 | 0 | 0.5 |
Pulmonary pathology | 0 | 0.5 | 0 | 0.5 |
PFT | 0.5 | 0.5 | 0.5 | 1.5 |
MICU | 2.5 | 2.5 | 0 | 5 |
MICU Nights | 1 | 0.5 | 0 | 1.5 |
MICU Procedure Team | 0.5 | 0.5 | 0 | 1 |
Trauma ICU | 0.5 | 0 | 0 | 0.5 |
Neuro ICU | 0 | 0.5 | 0 | 0.5 |
CVICU | 0 | 1 | 0 | 1 |
Surgical ICU | 0 | 0.5 | 0 | 0.5 |
Palliative Medicine | 0.5 | 0 | 0 | 0.5 |
LTACH | 0 | 0.5 | 0 | 0.5 |
Elective | 1 | 3 | 9 | 13 |
Right Heart Catheterization | 0 | 0 | 1 | 1 |
Critical
Care
Medicine
Diverse Training Curriculum
The Critical Care Fellowship at Cleveland Clinic is intended for graduates of Emergency Medicine and Internal Medicine training programs as well as trainees with prior subspecialty training in Cardiology, Infectious Diseases, Hepatology, and Nephrology.
Overview.
The Critical Care Fellowship requires a 2-year commitment for most trainees.
We offer dedicated 3-year tracks for those trainees interested in pursuing a Master’s or additional research in medical education, basic/translational science or clinical trials.
Education
First Year
The first year of fellowship focuses on developing clinical expertise in critical care medicine. During this period, our fellows complete a series of core rotations focused on building knowledge and mastering skills specific to critical care including bronchoscopy, bedside ultrasound/echo, intubation, line placement, and ventilator management. During this year, it is pivotal for fellows to identify an academic mentor (a key aspect of our program) and choose an area of interest from the multiple academic opportunities available. Mentorship and scholarship occur in a coordinated fashion. For example, first year fellows participate in a structured training program in leadership and quality improvement. This program, called Quality in Leadership (QuIL) provides trainees with leadership training, specific skills in quality and process improvement, and meaningful scholarship through team based projects. Electives during the first year emphasize opportunities to begin research and participate in non-core rotations. These opportunities include, but are not limited to:
- Cardiovascular Intensive Care Unit (post-operative cardiovascular patients, ECMO and ventricular assist devices)
- Coronary Intensive Care Unit
- Heart Failure Intensive Care Unit
- Trauma Intensive Care Unit and Burn Center (Metro Health Medical Center)
- Surgical Intensive Care Unit
- Community Hospital Intensive Care Units
- Infectious Disease
- Thoracic Surgery
- Radiology and Interventional Radiology
- Formal education courses (statistics, clinical trial design, epidemiology, teaching pedagogy, curriculum development, etc.)
- Leadership Education
- Pulmonary Hypertension ICU Management and Right Heart Catheterization
Second Year
The second year of fellowship focuses on developing a deeper understanding of the physiology of the critically ill patient and how organ support systems affect this. The goal is to master the nuances of mechanical ventilation and hemodynamic physiology and to tailor these to the critically ill patient. Further elective time is aimed at continued research, clinical electives and leadership development to support career goals. All fellows also participate in a mentored writing curriculum. By the end of the year, fellows should expect to submit at least one manuscript for publication and present their research project at an International Critical Care Conference.
Cardiology Track
The increasing complexity of patient care in Cardiovascular Intensive Care Units often requires an understanding and mastery of Critical Care Medicine. The Critical Care Cardiology (CCC) track at Cleveland Clinic offers additional training opportunities to applicants after completion of a General Cardiology Fellowship. We have a well-established history of training Cardiologists to pursue excellence in Critical Care Medicine and offer unique opportunities to gain experience in mechanical ventilation, advanced heart failure, imaging, Cardiac Intensive Care Unit, post Cardiovascular Surgery ICU and ECMO teams. Applicants can apply for either a one or two year training program in Critical Care Cardiology. One advantage of our program is that cardiologists work in lockstep with both the Cardiology and Critical Care Medicine fellowships. The first year of training focuses heavily on mastering the essentials of critical care and mechanical ventilation. There is wide latitude for those who do a second year to gain expertise in mechanical circulatory support, peri-operative support, and to pursue mentored research with leaders in both Cardiology and Critical Care Medicine.
Education Track
The Clinical Education Track is designed to provide in-depth training to fellows who aspire to a career in academic medical education. This is done through:
- Training in the science of medical education, theoretical frameworks, and principles
- Development of effective didactic and clinical teaching skills
- Development of skills needed to create and implement curricula and methods of assessment
- Research and scholarship in medical education
- Networking with leaders in the field of medical education
The fellows accepted for this track will:
Complete their clinical rotations in the first two years similar to traditional fellows and continue for a third year as a clinical instructor. Fellows will earn a Master of Education in Health Professions Education (MEHPE) during their second year of training and third year as clinical instructor.
The MEHPE program is a collaboration between the Cleveland Clinic Center for Educational Resources and Cleveland State University. It offers a two-year cohort-based curriculum focusing on the skills needed to be a medical educator. The cohort model includes a group of students who progress through the MEHPE program together (i.e., starting/ending at the same time; following a pre-determined schedule of courses). The benefits to the cohort model are that it provides opportunities for cohort members to learn with and from each other while building professional networks and connections.
Specifically, courses address adult learning theory, curriculum design and instruction, learner assessment, evaluation of educational programs, healthcare education research and technology in health professions education. The pedagogy is blended between live and online courses, with live courses delivered at Cleveland Clinic main campus during the evening to accommodate working health professionals. The program occupies six semesters of instruction and 30 credit hours for degree attainment.
Clinician Scientist
Beyond excellent clinical training, the Critical Care Fellowship offers a wide array of options for fellows with interest in becoming clinician scientists. Supported by an NIH T32 grant as well as philanthropic and other funding, we offer dedicated training to fellows interested in basic science, translational or clinical trials research. These pathways offer additional masters or PhD training for those interested. Critical Care areas of interest include:
- ARDS
- ECMO
- sepsis
- mechanical ventilation
- point of care ultrasound
- medical education
- simulation
- informatics/big data
Sample Rotation Overview (CCM)
Title | 1st Year | 2nd Year | Total |
|---|---|---|---|
MICU Nights | 1.0 | 1.0 | 2.0 |
MICU Procedure | 0.5 | 0.5 | 1 |
MICU | 3 | 2.5 | 5.5 |
Orientation | 0.5 | 0 | 0.5 |
Bronchoscopy | 0.5 | 0.5 | 1.0 |
LTACH/Rehab | 0.5 | 0 | 0.5 |
Nephrology ICU | 0 | 0.5 | 0.5 |
Neuro ICU | 0.5 | 0.5 | 1.0 |
Trauma ICU | 0.5 | 0 | 0.5 |
Surgical ICU | 0 | 0.5 | 0.5 |
CVICU | 0 | 1.0 | 1.0 |
Intubation | 0.5 | 0 | 0.5 |
Echo | 0.5 | 0 | 0.5 |
Palliative Medicine | 0 | 0.5 | 0.5 |
Academic Time | 4 | 4.5 | 8.5 |
Total (core) | 12 | 12 | 24 |