Clinical Training

First Year (14 rotation blocks)

The first year is designed to provide the seven 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: UC Health (UCH), Denver Health Medical Center (DHMC), Veteran's Administration Medical Center (VAMC), and St. Anthony Central (SAC).
• Management of patients with chronic respiratory insufficiency due to asthma, COPD, ILD, tuberculosis, atypical mycobacterial disease and immunologic deficiency states. The physiology rotation at National Jewish Health (NJH) also includes time in the following subspecialty clinics: occupational medicine, interstitial lung disease, airways clinic, and adult cystic fibrosis clinic. 
• 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 at NJH 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. 
• Attendance and participation at weekly Pulmonary and Critical Care Grand Rounds, weekly Chest X-Ray Conference, and monthly education days.  Attendance at the weekly divisional research conference while on rotation at NJH.
• Formal and informal teaching of housestaff, medical students, nurses and allied health professionals.

Fellows are excused from clinical service for research week in the fall.  This week is used to introduce research opportunities to the fellows and to provide protected time to meet with prospective mentors. All fellows are supported to attend the annual American Thoracic Society meeting.  Fellows are expected to present an abstract at the meeting (cases are acceptable during the first year). 

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 or the Masters in Clinical Science program is encouraged 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.

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 possible within the confines of a 4 year program.

Second Year

The second fellowship year is 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), NJH, the VAMC, or the divisional research laboratories in the medical school 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.

A grant writing workshop is conducted during five education days for second year fellows to assist with NRSA (or equivalent) grant submission.

The required clinical responsibilities during this year include a weekly half-day continuity clinic, three rotations of advanced lung disease training at UCH (lung transplantation, pulmonary hypertension, and pulmonary consults), one month of critical care at the VAMC, and attendance at conferences.

Third Year

This year is a continuation of the second year experience. Two critical care rotations are spent in the medical ICU at DHMC, and an additional ICU rotation at the VAMC. In addition, trainees complete an additional rotation on the pulmonary hypertension service. Fellows will also complete a six-month half-day pulmonary outpatient subspecialty clinic experience during the second or third year. 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.​

Clinician Educator Track

We have added a separate Clinician Educator track to ERAS.  The Pulmonary and Critical Care Medicine Track is our traditional, research-focused track.  The Clinician Educator track is for fellows aspiring to a leadership career in medical education.  We established the Clinician Educator track in 2017, but this is the first year we are specifically recruiting one or two candidates to this track through ERAS.  Our goal is to ensure a balance of research-focused fellows and education-focused fellows. 

Both tracks have similar clinical schedules (approximately 19 months of clinical rotations), a regular continuity clinic that extends across the three years, and an additional weekly, subspecialty clinic for 6 months during research months.  The Clinician Educator track has similar protected time during years 2 and 3, and the Clinician Educator Fellow track is eligible for a 4^th year of fellowship if this will benefit the fellow’s career.

The Clinician Educator track will have the following career development elements:

• Protected time to develop medical education scholarship.  The fellow will participate in the University of Colorado’s Teaching Scholars Program.  This 18 month program comprises two afternoons per week for one year, and additional monthly sessions for the remaining 6 months.  It is expected that the fellow will publish a first author manuscript by the end of fellowship. They will also submit abstracts to annual meetings.
• Training to improve the fellow’s ability to teach.  This will occur via our Fellow as Educator training (which all of our fellows receive) and participation in the CU Department of Medicine’s Resident and Fellow as Educator rotation.
• A focus on a subspecialty niche to provide added value to the fellow’s future career.  This generally includes additional subspecialty expertise (e.g. pulmonary hypertension, interstitial lung disease) or a clinical skillset such as ECMO or bioethics.
• Attendance at our monthly Medical Education Working Group meetings.
• The fellow will have 2 co-mentors that they meet with regularly, as well as a Career Advisory Committee that meets at least semiannually. (This requirement is similar to the mentorship requirements for our other PCCM fellows).

 The Clinician Educator fellow will apply for the CU Department of Medicine Clinician Educator Fellowship to provide support.