Curriculum

Corewell Health William Beaumont University Hospital has a high acuity MICU with an incredible diversity of pathology. Under a high intensity staffing model, care in the MICU is provided by PCCM attendings and fellows overseeing 4 senior residents and 5 interns from internal medicine, internal medicine/pediatrics, emergency medicine, anesthesia, and transitional year programs. Daily multidisciplinary rounding occurs, which the fellow will be trained to lead. This rotation provides a rich environment for assessing and triaging patients presenting with or progressing to critical illness, with daily opportunity for procedures.

The pulmonary consult service is comprised of PCCM attendants and fellows working with advanced practice providers, residents, and medical students. The fellow is the first contact for any consult request. This service cares for a wide array of acute pulmonary needs, including patients in other ICUs and the high acuity Medical Progressive Care Unit (MPCU). Fellows are trained to lead an intra-professional consult team, and perform or assist with all procedures for any patient on the service. There is emphasis on transitions of care to ensure that patients have all the system resources they need for safe discharge and continuity for their pulmonary conditions.

After learning foundational concepts of pulmonary medicine and critical care, fellows will gain autonomy overseeing pulmonary and critical care patients overnight. This includes supervision of residents providing care, evaluating someone for ICU admission, and performing procedures. There is indirect supervision, with on-call attendants available to assist. The PCCM nocturnist rotation is limited to 2-week blocks, during which time fellows are excused from continuity clinic.

In collaboration with multiple services and faculty members, the fellow assists or performs multiple procedures. This rotation is the primary mechanism for performing procedures on patients not in the MICU or on the pulmonary consult service, who may be outpatient or exist on a different internal clinical service such as in internal medicine resident team. In additional to traditional diagnostic bronchoscopy, there is additional exposure to endobronchial ultrasound guided transbronchial airway needle biopsy, and electromagnetic navigational bronchoscopy. The procedural fellow interprets pulmonary physiology testing during this rotation.

In a model of patient and family centered care, the skills to have caring conversations regarding patient goals and expectations are bolstered through experience with our skilled palliative care service. Additionally, this rotation focuses on identification and management of pathophysiology which can be aided through palliation.

As part of our airway management curriculum, fellows participate in an anesthesiology rotation to gain comfort in oxygenation strategies and intubation in the non-critically ill patient. There is opportunity for other procedural participation.

Second and third year fellows participate in critical care outside of the medical ICU. Specialty areas of non-medical critical care offer exposure to trauma surgery, neurosurgery, transplant surgery, ECMO, and cardiovascular surgery. This includes care for patients who have sustained trauma, underwent neurosurgery, our transplant patients, undergoing ECMO, or who are cardiovascular surgery patients.

Outpatient pulmonary experiences are essential to the development of a well-rounded and highly competent practitioner of pulmonary and critical care. When not participating in core inpatient rotations, fellows grow through the following outpatient experiences.

Outpatient experiences in general pulmonary medicine include one half-day per week participation in a fellow’s continuity clinic, except during PCCM nocturnist rotation, ICU rotations, or vacation. This clinic is housed on the Corewell Health Royal Oak campus, in the medical office building. Pulmonary medicine cares for patients from multiple referral points.

To provide greater depth in areas of outpatient pulmonary medicine, fellows rotate in specifically clinics during dedicated blocks, and when on research elective time. Sub specialty clinics include:

• Sleep medicine
• Lung nodule clinic
• Interstitial lung disease
• Pulmonary hypertension
• Advanced asthma
• Acid-fast bacilli (AFB)
• Cystic fibrosis
• Thoracic oncology
• Transplant

Simulation learning is used to enhance cognitive and procedural skills. Corewell Health William Beaumont University Hospital is fortunate to be home to the Oakland University William Beaumont Microsurgery Training Institute, which is one of the most advanced medical simulation facilities in the country. Fellows are trained in several procedures, such as central line and arterial line placement, bronchoscopy, airway management, and ultrasound, in a simulated environment. Case simulation is also possible through use of human physiologic simulators. As a capstone project, year fellows have dedicated time to create simulated cases in the SLI, contributing to the learning environment of the fellowship.

• Core pulmonary and critical care curriculum: The curriculum is designed to provide fellow and attending level depth of educational content in pulmonary medicine and critical care. While reviewing historical best practice, and discussing cutting edge concepts, these didactics serve as core material as outlined by the American Board of Internal Medicine
• Shared pulmonary and surgical critical care curriculum: Principles of critical care medicine are provided jointly by faculty pulmonary and critical care, as well as Surgical Critical Care. This effort permits fellows from both specialties to interact, and review similarities and differences in approaches to intensive care
• Case conference: These interactive sessions are utilized to highlight interesting cases or review foundational principles of care to common conditions
• Journal club: Literature is reviewed regularly to make note of new findings learning the skill of critically appraising research
• Research conference: Fellows, with support of their faculty mentor(s), present research from inception to completion. These conferences facilitate the timely completion of academic projects, while educating the group regarding design and analysis
• Thoracic tumor board: This is a clinical, radiographic, and pathological multidisciplinary review of various pulmonary pathologies, including lung cancer, with excellent dialogue regarding differential diagnoses, and diagnostic planning
• Interstitial lung disease multidisciplinary conference: This is a clinical, radiographic, and pathological multidisciplinary review of patients with known or suspected interstitial lung disease, with emphasis on diagnostic planning and management
• Internal medicine grand rounds: Presentations are provided from faculty and guest speakers, addressing all areas of Internal Medicine. PCCM represents 3-4 lectures annually

Noting the commitment to medical education, fellows have opportunities for growth as clinician educators and improve understanding of medical education administration.  

• Stanford Clinical Teaching Curriculum: This 7 session interactive small group program enhances the clinician educator’s awareness of learning climate, controlling an education session, communicating goals, providing feedback and evaluation, promote understanding and retention of material, and promote self-directed learning. Certification is provided upon completion
• Residents As Teachers (RAT) Program: This longitudinal large group curriculum is designed for residents desiring a deeper understanding of medical education, with emphasis on different learning and teaching styles, and development of an academic career. Certification is provided upon completion

The field of pulmonary and critical care medicine is ripe for opportunities in research and quality improvement. Research is carried out with support of the Corewell Health Research Institute, on the Corewell Health William Beaumont University Hospital campus, which has facilitated numerous investigations for the institution. PCCM faculty are academically productive through conference presentations, manuscripts, book chapters, and other means. Most academic productivity is performed with a medical trainee.

PCCM fellow scholarly activity is performed in conjunction with identified faculty in the desired area of scholarly activity, with expectation at dissemination following culmination of efforts. While there may be basic science opportunities, most research is clinical, and can leverage data from all hospitals of Corewell Health.  Fellow research is designed to be presented at regional, national, and international conferences, including American Thoracic Society, American College of Chest Physicians, and Society of Critical Care Medicine.  

All fellows participate in quality and safety activities as a part of their training. When opportunities for improvement are identified, Corewell Health subscribes to a Kaizen process, which allows for trial implementation of new initiatives for continues system improvement.