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Clinical Training


First Year (six 2-month rotations)

The first year is designed to provide the six trainees with the necessary experience to become accomplished specialists, excellent clinician-teachers and clinical researchers. The year consists of fully structured clinical work. Responsibilities include the following:

  • Management of patients with all acute medical problems admitted to the intensive care units of five hospitals (UH, DHMC, DVAMC, SAC and CRMC).

  • Management of patients with chronic respiratory insufficiency due to asthma, COPD, ILD, tuberculosis, atypical mycobacterial disease and immunologic deficiency states. The physiology and sleep medicine rotation at NJMRC also includes a required elective in two of the following: occupational medicine, pulmonary rehabilitation, interstitial lung disease, or chest imaging.

  • Handling large numbers of consultations and providing advice for the consulting physicians in the core hospitals.

  • Performing diagnostic and therapeutic procedures: fiberoptic bronchoscopy, bronchoalveolar lavage, transbronchial biopsy, needle biopsy, pleural biopsy, intubations, right heart catheterization, chest tube insertion, and percutaneous tracheostomy.

  • Learning the principles and interpretation of pulmonary physiology and sleep at NJMRC as well as how to organize a pulmonary function and exercise laboratory.

  • Participating in one afternoon weekly outpatient continuity clinic at one of our clinical training sites for the entire 3 year period.

  • Weekly attendance and participation at Pulmonary and Critical Care Grand Rounds, Chest X-Ray Conference, and Pulmonary and Critical Care Lecture Series. Attendance at the weekly divisional research conference while on rotation at NJMRC.

  • Formal and informal teaching of housestaff, medical students, nurses and allied health professionals.

It should be clear that these activities will occupy most of the first-year fellow's time. In many cases, however, clinical research projects are initiated and it is common for significant clinical research to be conceived, initiated and completed within the first year, often leading to presentations at regional and national meetings.

Research Pathways

The research training will be in either one of two pathways:  the Clinician Scientist or the Basic Investigator Pathway.  Because of established center grants and multiple individual grants, the research opportunities are excellent.

Clinician Scientist Pathway:  For trainees who elect the Clinician Scientist Pathway, course work in the School of Public Health is required during research year one.  During research year two a didactic series in the design and evaluation of clinical trials is offered by the Department of Medicine and required of those fellows in the clinician scientist track.  This consists of 13 weekly lectures in the fall and winter.  The goal of this pathway is to prepare clinical investigators to carry out population based and epidemiologic studies.  Because of established clinical centers in ARDS, interstitial lung disease, asthma, sleep, pulmonary hypertension, lung cancer, lung transplantation, sepsis trials and cystic fibrosis there are a number of ongoing and new studies.  Trainees who select this pathway also establish collaborative relationships with basic science laboratories in the division and enter one of the clinical Ph.D. pathways.

Basic Investigator Pathway:  For trainees electing this pathway the Department of Medicine's Basic Science course is required during research year one.  This course is divided into three parts and meets three times weekly for 2 months in the summer. 

Ph.D. Program:  For either pathway, a Ph.D. program in Health Services Research, Clinical Investigation or Basic Sciences is now obtainable within the confines of a 4 year program.

Second Year

The second and subsequent fellowship year(s) are devoted to specific research training arranged with a mentor in the division.  This is protected time and careful planning will ensure that productivity will result.  One can elect almost any experience, including both basic and clinical research.  Excellent experience is available in applied physiology, biochemistry, immunology, molecular biology, genetics, cell biology and epidemiology.  This is a time when many fellows will elect experience at the Cardiovascular-Pulmonary Research Laboratory (CVP), the National Jewish Medical and Research Center (NJMRC), the Denver Veterans Administration Medical Center (DVAMC) or the divisional research laboratories in the medical school (DL) with either clinical translational or basic investigators.  It is possible to develop a relationship with these researchers during the first year in preparation for conducting research with them during the second and third years, as well as additional years.

The required clinical responsibilities during this year include a weekly half-day continuity clinic, two months of advanced lung disease training at UH, one month of critical care at the Anschutz Inpatient Pavilion (Fitzsimons) and attendance at conferences.

Third Year

This year is a continuation of the second year experience.  The two critical care clinical months are spent in the medical ICU at DHMC. In addition, trainees complete one month of an inpatient pulmonary elective rotation and a  six-month half-day pulmonary outpatient subspecialty clinic experience. The continuity clinics and conference attendance continues.  As in year two, the research training continues.

Fourth Year

This is an optional year added to ensure continuity of research for those desiring it.  For all trainees selecting one of the Ph.D. programs, the fellowship will be four years.

Additional Years

Additional years of training and faculty appointments are often available based on the ability of the fellow to receive a career development award and the availability of positions in the division.