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Pulmonary / Critical Care Fellowship Program

New York University School of Medicine
New York, NY

Doreen Addrizzo-Harris, MD

How has our Pulmonary and Critical Care Training program exemplified an environment of educational excellence?

Our program at New York University/ Bellevue hospital exemplifies educational excellence in many ways.  These include having outstanding clinical rotations in both pulmonary and critical care amongst four hospitals, having outstanding faculty supervision and involvement and having a robust system of clinical exercises to monitor levels of fellow development and competency.

For this award, I would like to highlight our excellence in curriculum development and assessment.

We are very fortunate to have a large program of 22 fellows and more than 40 full time faculty at four major hospitals.  We have developed, as many other fellowship programs a robust pulmonary and critical care curriculum on paper, which is used as a roadmap for teachings on rotations and for development of core conferences.  What we have done that is different is two-fold.  We have a unique, active curriculum committee of faculty and fellows that meets regularly as a workgroup and we have a very structured curriculum roadmap for our fellowship training program that includes hands on assessments.

Our curriculum committee is made up of a core group of faculty who are dedicated to curriculum development.  This group is a subgroup of all of the faculty who take part in the required annual curriculum committee meeting mandated by the ACGME.  This curriculum committee is made up of the program director, associate program director and three assistant program directors (each with a specific curriculum focus), bronchoscopy director, a faculty representative from each of our additional teaching hospitals (Tisch and the VA) and a fellow representative from each fellowship year.  The three assistant program directors each have an area of focus in curriculum development.  The three areas are simulation, ultrasound and patient safety and program improvement.  The committee meets monthly to revise curriculum and to develop new and better assessment tools.

Our curriculum is laid out in a very structured format for fellows. At the beginning of fellowship, first year fellow have 7 days of dedicated core curriculum lectures, workshops and simulation exercises that are free from patient responsibilities.  The remainder of the summer has a daily core conference or workshop for all fellows so that by September fellows have all had an intensive core curriculum. We decided to teach our critical care curriculum in 9 critical care blocks which include for example; shock, respiratory failure, airway, toxicology, cardiology, ethics.  During these blocks fellows receive several mandatory lectures, perform a journal club on an associated topic with reading material, have at least one 2 hour simulation session on the topic and end the block with a jeopardy style conference designed by the senior fellows. Goals and objectives have been developed for these blocks as well as common case scenarios that the fellows are presented with during the simulation sessions.  This block style multimodality teaching of the curriculum has been well received by fellows and faculty. We plan to structure our pulmonary curriculum similarly as well in the next year; our first block which has been developed is on asthma.  We plan to have 10-12 blocks.

As part of this critical care curriculum we have developed assessments for simulation (based on the above curriculum), ultrasound and bronchoscopy which all fellows will have to complete by the end of each clinical year.

Our curriculum committee and curriculum structure allow us to educate our fellows using multiple modalities and to integrate changes rapidly into our program curriculum with both faculty and fellow feedback.  It has also allowed us to have better tools for assessment of our fellows and better tools for educational feedback.