Curriculum & Rotations

The Fellowship Program consists of two years of core clinical rotations and electives and one year of research. The critical care experience provides the opportunity to manage adult patients with a wide variety of serious illnesses requiring treatment in a critical care setting.

The majority of the intensive care unit rotations are in the Medical Intensive Care Unit (MICU). Because critical care is multidisciplinary in nature, Fellows also rotate for a minimum of three months in additional specialties, which may include:

  • Surgical (Trauma) Intensive Care Unit
  • Pediatric Intensive Care Unit
  • Cardiac Intensive Care Unit
  • Burn Unit
  • Anesthesia Service
  • High-Risk Obstetrics

As a busy Level I Trauma Center, rotation on these electives offers a unique experience that is not available with many other programs. The Fellow assumes responsibility, under appropriate supervision, for the care of patients throughout their stay in the critical care unit. 

Other core rotations include the Pulmonary Consult Service and the Physiology Service. On consults, fellows can expect to see a wide variety of pulmonary diseases on this service. The experience is enhanced by MetroHealth’s Tuberculosis Clinic (serving all of Northeast Ohio) and the Physical Medicine and Rehabilitation Unit, which cares for a number of patients with chronic respiratory failure.

Fellows follow their patients from hospital discharge to the outpatient arena, providing for continuity of care. Fellows spend a half-day per week in the clinic during the three-year Fellowship on the physiology service.

While on clinical rotations, the Fellow learns decision making and performs all indicated diagnostic procedures, such as fiberoptic bronchoscopy, pulmonary artery catheters, pleural biopsies, chest tubes and intubations.

The fellow also learns to interpret pulmonary function tests and how to conduct and interpret cardiopulmonary exercise studies. There is significant exposure to Sleep Medicine as well. MetroHealth is a primary training site of the Case Western Reserve University Sleep Fellowship.

Core Rotations

MetroHealth MICU

The Medical Intensive Care Unit provides the Fellows with clinical experience in a high-intensity environment. As MetroHealth is the Cuyahoga County Hospital and a Level 1 trauma center, ICU patients are of  high-acuity status and the interventions provided are critical and detailed.

The patient mixture is varied, including large numbers of patients with ARDS, drug overdoses, GI bleeding, pneumonia, septic shock, COPD, neuromuscular disorders, and immunosuppressed illnesses. While on this rotation, Fellows participate in the triage of patients from the Emergency Room and the floors of the hospital to the MICU (this triage is done in consultation with the ICU Attending).

They also participate in decisions made to transfer patients to the medical floor once their condition improves.  The Fellows, Residents and Attending meet for a three to four hour block of time in the morning to review new cases, review morning radiographs, examine patients and plan the overall strategy of the day’s care plan for each patient.

The Fellow and Attending jointly plan and carry out all major procedures.

Pulmonary Consultation

While on this rotation, Fellows provide inpatient pulmonary consultations for medical and surgical patients throughout MHMC. This rotation also provides Fellows with an opportunity to gain experience with and to perform a large number of diagnostic procedures (e.g., bronchoscopies, pleural biopsies, thoracenteses, transbronchial biopsies, etc.).

Physiology Service

As part of this rotation, Fellows technically perform a number of pulmonary function tests and all cardiopulmonary exercise tests. In addition, they review all pulmonary function tests and exercise tests done at MetroHealth and interpret these in consultation with the Attending Physician. Fellows also participate in the Pulmonary Rehabilitation Program and perform all outpatient bronchoscopies during this rotation.  Part of this rotation also includes a long-term ventilation unit at an affiliate hospital.

Electives

Rotations are also offered  in Cardiac Intensive Care Unit (CICU),  the Trauma Service and the SICU, the Burn Unit, Anesthesia, the Pediatric ICU, Cardiothoracic Surgery, Sleep (MetroHealth and VA), Rehabilitation, TB clinic, Asthma, Radiology, ENT, and Infectious Diseases.

Fellows are expected to do rotations in the CICU, SICU, and Anesthesia Service as part of their critical care requirements. Additional electives at affiliate institutions are also available and include Radiology (UH), Pulmonary HTN (CCF), and Lung Transplant/Invasive Bronchoscopy (CCF).

Electives other than those listed can be arranged but must be approved by the Program Director. Objectives for each elective are available from the Program Coordinator.