Academic programs with strong clinical training??

[cavitarynodule]

I'm applying to pulm/ccm and, as of now, I have minimal interest in joining the grant-application rat race of a research career and mainly want to be a good clinician. However, I am learning that many ‘top’ pccm programs seem to have poor clinical training.

While getting strong clinical training is my priority, I would prefer to get this at an academic program for 2 reasons: 1. To not close any doors just in case there is something I end up liking during the mandatory research time in fellowship and 2. To avoid having mentors and co-residents badgering me about why I chose some random program they haven't heard of.

Here are things that I would consider important for strong clinical training:

- Pulm/CCM is primary on airways instead of anesthesia (or by some method gets a large amount of airway exposure including difficult airways)
- There is an option for 24 or more months of clinical time instead of only 18
- Procedures: Plenty of bronchs, EBUS, chest tubes
- adequate volume with variety of patients (ideally both county hospital + tertiary center patients, including good exposure to ILD, peri-transplant, ECMO)
- Closed ICUs at all sites
- Fellows and attendings freely adjust vents (I hear some places have extremely strict ‘only RTs touch the vent’ policies that seem detrimental to training)
- bonus: manage pulm HTN instead of cards

So, I was hoping we could start a list of academic programs that fit these criteria (or almost all and are known to have very strong clinical training).

Also - any programs to stay away from based on these criteria?

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[UofM527]

Hard to comment on any program in regards to all of these criteria beyond the one I chose for fellowship (UCLA)

When interviewing, I got the general sense (obviously exceptions will exist aplenty), that the airway and procedure aspect of training may be a greater focus with West Coast programs over some otherwise similar East Coast programs

In regards to your specific bullet points:
- we are primary airway & difficult airway on any of our ICU patients, and at some hospital sites, for any floor code events as well
- fairly flexible design in regards to research vs clinical plans pending your interests, certainly open to clinical research and clinician educator tracks
- regular procedure experience includes bronchs, EBUS, chest tubes, PleurX catheters, perc trachs, and the other usual procedures - there is IP if you want to work with them and gain other procedural experiences
- 4 different hospital sites including a VA and county site, specialty clinics in ILD, pulm HTN, lung transplant, as well as special inpatient services for these groups of patients; ECMO mostly domain of CT-surgery, who you can rotate with as elective
- all closed ICUs
- you can adjust vents hands on, but have to alert RT and change order immediately, which seems reasonable
- pulm HTN belongs to pulmonary (this particular aspect seems to vary somewhat randomly in my interview experiences, not sure how some places end up with one specialty over the other)

 

[Green Man]

Based on your criteria, I would recommend to check out University of Miami PCCM program. Fellows rotate at 4 hospitals, 1500-bed county hospital, 400-bed VA, 450-bed community hospital (named UM hospital recently) and 100-bed cancer center. All of them have ICUs and you will see different kind of pathology and practice set up but all closed ICUs.


1. Airways
ICUs take care of their own airways. Some research attendings may call Anesthesia for difficult ones but several "newer" attendings are changing that dynamic. Program pays for you to go to difficult airway course run by Dr. Levitan and one of UM faculty is an instructor there, too.

2. Yes, you can do more clinical months if research is not your thing. Minimal requirement for research is about 3-4 months in 3 years for clinical fellows.

3. Yes, plenty of Bronchs, EBUS, perc trachs, etc. There's an IP attending (trained in Hopkins) but no IP fellowship here so you get to rotate in "IP only months", which is cool. You will get to see rigid Bronchs, stents, cryobiopsy, too. There are 3 other attendings that do EBUS. You can rotate in Trauma Bay for additional surgical chest tubes.

4. As above, 4 very different hospitals including "crazy" County hospital, which is a referral center for South Florida as well as Latin America and Caribbeans. Amazing mix of cases there. There are sub-sub specialist attendings in ILD, sarcoid, PH, sleep, CF, lung transplant and huge volume for all diseases as this is the tertiary/quarternary referral center. You can do Specialty clinic rotation (all of above including lung cancer clinic), dedicated PH/CF/ transplant/inpatient TB rotations. (Jackson is the only inpatient adult TB hospital for Florida.)
ECOM is run by CTS and CSICU but this can be an elective.

5. All closed ICUs

6. Only attendings and fellows can adjust the vents. Need to let RTs know or place order so that RT can document.

7. Current PD is PH specialist (trained in UCSD) + 2 more PH attendings. And yes, pulmonary manages PH and there's a separate PH rotation which expose you to both inpatient and outpatient PH patients plus RHC.

