The Interventional and Advanced Diagnostic Pulmonology Fellowship provides intense pulmonary procedural training with the goal of developing future leaders in the field.

The fellowship consists of 12 months of continuous training. Eleven of these months are spent in interventional pulmonology with time divided between the:

• Complex airway procedural suite
• Diagnostic bronchoscopy and complex pleural procedures suite
• Inpatient interventional pulmonology/pleural disease consult service
• Outpatient pleural diseases clinic

At any one time with four procedural services functioning simultaneously, there may be several cases presented at once. The fellow is expected to maintain awareness of which procedures are occurring at any one time and choose to participate in those procedures most beneficial to the fellow.

The fellow also operates an outpatient clinic daily that is populated with patients from the interventional and pleural services. Access to this clinic is managed internally by the interventional pulmonary staff to ensure a clinic experience that is focused on interventional pulmonology disease states.

During the 12-month curriculum, one month is devoted to either a rotation in thoracic surgery or, if deemed appropriate by the program director, a two-week block in interventional radiology followed by two-weeks in thoracic pathology.

Aside from direct patient care, a human cadaver lab and a state-of-the-art medical simulation center are used during this fellowship to augment the procedural experience and ensure optimal hands-on training while ensuring patient safety.

One morning per quarter is devoted to faculty-mentored cadaver work with the intent to expose the fellow to basic skills as well as enhanced exposure to new and advanced techniques in preparation for patient contact. A live animal lab is also available and employed to perform research studies, as well as to expose fellows to hemorrhage control techniques and to gain a better appreciation for the effect of various instruments on live tissue.

Clinical training

This is a high-volume procedural fellowship. The procedural volumes well exceed all requirements for accreditation. Although procedural volumes vary slightly from year-to-year, it is reasonable to expect the following:

In addition, fellows can expect to have robust exposure to and gain expertise in the use of laser, argon plasma coagulation, cryotherapy (to include cryobiopsy), electrocautery, balloon and rigid dilation and endobronchial valve placement among other procedures.

The procedural group also performs in excess of 2,000 diagnostic and therapeutic flexible bronchoscopies, 600-800 endobronchial ultrasound-directed procedures, and 800-900 thoracenteses (to include thoracenteses performed with the use of pleural manometry) yearly.

In our current configuration, fellows do not perform bronchial thermoplasty, percutaneous endoscopic gastrostomy (PEG) tube placement, transthoracic oxygen (TTO) catheter placement, or transthoracic needle aspiration (TTNA). Fellows should not expect to gain significant exposure to those procedures.

All procedures and patient encounters will be supervised by the responsible consultant regardless of the simplicity of the procedure and experience of the fellow. Early in the training year supervision may include the immediate presence of the consultant, however as the training year progresses supervision may become less rigid thus allowing the fellow to progress toward more independent practice.

Call frequency

Fellows cover the inpatient interventional pulmonology/pleural disease service along with overnight call from home one weekday per week when the general pulmonary fellow takes their day off. You will have responsibility for disposition of outpatients after interventional procedures and are expected to round on all inpatients after interventional procedures. Occasionally, this may require brief rounds on the weekends. If you wish to be involved in weekend and night coverage for interventional procedures, that is possible on request, although weekend and night interventions are uncommon.

All duty responsibilities are maintained within the guidelines of the Accreditation Council for Graduate Medical Education (ACGME).

Moonlighting

Moonlighting is generally not allowed as it does not contribute to interventional pulmonary experience. The Interventional and Advanced Diagnostic Pulmonology Fellowship is a fully funded fellowship designed for one year of focused training and research.

Didactic training

Didactic instruction is multifaceted and includes faculty-delivered lectures as well as pre-recorded lectures and videos, lecture sets provided by the AIPPD, case discussions and presentations, and required reading assignments.

Conferences

There are several conferences scheduled throughout the workweek. Fellows are welcome to attend any or all them as time and interest permits:

• Monday, 7 a.m. – 8 a.m.: Multidisciplinary Thoracic eTumor Board*
• Tuesday, 1 p.m. – 1:30 p.m.: Multidisciplinary Tumor Board
• Wednesday, 7:30 a.m. – 8:30 a.m.: Pulmonary Case Conference
• Wednesday, 1 p.m. – 1:30 p.m.: Multidisciplinary Tumor Board
• Thursday (second and fourth), 7 a.m. – 8 a.m.: Interventional Pulmonology Case Conference*
• Thursday (second and fourth), 1 p.m. – 1:30 p.m.: Multidisciplinary Tumor Board
• Friday, 7 a.m. – 8 a.m.: Thoracic Surgery Case Conference
• Friday, 7:30 a.m. – 8:30 a.m.: Pulmonary Medicine Research Conference
• Friday, 12:30 p.m. – 1:30 p.m.: Pulmonary Division Friday Lecture

*Indicates a required conference

Committee assignments

The Interventional and Advanced Diagnostic Pulmonology fellow has the opportunity to serve as a trainee representative on the Fellowship Program Evaluation Committee. This is an optional assignment.

Research training

The Interventional and Advanced Diagnostic Pulmonology Fellowship faculty consider it their responsibility to ensure graduates are highly competitive for academic employment and view demonstrated academic accomplishments as a key indicator.

At any one time, a multitude of studies are ongoing within the Interventional Advanced Diagnostic Pulmonology group as well as the division of Pulmonary and Critical Care and Thoracic Surgery. Fellows are expected to be actively engaged in ongoing studies of their choice based on their areas of interest. They are also expected, and will be mentored, to formulate a research question and see studies through to conclusion. During the course of fellowship, fellows will complete at least one retrospective study and one review article. Fellows will also participate in at least one prospective ongoing interventional study.

Due to the very compressed schedule inherent in a one-year fellowship, there is not a prolonged block of time dedicated to research alone. Instead, fellows will be expected to make maximum use of unscheduled time to conduct their research with the intent to lead to publication.

Mayo Clinic also has a very generous travel policy for fellows to present their research and it is expected that fellows will travel to and present at least one national or international meeting during their fellowship year. Opportunities also exist to earn credits toward a master's degree in clinical research via the Mayo Graduate School during the fellowship year.

Teaching opportunities

Effective teaching is considered an essential skill of all graduates. Fellows have opportunities to teach rotating pulmonary and critical care fellows in the endoscopy suites, as well as teach residents and fellows during conferences.

The fellows' teaching ability will be closely scrutinized by faculty and feedback freely provided. Fellow presentations to the Division of Pulmonary and Critical Care will be assessed by members of the division's education committee with written evaluations provided. These evaluations will be reviewed by the program director and remain as part of the fellow's official record.

Career development

It is our goal to assist and prepare each fellow to be highly competitive for positions of their choice upon graduation. Since the fellowship began in 2013, there have been four graduates, with a fifth scheduled to graduate in June 2018. All five fellows have successfully earned positions in highly acclaimed academic health centers and are functioning or will function as interventional pulmonologists at each of these centers.

Evaluation

To ensure proficiency is gained and corresponding technical skills are developed, performance is monitored throughout the Interventional and Advanced Diagnostic Pulmonology Fellowship. A procedure log is required to be kept up to date and must include data pertaining to diagnostic yield and complications.

Fellows are formally evaluated by their supervising faculty member after each clinical rotation and then evaluations are reviewed with the program director. Fellows also have opportunities to regularly evaluate the faculty to confirm that educational needs are met.