The Division of Pulmonary and Critical Care Medicine at Harlem Hospital offers 2 Fellowship positions in Pulmonary Medicine each year. The successful candidates enter into a two year training program that provides a rich and comprehensive exposure to the various facets of pulmonary medicine and which also provides a strong foundation for even further subspecialty training.

During the two year period training will take the fellows through the following rotations:

Critical Care
Pulmonary Consult
Pulmonary Function/Physiology
Pulmonary Clinics
Pulmonology Procedures
Research
Sleep Medicine
TB clinic (together with the Division of Infectious Disease)
Apart from the rotations themselves, continuing medical education is enhanced with the following regular conferences:

Weekly Journal Club
Weekly Case Conference
Monthly Pathology Conference
Monthly Cardiopulmonary Conference
And as part of the interdisciplinary team there is regular participation in the hospital tumor board
The Fellows are also supported towards attendance at Major Subspecilaty conferences and encouraged towards continued education and further subspecialty in fields such as critical care and sleep medicine.

All of the fellows who have thus far sought further training have been accepted and well recieved at other large training programs, and for those who have chosen more direct carreer paths, excellent practice positions have not been difficult to obtain. The programs' ABIM Pulmonary subspecialty board passing rate is 100%.

As with the other Internal Medicine Programs at Harlem Hospital the Division faculty are all affiliated with the Columbia University and all hold academic positions there.

Critical Care (6 months)
This rotation provides the Fellow with in-depth exposure to patient care in all aspects of the ICU setting. Exposure during the rotation includes Critical Consult which provides exposure to patients at the point of intake and triage. The Pulmonary fellow, with the constant guidance and support of the ICU attending is given charge of the daily care of all ICU patients affording the chance for constant practice of critical thinking and decision making. This is also a rich ground for exposure to ICU related procedures such as central and arterial line placement, dialysis catheter placement, swan ganz catheterization, thoracostomy tube placement, endotracheal intubation and mechanical ventilation and weaning/liberation.

Pulmonary Consults (6 months)
During Pulmonary Consult service the Fellow is exposed to participation as a specialty consultant in the multispecialty team care approach to patient management. The consult service answers referrals from all the medical and surgical specialties and works in close collaboration with the other medical specialties in patient care.

Pulmonary Function and Research (4 months)
This is a combined rotation. During this rotation the fellow is in charge of reading all pulmonary function tests done at the lab together with an attending also assigned to the same rotation for that month. During this time the fellow is also afforded the chance to pursue his or her research interests. They are encouraged to maintain inquisitiveness in their thought process and to follow through with research proposals in to clinical questions of interest to them. The division faculty is well published and constantly available to provide guidance and support for the fellows planned research initiatives.

Chest and TB clinic (4months)
All fellows attend clinic 3 times a week for the regular chest clinic and twice a week for TB clinic while doing their PFT rotation. The TB clinic gives the fellow exposure to a rich base of patients who come in for purposes ranging from TB clearance to management of active TB. The clinic is closely attended by bpth the division of Pulmonary Medicine and Infectious Disease. It functions in close collaboration with the Department of Health and currently is participating in two large studies that are looking in to the management of both latent and active TB disease.

Sleep Medicine (2 months)
This comlement of the program is carried out at the Columbia Presbyterian Sleep Center. It offers a brief but very informative exposure to the evaluation of sleep diordered breathing and other parasomnic events. The fellows are afforded the chance at learning how to score and read polysomnograms with the attending staff at Columbia as well as the management of the identified disorders.

Journal Club (weekly)
This conference starts out in the year with review of basic epidemiology and statistics as well as article critique. Subsequently each week a clinical/research article chosen apriori by the fellow is presented. the fellow is given freedon to chose the article which is of most interest in the literature at the time.

Case Conference (weekly)
The case conference is conducted by the fellow who at the time is doing the pulmonary consult service. The cases chosen for presentation are usually examples of rare instances of disease or cases that have involved intreseting and complicated evaluation and management strategies

Pathology Conference (monthly)
This is a once monthly conference conducted together with the Department of Pathology in order to expose the fellows and staff to the various histologic and cytologic findings associated with the cases being managed in the service. Cases presented are those who have undergone diagnostic procedures and who have actual specimens for presentation.

Cardiopulmonary Exercise Testing Conference
This is a once monthly conference during which cases involving cardiopulmonary exercise testing have been done are discussed.

Tumor Board
As part of the multidisciplinary approach to the management of tumors and malignancies, the fellows present all patients that have findings of masses or tumors of the respiratory system to the surgical, oncology, and pathology services in order to facilitate discussion and the arrival at definitive diagnostic and management strategies for these patients.

Lecture series
As part of the drive for continuing and updated medical education the Division also brings in oitside speakers who have been recognized for their expertise in a particular field.


Sami Nachman, MD
Chief Division of Pulmonay and Critical Care Medicine

John Salazar Schicchi, MD
Director Fellowship Training Program

Peter Spiro, MD

Gene Pesola, MD

Margaret Olibrice, MD