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Pulmonary/Critical Care Fellowship Program
Phoenix VA/BGSMC
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History
Fellowship started in 1980 Three Year Fellowship Program Leads to certification in :
– Pulmonary Disease– Critical Care
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History
As of June 2008, ALL graduated fellows: Board Certified
Graduated Fellows: primarily in Private Practice
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Staff Members VAMC Richard A. Robbins
– Program Director, Chief Pulmonary/Critical Care VAMC
Owen Austrheim– Associate Section Chief & Director, Sleep Medicine
VAMC Lillibeth Pineda Patricia Rocha John Roehrs Clement Singarajah
– Director Critical Care VAMC Allen Thomas
– Director Pulmonary VAMC
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Staff Members (BGSMC)
Pulmonary Associates– David Baratz (Director Pulmonary BGSMC)– Mark Gottfried– Manny Mathew– Da-Wei Liao
SAFA (Critical Care BGSMC)– Robert Rashke (Director Critical Care BGSMC)– Huw Owen-Reece– Thomas Bajo
Arizona Center Chest Diseases – Arcot Premkuar– Cameron Dick
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Other Affiliated Hospitals Mayo Clinic
– Pulmonary Pathology St. Josephs Medical Center
– Pulmonary transplant– SICU/Trauma
Scottsdale Shea– Pulmonary radiology
JC Lincoln– Trauma
Maricopa Medical Center– Pulmonary – MICU
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Current Fellows
Kevin Park (Third Year Fellow) Evan Schmitz (Third Year Fellow) Roxanne Garcia-Orr (Second Year
Fellow) Jessica Hurley (Second Year Fellow) Christian Jivcu (First Year Fellow) Henry Leudy (First Year Fellow) Emad Wissa (First Year Fellow)
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Pulmonary Fellows (2011) Tonya Whiting (Good Samaritan) Joshua Jewell (University of
Nevada)
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Current Fellow Demographics (includes 2011 fellows)
4 /9 are from the Good Samaritan residency program
Other institutions include University of Massachusetts, Rutgers, St. Joseph’s in Phoenix, Maricopa in Phoenix.
3 / 9 are international graduates.
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VA Staff
Fellowship coordinator (Nancy Brown) 1 research PhD 1 physician assistant 1 research coordinator Multiple respiratory therapists including
– Bronchoscopy– Oxygen/CPAP
2 section secretaries
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VA PulmonaryCritical Care Section
Endoscopy suite (flouro, Super Dimension)
Sleep Lab (3 beds) MICU (10 beds) 3 pulmonary function labs (>1000
PFTs per year)
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Fellowship Program Structure 3 year Program (Clinical)
– 6 months research– 30 months clinical (below is
approximate and can be varied) 10 months VA
– Half pulmonary/half ICU 10 months BGSMC
– Half pulmonary/half ICU 10 months electives
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Fellowship Program Structure - VA Consultations (in-patients) Pulmonary Clinic (1/2 day once a
week at VAMC and 1/2 day once a week at private office).
MICU (closed unit with primary care responsibility).
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Fellowship Program Structure - BGSMC Pulmonary
–Consultation and primary care
ICU–Primary care
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Fellowship Program Structure Most Popular Electives
Pathology Mayo Clinic Sleep (both VA and BGSMC) Infectious disease (BGSMC) Toxicology (BGSMC) Pulmonary transplant (St.
Josephs) Pulmonary radiology (Shea)
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Clinical and Basic Research Biostatitics/Epidemiology (Dr
Gerkin BGSMC) Areas of interest:
–COPD–Pulmonary inflammation–Nitric oxide and oxidants–Clinical research
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Fellowship Program Structure
– Most fellows present at national meetings (ATS or ACCP).
– Case presentations at both Arizona ATS and National ATS
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Pulmonary/Critical Care Conferences
Wednesdays (2-4 hours)– Journal Club– Pulmonary presentation– Critical care presentations
Monthly-Arizona ATS multidisciplinary conference
Every 2 weeks-tumor board
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FellowshipWeekend Call 2 fellows BGSMC
– One in ICU– One in Pulmonary
1 fellow at VA (AM only) BGSMC pulmonary fellow covers
nights at VA.
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Fellowship Governance Fellowship Committee
–5 faculty Robbins, Baratz, Rashke, Singarajah,
Thomas
–3 fellows one from each year
–Meets monthly
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VA Pulmonary Fellowship Consults & Procedures Consultations: >3000 Bronchoscopies: >200 Sleep studies: >500 Other frequent procedures
– Needle biopsies ─ Chest tubes– Thoracentesis ─ Central lines– Pleural biopsies ─ Pleurex
cathers
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Average ICU census ~ 7 Critical Care Consults: ~50 Procedures in ICU per year
– Percutaneous tracheostomies: ~50– Bronchoscopies: ~120– Intubations: ~120– Variety of other ICU procedures (lines,
thoracentesis, paracentesis, etc) done mostly by residents with fellow supervision
VA Critical Care Fellowship Census & Procedures
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Banner GSMC Pulmonary Rotation Average Daily Census - 25
7 ICU patients18 ward patients
Average Consults / Day – 5 Supervision of Residents / Medical
Students that are on service
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Banner GSMC Pulmonary Rotation Procedures per year
– Percutaneous tracheostomies: ~50– Bronchoscopies: ~200 – Intubations: ~ 100– Variety of other ICU procedures
(lines, thoracentesis, paracentesis, etc)
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Pulmonary Associates Continuity Clinic Each fellow works a half day per
week in the Pulmonary Associates office seeing private practice patients with a wide variety of pulmonary diseases.
Fellows will have direct responsibility for patients on an ongoing basis over 3 years.
An opportunity to interact with private practice pulmonary medicine
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GOALS
Board Certification Consultant in Pulmonary and Critical
Care Clinical Research Provide direct patient care especially
in ICU Competence in bronchoscopy and
other procedures Teaching
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Ultimate Goal
LEADER IN PULMONARY and CRITICAL CARE !!!