Pulmonary and Critical Care Fellowship

The Pulmonary and Critical Care Medicine Fellowship at Yale New Haven Health-Bridgeport Hospital is an ACGME-accredited 3 year training program. The primary site is Bridgeport Hospital in Bridgeport, Connecticut (CT) where the vast majority of the training experience occurs. Additional critical care and inpatient pulmonary consultative service rotations at Yale New Haven Hospital in New Haven, CT provide a university-hospital experience. Fellows also rotate at the Hospital for Special Care in New Britain, CT for training in pulmonary rehabilitation and long term ventilator management.

Completion of the three-year training program fulfills the requirements for certification by the American Board of Internal Medicine (ABIM) in both Pulmonary Disease and Critical Care Medicine. The aim of the program is to prepare trainees for careers in clinical pulmonary and critical care medicine in either an academic or non-academic setting and provide the foundation for additional training in a more specialized area within the field if desired.

Application to our program is through the Electronic Resident Application Service (ERAS). The Bridgeport Hospital Pulmonary and Critical Care Fellowship participates in the National Resident Matching Program (NRMP) Medical Specialties Matching Service (MSMP). The Fellowship has a total of six fellows, two fellows in each of the three years.

Jeff S Kwon, MD, Fellowship Program Director
Charlotte Evanko, Program Coordinator

Training Experience

Fellows spend approximately 8 months on medical ICU and an additional 3 months on non-medical ICU services for training in critical care. Another 12 to 13 months are spent on inpatient pulmonary consult services. Approximately 4 to 5 months are spent on various other rotations including thoracic radiology, pulmonary function testing, echocardiography, and pulmonary rehabilitation. During the course of their training, fellows will work alongside faculty, internal medicine house staff, advanced practice providers, and medical students to manage the full spectrum of critical care and pulmonary disease including but not limited to sepsis, cardiogenic shock, respiratory failure, acute kidney and liver failure, acute neurologic disorders, pulmonary infections, thoracic malignancy and complications of cancer therapy, airways disorders, and pleural disease.

Fellows are trained to use point-of-care ultrasound, primarily echocardiography and thoracic ultrasound, to supplement their bedside clinical evaluations and assist in performing invasive procedures (such as central venous catheter placement and thoracentesis). Fellows are also trained to become highly proficient in fiberoptic bronchoscopy and related procedures, as well as endobronchial ultrasound (EBUS). Simulation training in both fiberoptic bronchoscopy and EBUS is used to accelerate development of procedural competency.

A rigorous ambulatory experience including a continuity clinic, a private community office practice, and the Airways Disorders Clinic provide a broad and rich exposure to outpatient pulmonary and sleep medicine, including dyspnea evaluation, COPD, asthma, lung nodules, thoracic malignancy, sarcoidosis and other interstitial lung diseases, pre-operative respiratory evaluation, and sleep disordered breathing.

Research blocks are provided for trainees to have meaningful opportunities for clinical and research scholarship. Fellows are encouraged to attend regional and national meetings to present their work.

Conferences

The Section of Pulmonary, Critical Care, and Sleep Medicine has a robust conference schedule. In the first couple months of each academic year, faculty provide an introductory core lecture series that covers the most common topics in pulmonary, sleep, and critical care. Thereafter the didactic program switches to a weekly journal club, clinical topic and case-based conferences, research conferences, and a monthly morbidity and mortality conference. Multidisciplinary conferences with radiology, pathology, oncology, surgery, and radiation oncology are also included in the form of a monthly clinical-radiology-pathology conference, a bimonthly thoracic oncology conference, and a monthly pulmonary pathology conference. Fellows are expected to prepare numerous presentations over the course of their training with a focus on utilizing the published medical literature to help guide their approach to clinical care, while laying the foundation for life-long learning beyond fellowship.

Facilities

The Section of Pulmonary, Critical Care, and Sleep Medicine maintains a full spectrum of related facilities at Bridgeport Hospital.

There is a Pulmonary Physiology lab for pulmonary function testing. This includes the ability to perform advanced cardiopulmonary exercise testing as well as the standard testing of spirometry, lung volumes, and diffusion analysis. Our bronchoscopy suite provides for standard bronchoscopic evaluation. We have fluoroscopy for performing transbronchial biopsies and bronchial brush. Endobronchial ultrasound (EBUS) is also performed. Bronchoscopic procedures are assisted by nursing and respiratory therapy staff and anesthesiology services are available if needed. The medical intensive care unit is a 16-bed unit capable of the full support of the critically ill patient. We have bedside ultrasonography for line placement, pleural procedures, and critical care echocardiography. We have a Glide Scope for airway management. The fellows have ample opportunity for performing the standard ICU related procedures including the insertion of central venous catheters, arterial lines, thoracentesis, and placement of endotracheal tubes. Our Center for Sleep Medicine is a full service sleep center evaluating and treating a broad spectrum of sleep disorders for adult patients. We provide consultative services and testing including standard polysomnography, home-based sleep apnea testing, multiple sleep latency testing, and wrist actigraphy. The Center for Sleep Medicine is staffed by two full-time Clinical Sleep Specialists.