8. Extras in this program
- Formal bedside US training with access to Emsono site videos, followed by faculty-run bedside US classes and case logs to get certified.
- This program is "Fellow-run", not residents. You're very busy but that's great for training.
- In 2 ICU rotations, you get to work with NPs but they used to be ICU nurses or nurse managers here. If anything, they're very helpful to guide you through the system. NPs like to do lines (if you're tired of it in second year) but you get to do all intubations, chest tubes, etc unless you give them away.
- Night ICU attendings are known to be great with difficult Airways and all procedures in addition to clinical management. Since they also "help out" other non-medical ICUs that don't have in-house fellows or attendings, there can be plenty of procedures for you. And yes, you run all codes at night. May even go to all rapid responses depending on the attendings.
- PD is trying to expand research training. If you have interest, there's an option for 6-12 months of research in the third year.
- The first month of fellowship is "Pulmonary medical school" when you don't work but get lectures and hands-on training. There's an airway "exam" started last year.
- Spanish is first language in Miami but phone interpretation is always available. Most attendings/nurses/residents speak Spanish so you are not left alone.

 

[jkc17]

Can anyone provide any further recs? Maybe you’ve noticed some clinically heavy programs during interview season?

 

[cavitarynodule]

Can anyone provide any further recs? Maybe you’ve noticed some clinically heavy programs during interview season?

Here are a few impressions after mainly west coast interviews including some of the "top" programs. This is not to get into an argument but just based on the objective criteria in the first post.

Good clinical training:
Colorado
UCLA
UCSD

In-between:
Michigan
UChicago

Poor clinical training:
UWashington
UCSF
Stanford
Northwestern

 

[Nealzer80]

I agree to the list with poor clinical training, being a grad of one of those programs :-(

 

[benfolds21]

I’d echo what was said about the west coast programs. I matched on the other other coast but interviewed at most of those programs. For me it was important to find very strong clinical training that equally matched strong research experience.

For the “east” coast I’d include Duke, Columbia and UPMC as programs that provide a strong healthy mix of clinical/research. I sensed that OSU also provided this but I cancelled my interview there. The other “top” programs were either too clinical or too research focused.

 

[pccmhopeful]

I agree to the list with poor clinical training, being a grad of one of those programs :-(

As someone interviewing at some of those programs, do you feel comfortable elaborating at which program and in what way you felt it was lacking?

 

[deleted547339]

I work with someone who trained in Denver who is very good. I trained with someone who did residency at Chicago and chose to go elsewhere for better training.

Surprised to hear people say Michigan, Uwash and Stanford have marginal clinical training programs - they all have good reputations in the CCM world.

 

[cavitarynodule]

Surprised to hear people say Michigan, Uwash and Stanford have marginal clinical training programs - they all have good reputations in the CCM world.

I think the issue is that many 'reputable' programs are only focused on producing NIH funded researchers to bring in $$$ to the division and clinical training takes a back seat

 

[asdfTT123]

Take my advice with a grain of salt as I'm looking for more research focused programs but I interviewed at UTSW and it checks off all your boxes above. Colorado sort of does but I believe they're an 18 month structure and although their clinical training is perceived as very strong, they're still interested in training academic clinician investigators.

 

[swimminginloansMD]

Hi all,

In light of virtual interviews this year, I wanted to revive this thread to ask about academic programs with strong clinical training as well. Could any prior applicants be able to comment about academic programs with stronger vs weaker training, not just on the west coast but other regions as well (east coast, midwest, south, etc.)? We can use the criteria in the above post, though it appears that most academic programs seem to do 18 months of clinical training as opposed to more...

Also, re: airway - if we end up training at a program where anesthesia is primary (lets say the match places us there, or we have geographic constraints, etc._, does that significantly limit where we can practice afterwards, even within academic settings?

Thanks!

 

[chessknt]

Hi all,

In light of virtual interviews this year, I wanted to revive this thread to ask about academic programs with strong clinical training as well. Could any prior applicants be able to comment about academic programs with stronger vs weaker training, not just on the west coast but other regions as well (east coast, midwest, south, etc.)? We can use the criteria in the above post, though it appears that most academic programs seem to do 18 months of clinical training as opposed to more...

Also, re: airway - if we end up training at a program where anesthesia is primary (lets say the match places us there, or we have geographic constraints, etc._, does that significantly limit where we can practice afterwards, even within academic settings?

Thanks!

In real life completely unqualified people do airways all the time so it won't limit your practice. If you don't feel good about your skills you can usually find opportunities on your own time to improve it as well as take a course to get a structured approach to a challenging airway. If by the end you don't feel good about your training then it is on you to determine how much handholding/backup you want to have at a job.

Picking a fellowship for its airway exposure as a primary factor is a bit ludicrous. The key at getting good is seeing a lot of sick and complicated people. If you go to a community hospital that transfers every complicated heart/liver/neuro patient to an academic center or only has 100 icu admits a year but you get to do a bunch of airways for cap or post-op bleeds then you are going to be a garbage ccm that is good at procedures.