Pulmonary/Critical Care Fellowship Program Phoenix VA/BGSMC

History Fellowship started in 1980 Three Year Fellowship Program Leads to certification in : Pulmonary Disease Critical Care

History As of June 2008, ALL graduated fellows: Board Certified Graduated Fellows: primarily in Private Practice

Staff Members VAMC Richard A. Robbins Owen Austrheim Lillibeth Pineda Program Director, Chief Pulmonary/Critical Care VAMC Owen Austrheim Associate Section Chief & Director, Sleep Medicine VAMC Lillibeth Pineda Patricia Rocha John Roehrs Clement Singarajah Director Critical Care VAMC Allen Thomas Director Pulmonary VAMC

Staff Members (BGSMC) Pulmonary Associates David Baratz (Director Pulmonary BGSMC) Mark Gottfried Manny Mathew Da-Wei Liao SAFA (Critical Care BGSMC) Robert Rashke (Director Critical Care BGSMC) Huw Owen-Reece Thomas Bajo Arizona Center Chest Diseases Arcot Premkuar Cameron Dick

Other Affiliated Hospitals Mayo Clinic Pulmonary Pathology St. Josephs Medical Center Pulmonary transplant SICU/Trauma Scottsdale Shea Pulmonary radiology JC Lincoln Trauma Maricopa Medical Center Pulmonary MICU

Current Fellows Kevin Park (Third Year Fellow) Evan Schmitz (Third Year Fellow) Roxanne Garcia-Orr (Second Year Fellow) Jessica Hurley (Second Year Fellow) Christian Jivcu (First Year Fellow) Henry Leudy (First Year Fellow) Emad Wissa (First Year Fellow)

Pulmonary Fellows (2011) Tonya Whiting (Good Samaritan) Joshua Jewell (University of Nevada)

Current Fellow Demographics (includes 2011 fellows) 4 /9 are from the Good Samaritan residency program Other institutions include University of Massachusetts, Rutgers, St. Joseph’s in Phoenix, Maricopa in Phoenix. 3 / 9 are international graduates.

VA Staff Fellowship coordinator (Nancy Brown) 1 research PhD 1 physician assistant 1 research coordinator Multiple respiratory therapists including Bronchoscopy Oxygen/CPAP 2 section secretaries

VA Pulmonary Critical Care Section Endoscopy suite (flouro, Super Dimension) Sleep Lab (3 beds) MICU (10 beds) 3 pulmonary function labs (>1000 PFTs per year)

Fellowship Program Structure 3 year Program (Clinical) 6 months research 30 months clinical (below is approximate and can be varied) 10 months VA Half pulmonary/half ICU 10 months BGSMC 10 months electives

Fellowship Program Structure - VA Consultations (in-patients) Pulmonary Clinic (1/2 day once a week at VAMC and 1/2 day once a week at private office). MICU (closed unit with primary care responsibility).

Fellowship Program Structure - BGSMC Pulmonary Consultation and primary care ICU Primary care

Fellowship Program Structure Most Popular Electives Pathology Mayo Clinic Sleep (both VA and BGSMC) Infectious disease (BGSMC) Toxicology (BGSMC) Pulmonary transplant (St. Josephs) Pulmonary radiology (Shea)

Clinical and Basic Research Biostatitics/Epidemiology (Dr Gerkin BGSMC) Areas of interest: COPD Pulmonary inflammation Nitric oxide and oxidants Clinical research

Fellowship Program Structure Most fellows present at national meetings (ATS or ACCP). Case presentations at both Arizona ATS and National ATS

Pulmonary/Critical Care Conferences Wednesdays (2-4 hours) Journal Club Pulmonary presentation Critical care presentations Monthly-Arizona ATS multidisciplinary conference Every 2 weeks-tumor board

Fellowship Weekend Call 2 fellows BGSMC One in ICU One in Pulmonary 1 fellow at VA (AM only) BGSMC pulmonary fellow covers nights at VA.

Fellowship Governance Fellowship Committee 5 faculty Robbins, Baratz, Rashke, Singarajah, Thomas 3 fellows one from each year Meets monthly

VA Pulmonary Fellowship Consults & Procedures Consultations: >3000 Bronchoscopies: >200 Sleep studies: >500 Other frequent procedures Needle biopsies ─ Chest tubes Thoracentesis ─ Central lines Pleural biopsies ─ Pleurex cathers

VA Critical Care Fellowship Census & Procedures Average ICU census ~ 7 Critical Care Consults: ~50 Procedures in ICU per year Percutaneous tracheostomies: ~50 Bronchoscopies: ~120 Intubations: ~120 Variety of other ICU procedures (lines, thoracentesis, paracentesis, etc) done mostly by residents with fellow supervision

Banner GSMC Pulmonary Rotation Average Daily Census - 25 7 ICU patients 18 ward patients Average Consults / Day – 5 Supervision of Residents / Medical Students that are on service

Banner GSMC Pulmonary Rotation Procedures per year Percutaneous tracheostomies: ~50 Bronchoscopies: ~200 Intubations: ~ 100 Variety of other ICU procedures (lines, thoracentesis, paracentesis, etc)

Pulmonary Associates Continuity Clinic Each fellow works a half day per week in the Pulmonary Associates office seeing private practice patients with a wide variety of pulmonary diseases. Fellows will have direct responsibility for patients on an ongoing basis over 3 years. An opportunity to interact with private practice pulmonary medicine

GOALS Board Certification Consultant in Pulmonary and Critical Care Clinical Research Provide direct patient care especially in ICU Competence in bronchoscopy and other procedures Teaching

Ultimate Goal LEADER IN PULMONARY and CRITICAL CARE !!!