Osteopathic Pulmonary/Critical Care Fellowship
Applications for the Parkview Medical Center Pulmonary/Critical Care Fellowship Program are done through ERAS. If you are interested in more information, please contact Megan Sefcovic, Program Coordinator, 719-584-4980.
General Objectives of the Osteopathic Pulmonary/Critical Care Fellowship Program
The Fellowship program seeks to provide candidates with the opportunity to become consultant level subspecialists, qualified to function as independent resources for the communities in which they practice. The Fellowship program provides an intensive clinical exposure, an extensive didactic program, in which the Fellow is expected to actively participate, both as a student and a trainer, and an introduction to clinical research. While opportunities to participate in active research projects are available, this is not a research based fellowship program and candidates anticipating careers as physician-researchers are encouraged to seek training in programs more closely suited to their chosen career paths.
A thorough understanding of normal pulmonary anatomy and physiology form the basis from which to study the broad spectrum of clinical pulmonary disorders, including obstructive and restrictive lung diseases, interstitial and infiltrative lung diseases, pulmonary vasculitis, primary and metastatic malignancies, and pulmonary infections, including tuberculosis, nontuberculous mycobacterial infections, pneumonias, and opportunistic infections seen in clinical practice. An appreciation of the pathology and pathophysiology of the disorders leads to an awareness of the clinical manifestations to be expected and the possible therapies. The program emphasizes clinical assessment, judicious use of laboratory and imaging studies, and invasive diagnostic procedures.
Critical Care medicine is a broad, multidisciplinary specialty, encompassing the comprehensive care of critically ill and injured patients. A thorough understanding of normal physiology and variations, which may be beneficial or harmful effects, the interdependency of all organ systems and the patient as a whole person, interacting with their environment and family, are the basis from which to learn the appropriate use of pharmacology, invasive and noninvasive diagnostic and therapeutic interventions with an emphasis on medical ethics, including end-of-life decisions and support of patients and their families in times of extreme stress.
Internal Medicine sub specialties have, as their base, excellence in Internal Medicine. The Fellowship Program seeks to build on previously established knowledge and skills. The successful candidate will demonstrate competence in the broad field of Internal Medicine. Excessive exposure to Pulmonary Diseases or Critical Care Medicine during an Internal Medicine Residency, thus limiting training in the other aspects of Internal Medicine does not optimally prepare a physician to specialize in these fields. The well-rounded candidate, demonstrating mastery of the primary specialty, will ultimately become a better consultant and physician. During the course of the Fellowship program, the trainee will spend a considerable amount of time on services other than Pulmonary Diseases or Intensive Care. These rotations are expected to broaden the knowledge and experience of the Fellow in such areas (i.e. Radiology, pathology, Surgery, Infectious Disease) which impact directly on patients with Lung Diseases or Critical Illness.
This Fellowship program reflects the unique Osteopathic philosophy. As such, structure-function relationships, the integration of all body systems and Osteopathic Manipulative Therapy are integrated throughout the training program.
The program emphasizes graduated responsibility with the Fellow gradually assuming responsibility under the supervision of both the rotation supervisor and the Program Director. It is expected that the trainee will interact closely with attending physicians and other consultants. The Fellow serves as an educator, mentor and supervisor for junior house-staff. The Fellow is also expected to serve as a resource and aid to the Nursing Staff of the Hospital. The Fellow will be assigned to medical staff committees in a nonvoting status with responsibilities commensurate with level of training and skill. Administrative responsibilities are assigned under the supervision of the Program Director. In order to function effectively in the medical environment, the Fellow must become aware of costs, cost containment efforts, and the medical-legal implications of clinical decisions.
Outpatient experience occurs in the private offices of faculty members. Fellows in Pulmonary are assigned four hours of clinic on average of one clinic a week.
The Fellow is encouraged to prepare an annual scientific paper upon a subject acceptable to the Program Director. The paper is to be suitable for publication, and, following approval by the Program Director should be considered for submission for publication to an appropriate per-review journal. The paper may take the form of an independent research project, a case report and review of the literature or such other form as the Program Director may approve. If the paper is accepted for presentation at a national conference, the program will pay the air fare, room and board, and presentation expenses for the fellow to attend the conference. There may a possibility of coordination with the basic science or translational research departments at CSU-Pueblo for research projects as well.
It is anticipated that the Fellow will maintain membership in the American College of Osteopathic Internists, the American Thoracic Society, the American College of Chest Physicians, and the Society of Critical Care Medicine. During the course of the Fellowship program the Fellow is encouraged to attend at least one of the annual meetings of these organizations. The choice of meetings is subject to the approval of the Program Director. The goal is for the Fellow to gain exposure to the professional societies they will interact with for the remainder of their career.
The program will pay for each fellow to sit for the Pulmonary Board Review Course at the end of their second year and the Critical Care Board Review Course at the end of their third year. Payment will include the cost of the course, airfare, room and board.
The Fellow is expected to gain competence in the clinical and ancillary evaluation of patients presenting with symptoms potentially arising from pulmonary disease and/or critical illness. Listed below are procedural skills which should be acquired by the trainee during the course of the program. The Program Director, advised by the faculty members, serves as the final arbiter of competence and satisfactory completion of the goals and objectives of the training program.
This program involves General Pulmonology and Critical Care, as well as Interventional Pulmonology, Pulmonary Hypertension and Sleep. Below is an example of the program curriculum.
