University of Pittsburgh
Pittsburgh, PA
John W. Kreit, MD
The goal of the fellowship program in Pulmonary and Critical Care Medicine at the University of Pittsburgh is to train the next generation of physician-scientists, while ensuring that our graduates are also master clinicians. To do this, we’ve implemented a number of innovative programs to provide outstanding training in both clinical medicine and biomedical research.
Our fellowship consists of 18 months of clinical training followed by 18 months of protected time for research. During the first 2 months of the 1st year, fellows receive an intensive introduction to pulmonary and critical care medicine. Daily lectures supplemented by mannequin-based medical simulations allow our fellows to learn the essentials of critical care ultrasound, bronchoscopy, endotracheal intubation and airway management, ventilator management, hemodynamic monitoring, thoracentesis, and central venous and right heart catheterization.
Beginning in 2012, we will enhance this introductory training with a one-week PCCM boot camp prior to the start of clinical rotations. This program will focus on critical care ultrasound, bronchoscopy, endotracheal intubation, and central venous catheterization and allow our fellows to learn without being distracted by clinical duties. We will solidify and supplement this training with our usual daily lectures and hands-on instruction throughout the first two months of fellowship.
Throughout the remaining 18 months of clinical training, our fellows are encouraged to become increasingly independent, and they are given progressive responsibility based on objective assessments of their clinical knowledge and skills. We also provide our fellows with individualized training by giving them two months of clinical elective time in the 1st half of their 2nd year. This allows them to focus on areas of particular interest or fill in perceived gaps in their clinical knowledge or skills. Popular rotations include general thoracic surgery, chest imaging, pulmonary pathology, echocardiogram interpretation, and right heart catheterization. This individualization also extends to outpatient training. Each fellow selects a series of 6-month continuity experiences, which can include general pulmonary medicine, sleep medicine, asthma and allergy, interstitial lung disease, pulmonary vascular disease, lung cancer, lung transplantation, cystic fibrosis, and emphysema.
We introduce our fellows to research long before the end of their clinical training. In January of their 1st year, fellows are removed from the clinical services to participate in an off-site, 3-day research retreat. There, senior fellows and junior and senior faculty members discuss a variety of important topics, including how to choose a research mentor, how to be successful in academics, how to apply for grant funding, and how to transition from a mentored to an independent investigator. Every RO-1-funded investigator then gives a description of their research and discusses potential fellow projects. During the next few months, each fellow meets with potential mentors and regularly reviews their progress with a research committee composed of the division chief, the fellowship director, and the fellowship research director. By the end of their 1st year, every fellow has a research mentor and a well-defined project that has been evaluated and approved by the research committee.
In July of their 2nd year, fellows are excused from the clinical services for a 2-week introduction to research course. Lectures by our faculty cover topics ranging from cell biology and immunology to mouse physiology to IRB protocols. Fellows are also provided with 30 hours of hands-on experience performing important laboratory techniques, such as cell culture, Western blot analysis, RNA extraction, laser capture micro-dissection, proteomics, and microarray. Between July and December of their 2nd year, fellows use their “spare time” to meet with their mentor, practice laboratory techniques, and even collect preliminary data. Although they have not yet finished their clinical training, almost all of our fellows submit an ATS abstract in November of their 2nd year.
Clinical training ends in January of the 2nd year and except for a weekly, half-day outpatient clinic, the next 18 months are devoted solely to training in biomedical research. Fellows are closely monitored as they read all relevant literature, learn research techniques, and collect data. At least twice a year, the research committee meets with each fellow and mentor to ensure that the fellow is on track to meet pre-specified milestones, including applying for grant funding and submitting abstracts and publications. Second and third-year fellows also make regular presentations at our weekly research in progress conferences.
All fellows apply for NRSA funding. These grants are written, critiqued, and rewritten during a series of regularly-scheduled grant writing workshops. These sessions, which are led by our director of fellow research, not only teach our fellows how to write a grant application, they have also led to a very high success rate. Similar workshops are provided for 3rd and 4th-year fellows who are preparing for a k-08 or k-23 submission.
From the beginning of their training, we make it clear to our fellows that an academic career requires at least 2 years of protected time to collect data, publish and secure k-level grant funding. Staying for one or more years of additional research training has now become the norm, and many of our fellows have become successful, independent physician-scientists. We believe that our innovative programs to enhance both clinical and research training and to provide ongoing and effective research and career mentoring have significantly contributed to this success.
