Curriculum highlights

• There is no in-house call required on any rotation. There are three months of home call and ICU coverage is done as dedicated night shifts when on an ICU rotation.
• Elective opportunities (with travel and housing provided) are available at the Mayo Clinic campuses in Arizona and Florida as well as in community practices at Mayo Clinic Health System sites.
• There are rotations in the county tuberculosis clinic within the standard curriculum, with opportunities to do elective international rotations.
• There is a dedicated interventional pulmonary team and emergency bronchoscopy rotation.
• There is an opportunity for one year of dedicated mentored research time in an area of interest to the fellow.
• Trip allowance: 10 days a year for presentations, one attendance-only trip during fellowship, and yearly attendance for the regional meeting.
• Opportunity for attendance at Mayo Board Review Course during the second and third year.
• Mayo Clinic offers many excellent advanced fellowship opportunities in pulmonary medicine.

Clinical training

The curriculum for the Pulmonary and Critical Care Fellowship varies depending on whether you choose the Clinical Scholar Track or the Physician Scientist Track. All clinical training includes patient care, procedures, elective rotations, didactic training and teaching opportunities.

Patient care

Every ambulatory and inpatient rotation has been uniquely crafted to maximize learning and skills development. The hospital experience ranges from primary pulmonary services to pulmonary and procedural consults to medical, surgical and subspecialty ICUs.

The primary pulmonary service is run by internal medicine residents who are responsible for most direct patient care. As a fellow, you will serve in a junior faculty-type role, directly supervising and guiding medical residents and students on the team, together with the staff physician. In this rotation, you learn how to lead a large medical team and to balance patient care with supervision and teaching.

In contrast, on consultative inpatient rotations, you assume the primary role of expert specialists providing guidance and support to patients with pulmonary illnesses admitted to other medical or surgical services. These experiences help you learn pragmatic and scholarly approaches to a wide array of simple and complex inpatient pulmonary problems while working 1:1 with expert faculty. A separate dedicated bronchoscopy rotation will allow you to maximize your learning and practice diagnostic and therapeutic procedures with minimal disruption in the hospital.

The critical care rotations typically alternate every four weeks with outpatient clinics or procedures. You will rotate through many subspecialty clinics (asthma, interstitial lung disease, COPD, lung nodules, pulmonary vasculitis, pulmonary hypertension, bronchiectasis, cystic fibrosis, pleural disease, and cough) during your fellowship year to build a solid foundation across all areas of pulmonary medicine. In the outpatient clinics, you work directly with expert leaders and start building your own diverse panel of longitudinal patients, whom you will follow for the duration of your training.

Procedures

All procedures are performed under the direct supervision of Mayo Clinic staff interventional pulmonologists and intensivists. Procedural training (both inpatient or outpatient) includes flexible bronchoscopy, transbronchial biopsy, endobronchial ultrasound and transbronchial needle aspiration, thoracentesis, chest tube placement, tunneled pleural catheter placement, intubation, central line placement, dialysis line placement, arterial line placement and other procedures central to critical care. You also have opportunities to learn about robotic bronchoscopy, endobronchial valve placement, therapeutic bronchoscopy, medical thoracoscopy and percutaneous tracheostomy, among others.

The procedural rotations are built stepwise so that technical skills are learned in a complementary fashion from routine to highly complex. In addition, you will have dedicated procedure rooms where you will work 1:1 with interventional pulmonologists.

By the numbers

Average number of procedures done at Mayo Clinic Rochester each year:

• Flexible Bronchoscopy:  >2500
• Endobronchial Ultrasound: 700-900
• Thoracentesis: 1400
• Small bore chest tubes: 500
• Tunneled pleural catheters: 130
• Percutaneous tracheostomy: 50
• Rigid bronchoscopy: 130-150 

Rotation schedule

A typical schedule has 13 rotations per academic year that are four weeks in length. Fellowship schedules are flexible and allow for significant customization of rotations during the second and third year which align with a fellows career goals

Call frequency

Your call schedule is different for each track rotation. Mayo Clinic College of Medicine and Science follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).

Moonlighting

You may moonlight with program director approval. Moonlighting should not interfere with the required learning and must not violate the duty-hour rules of the Accreditation Council for Graduate Medical Education (ACGME) or visa regulations.

Teaching opportunities

Opportunities are available for teaching rotating residents and medical students. Also, fellows are given the opportunity to participate in educational workshops to improve teaching skills.

Evaluation

To ensure that you acquire adequate knowledge and develop your technical skills, your performance is monitored carefully during the course of the Pulmonary and Critical Care Medicine Fellowship and feedback is offered regularly. Formal evaluation is conducted by a supervising faculty member after each clinical rotation and reviewed with the program director. In addition, you regularly evaluate the faculty to confirm that your educational needs are being met.