ROGER WILLIAMS MEDICAL CENTER FELLOWSHIP IN PULMONARY DISEASES

PROGRAM DEMOGRAPHICS

• The sponsoring institution is Roger Williams Medical Center (RWMC), a major teaching affiliate of Boston University.
• This is a fellowship in the subspecialty of Pulmonary Medicine
• Address: Department of Medicine, Pulmonary Division

                 Roger Williams Medical Center

                 825 Chalkstone Ave.

                 Providence, Rhode Island

                 02908

• The program can be reached at (401) 456-2070
• Fax number is (401) 456-2016
• Inquires can be sent to cboutin@chartercare.org
• The Program Director is Dr. Joseph Vincent Meharg
  • He can be reached at jmeharg@chartercare.org

• Alternatively, Cynthia Boutin, the Program Coordinator, can be reached at cboutin@chartercare.org

INTRODUCTION

An accredited Pulmonary Fellowship has existed at RWMC since the late 1970.s.  Since 1984, 46 fellows have completed the training program, which is currently structured as a 2 year training program, the components of which will be described below.  In its’ current formulation, 100% of our fellows have passed the Boards on their first attempt.

Candidates for the fellowship will have completed an ACGME accredited 3 year categorical internship and residency program in internal medicine and must pass all parts of their USLME exam.  A minimum of 3 letters of recommendation must be submitted. These will hopefully attest to the robust clinical judgement, academic rigor, moral fiber, and sense of social responsibility we look for in an applicant.

Our Fellowship strives to produce physicians who are proficient in internal, pulmonary, and critical care medicine. They will provide superb subspecialty consultation in a variety of settings, possess the ability to interpret and participate in pulmonary research, and demonstrate ethical, compassionate care giving and a thirst for lifelong learning.

RESOURCES

Teaching Staff:

Drs. Rabih El Bizri, Joseph V. Meharg, Abd Abdelrahman and Thomas Raimondo provide coverage for the Med-Surg ICU and the pulmonary consultative services. The ICU is not a closed service, but we do have responsibility for all the medical patients. We, and the fellow, accept the orthopedic patients directly from the OR, accept the general surgical patients on day 2, and provide consultation for the neurosurgical and surg-onc patients when asked. We do this in association with a surgical PA service that is overseen by Dr. Meharg.

Dr. Meharg oversees the PFT and exercise lab. The Fellows are responsible for giving the initial reading on the PFTs, about 30 a week, and then discussing the results and the pathophysiology with Dr. Meharg. By the second half of the second year, if not sooner, the Fellow will be authoring the cardiopulmonary exercise test report (CPET). These tests occur at a rate of 4/month.

Dr. El-Bizri is the primary provider of interventional pulmonary procedures, averaging 3 to 4 Ebus’ per week, both standard and radial, along with pleurex catheter and tube thorocostomy insertions. Dr. Abdelrahman performs Ebus as well. Both Dr. Meharg and El Biri place endobronchial stents. The Fellow will attend lung nodule clinic with Dr. El Bizri and occasionally present cases to thoracic tumor board.

Mr. Richard Rounds, respiratory therapist, runs the PFT lab.  He will explain to the Fellow how PFTs are done, how to critique the validity of the data, and he will happily perform spirometry, plethysmography, oscillometry, and CPET, if the Fellow so desires.

Mr. Nate Barrington and Mr. Tim Burnap: the heart of our surgical PA program, they have been providing post op care at RWMC for more than 20 years now. They will be a valuable resource to the Fellow as the Fellow becomes comfortable with the care of critically ill post op patients,  they will be there  if  help is needed with a chest tube, line insertion, intubation, or just advice. 

FACILITIES

Consults occur in the ICU, Bone Marrow Transplant Unit (BMT), and General Medical Floors.

Pulmonary and lung nodule clinics are located across the street at 50 Maude street, 3^rd floor.

The Fellow is allotted one away elective per year.

We strongly recommend an elective at Rhode Island Hospital in Pulmonary

Hypertension, with Drs. James Klinger and Cory Ventatulo.

Boston Medical Center is another possibility for elective work with Dr. David Centers’ renowned group.