Fellows rotate at Yale New Haven Hospital in the Medical ICU, Neurosciences ICU, and inpatient Pulmonary Consult Service under the supervision of the Yale School of Medicine faculty and alongside Yale co-fellows, residents, and medical students. Yale New Haven Hospital is a large university referral center and includes a busy 40 bed MICU that has over 4500 admissions per year. The inpatient consult service at Yale will provide fellows an opportunity to encounter respiratory disorders less commonly seen in the community hospital setting, such as cystic fibrosis and interstitial lung disease, in addition to general pulmonary cases.

Hospital for Special Care in New Britain, CT is a large long-term acute care hospital specializing in rehabilitation of children and adults with cardiopulmonary and neurologic disorders. Fellows learn about ventilator weaning, inpatient and outpatient pulmonary rehabilitation, and tracheostomy management at this facility. There is also a neuromuscular clinic available for fellows to learn about the respiratory management of patients with neuromuscular disorders such as amyotrophic lateral sclerosis and Duchenne Muscular Dystrophy.

Scholarly Activities

The Section of Pulmonary, Critical Care, and Sleep Medicine maintains and encourages fellow participation in an active clinical research and patient care quality improvement effort. Fellows are expected to develop and produce substantive works of clinical scholarship and can take the form of published abstracts, peer-reviewed manuscripts, quality improvement, and patient-safety initiatives. Fellows are expected to attend regional and national meetings, such as the American Thoracic Society and the American College of Chest Physicians, to present their works of scholarship and learn from the broad array of scholarship being performed by others in our field.

A sample of publications in the Section include:

  1. Gittens AT, Clarke JD, Abdelbaki S, Kwon JS. A 72-Year-Old Man With a Violaceous Rash and Sepsis. Chest. 2020 Feb;157(2):e41-e45. doi: 10.1016/j.chest.2019.08.2186.
  2. Adeel MY, Clarke JD, Shetty S, Arora A, Buscher MG. Severe hypocalcemia mimicking acute inferior ST-segment elevation myocardial infarction. Oxf Med Case Reports. 2018 Nov 21;2018(12):omy103. doi: 10.1093/omcr/omy103. eCollection 2018 Dec.
  3. Winterbottom CJ, Shah RJ, Patterson KC, Kreider ME, Panettieri RA Jr, Rivera-Lebron B, Miller WT, Litzky LA, Penning TM, Heinlen K, Jackson T, Localio AR, Christie JD. Exposure to Ambient Particulate Matter Is Associated With Accelerated Functional Decline in Idiopathic Pulmonary Fibrosis. Chest. 2018 May;153(5):1221-1228. doi: 10.1016/j.chest.2017.07.034. Epub 2017 Aug 9.
  4. Gopalratnam K, Forde IC, O'Connor JV, Kaufman DA. Less Is More in the ICU: Resuscitation, Oxygenation and Routine Tests. Semin Respir Crit Care Med. 2016 Feb;37(1):23-33. doi: 10.1055/s-0035-1570358. Epub 2016 Jan 28
  5. Grewal K, Cohen P, Kwon JS, Kaufman DA. IgG4-related disease presenting as a lung mass and weight loss: Case report and review of the literature. Respir Med Case Rep. 2015 Dec 21;17:27-9. doi: 10.1016/j.rmcr.2015.12.001. eCollection 2016
  6. Chanda A, Wolff A, McPherson C, Kwon J. Utility of extended cardiac monitoring to detect atrial fibrillation in patients with severe obstructive sleep apnea. Sleep Breath. 2015 Mar;19(1):407-10. doi: 10.1007/s11325-014-0997-6. Epub 2014 May 9.
  7. Fortis S, Kittah J, De Aguirre M, Plataki M, Wolff A, Amoateng-Adjepong Y, Manthous CA. Perseverant, non-indicated treatment of obese patients for obstructive lung disease. BMC Pulm Med. 2013 Nov 22;13:68. doi: 10.1186/1471-2466-13-68. PubMed PMID: 24266961.
  8. Chanda A, Kwon JS, Wolff AJ, Manthous CA. Positive pressure for obesity hypoventilation syndrome. Pulm Med. 2012;2012:568690. doi: 10.1155/2012/568690. Epub 2012 Oct 11. PubMed PMID: 23094151; PubMed Central PMCID: PMC3475306.
  9. Bansal A, Chawla M, Cohen PJ, Kwon JS. Pleural epithelioid hemangioendothelioma. Lung. 2012 Aug;190(4):469-70. doi: 10.1007/s00408-012-9377-9. Epub 2012 Mar 6. PubMed PMID: 22392541. 5