Over a span of two years we anticipate the Fellow will complete:

• 12 months on service, which typically involves ICU rounds in the morning, consults and procedures in the afternoon, and evening rounds with the house officers covering the ICU prior to leaving for the day.
• 2 half days a week in outpatient pulmonary continuity clinic, one with Dr. Meharg, one with Dr ElBizri.
• 1 mos of Pulmonary Hypertension with Drs. Kilinger and Ventatulo.
• 1or 2 months away elective which can be subdivided into smaller aliquots.
• Other in house electives include time on the Bone Marrow Transplant Unit, Interventional and/or diagnostic radiology.
• Research during the weeks not on service: We anticipate the Fellow will present at least one poster at the annual ATS or Chest conferences involving a case report, and we hope that the Fellow will also have a poster stemming from their investigative efforts into a question identified over the first 6 months of fellowship.
• The Fellow will likely be involved in a quality improvement project during their two years. For example, we are presently looking at comparing our current ventilator associated pneumonia prevention procol with one that incorporates recent data on several variables, including subglotic suctioning.

BASIC CURRICULUM

• Obstructive and restrictive lung diseases, including the PFTs, pathology, pathophysiology, and radiology of these disorders.
• Lung cancers/ thoracic tumor board/lung nodule clinic.
• Opportunistic pulmonary infections/BMT unit/RI.State TB clinic can be arranged.
• Pulmonary vascular diseases/pulmonary hypertension at RIH
• Hemodynamics/sepsis
• Ventilator basics and management
• Collagen vascular related diseases of the lung

DIDACTIC SESSIONS

“ICU” didactic rounds occur 3 to 5 times a week, sometime after ICU rounds. Pulmonary consult cases are also reviewed here.

Friday morning city wide Brown Pulmonary Conference: 7:45 to 8:45 am at the old med school on Meeting Street. 

Friday morning RWMC Case Management conference: 11:30 to 12:30 am.

Physiology of the Lung: text will be provided. Didactics will occur on select Monday afternoons, approximately 20 sessions per year.

Pathophysiology of the lung: you will be taught and will apply this every day!

Lung Pathology:  Slide based didactics will occur 6 times a year, also on Monday afternoons.

The Fellow will be expected to review case materials with the pathologist and attending as these cases arise.

Thoracic Tumor Board: every other Thursday, 8:00 am Paolino Conference Room.

Brown Case Management Conference: Thursdays, RIH, 1:30 to 3:00pm, 3^rd floor radiology conference room.

PROCEDURAL REQUIREMENTS

We anticipate, based on recent graduates, that at the end of 2 years the Fellow will have performed 50 Ebus procedures, ≥ 100 bronchoscopies, 3 pleurex catheters, 1 airway stenting procedures, 6 swan ganz catheter insertion and data interpretations, 20 CPET, innumerable intubations, central lines, and arterial lines.  These should all be recorded in the procedure log which will copied for us before the Fellow graduates, as prospective employers will want us to give them this data.

If the Fellow is comfortable with a given procedure, Dr El Bizri or Meharg will observe the Fellow do one and if they are, in their opinion, competent, future such procedures can be done on their own. This will not apply to bronchoscopies, Ebuses, airway stenting, or pleurex catheter insertions which will always be done with an attending present.

YOUR SUPERVISORY AND TEACHING RESPONSIBILITIES

Teaching is one of the best ways to solidify knowledge base and evaluate progress, and there be numerous opportunities to instruct colleagues.

The pulmonary fellow will be responsible for overseeing the care plan and delivery to patients by the residents, and often the ancillary staff, in conjunction with the attending staff.  It is expected that the Fellow will teach during ICU rounds and the aforementioned conferences.

EVALUATIONS

The Fellow’s time on service will be evaluated monthly by Dr. El Bizri, Dr Meharg or Dr. Abdelrahman and the Fellow will have the opportunity to review these evaluations with the attending.  Every 6 months a summary evaluation will be derived by Dr. Meharg and discussed along with Milestone evaluations.

Evaluation from the clinic, ICU nursing, and endoscopy staff will be completed yearly and discussed.

By the end of two years, you will be able to move seamlessly from H&P to what the pathophysiology is, what the CXR and CT will show, what the PFTs may demonstrate, and generate a broad DDX.  In other words, you will be an excellent pulmonologist.

If you do apply, do not be surprised if I call you some evening and we discuss the alveolar gas equation.  I anticipate you will visit prior to Match Day, and I can assure you a learning experience as good or better than any you’ve yet had.  I look forward to reading (yes I read them) your personal statement, and meeting you in person.

                                                            Joseph V. Meharg, M.D.

                                                            Chief of Pulmonary and Critical Care Medicine

                                                            Program Director of the Pulmonary Fellowship