36 Months Total
3 months vacation
3-5 months research
1 month CVT
4 months MICU
4 months ICU/CCU
2 weeks anesthesiology/radiology
4 months NTICU
4 months ambulatory
9 months inpatient
1-2 months electives
Electives: Elective rotations allow the Fellow, with guidance from the Program Director, to tailor the program to their particular areas of interest and skill. The suggestions are not inclusive. As most elective rotations will occur outside of the parent institution, choices must be made as soon as possible in order for appropriate arrangements and affiliation agreements to be completed. Additional core rotations may be substituted for electives as requested.
Below is an example of the call schedule. Please keep in mind, the goal will be to have a in house “night float system in place by 2016.
Night Float rotations (2 week spans) - 4 months
Heavy and light call (weekends – Sat & Sun)
- Call will range from 12-18 per year depending on PGY year
- Heavy Call will take place from home after working rounds completed
- Light Call will take place at the hospital only during rounds
ICU - core weekly
Pulmonary - Core weekly
Radiology - case weekly/monthly
Tumor Board - 7am Tuesdays at the Dorcy Cancer Center
Journal Club - case presentation
RAD-PATH - case presentation
ICU Quality Control- case presentation
ICU/ Code Blue
PH meeting - every other month
ILD meeting - every other month
Morbidity and Mortality - 2nd & 4th Monday 7am
4 hours once a week
Fellows will complete understanding via direct hands on or modules for the below procedures. In addition, there will be hands on and strong experience with Endobronchial Ultrasound (EBUS) as well as Critical Care and Cardiac bedside ultrasound. There will be an expectation for hands on bedside Percutanuous Tracheostomy. Other potential interventional experiences will include bronchoscopic stenting, balloon dilatation, valves, APC/Cryo therapy and navigation bronchoscopy.
The fellow should develop competence in the performance of each of the following listed skills:
The fellow must become competent in the following:
- Examination and interpretation of sputum, bronchopulmonary secretions, pleural fluid and lung tissue for infectious agents, cytology, and histopathology.
- Imaging procedures including chest roentgenograms, pet interpretations, computed axial tomograms, radionuclide scans, and pulmonary angiograms.
- Pulmonary Physiology Testing: Interpretation, Indications, Performance
- Cardio-Pulmonary Stress Testing
- Medical Imaging Techniques: Interpretation, Indications
- Bronchoscopy: Biopsy techniques, Needle Aspiration, BronchoAlveolar Lavage
- Arterial and Central Venous Catheterization: The fellow must become competent in maintenance of circulation with arterial puncture and blood sampling, insertion of central venous, arterial, and pulmonary artery balloon flotation catheters, basic and advanced cardiopulmonary resuscitation, and cardioversion.
- Pulmonary Artery Catheterization and Right Heart Catheterization
- Intra Aortic Balloon Counterpulsation
- Airway Management: The fellow must become competent in establishment and maintenance of an open airway in nonintubated, unconscious, paralyzed adults.
- Mechanical Ventilation: The fellow must become competent in pressure-cycled, volume-cycled, time-cycled, and flow-cycled mechanical ventilation.
- Management of Intracranial Hypertension
- Fine Needle Aspiration
- Conscious Sedation
- Neuromuscular Blockade
- ICU Management, including protocol development, cost containment, etc.
- Thoracentesis: The fellow must become competent in thoracentesis.
- Pleural Biopsy
- Chest Tube Placement and Pleurodesis: The fellow must become competent in management of pneumothorax (needle insertion and drainage systems) and chest tube insertion.
- The use of reservoir masks and continuous positive pressure masks for the delivery of supplemental oxygen, humidifiers, nebulizers and incentive spirometry.
Pueblo Pulmonary Associates operates an ambulatory clinic that will be utilized for Fellowship training with continuity of care.
Clinic will be a mix of new and return patients. Disease pathology from COPD, dyspnea, ILD, nodules, mass, lymphadenopathy, effusions, pulmonary hypertension, asthma, sleep and mixed population s to name a few. Although subspecialty is not currently in process it will be considered in the future.
Joshiah Gordon, D.O., M.Sc. is board certified in Internal Medicine and Pulmonary Medicince and Critical Care and came to Parkview Medical Center most recently from Cincinnati, OH and a native to Colorado. He earned his Degree from Lake Erie College of Osteopathic Medicine in Erie, PA. His residency training was completed at University of Louisville, Louisville, KY and then his fellowship at University of Cincinnati, Cincinnati, Ohio. Dr. Gordon joined Parkview via Pueblo Pulmonary Associates in July 2011.
Dr Gordon will serve as Program Director for the fellowship.
Special interests include: Pulmonary Hypertension, ILD, Interventional Bronchoscopy, Critical Care Hemodynamics Monitoring and Ultrasound and sub specialty neuro and trauma critical care.
Craig Shapiro, M.D. is board certified in Internal Medicine and Pulmonary Medicine , Critical Care and Sleep Medicine and came to Parkview Medical Center from Kansas City, MO. He earned his Degree from the University of Nebraska Medical School, Omaha, NE. His residency was done at the Medical College of Virginia followed by Fellowship at TMC/UMKC School of Medicine, Kansas City, MO. Dr Shapiro joined the Parkview Medical Staff in July, 1994 and works with Pueblo Pulmonary Associates.
Dr. Shapiro will serve as the Director of the Pulmonary Clinic.
Dr. Shapiro has special interests in General Pulmonary Medicine, Sleep and Lung Cancer and expertise in the entire realm of pulmonary, critical care, and sleep medicine.
Marcel Junqueira, M.D. is board certified in Internal Medicine and Pulmonary Medicine and Critical Care and came to Parkview Medical Center from Philadelphia, PA. He earned his Degree from Faculdade de Medicina de Valencia, Valenca-RJ, Brazil. His residency was done at Columbia University, St. Luke’s-Roosevelt Medical Center, New York, NY followed by Fellowship at Kansas University Medical Center, Kansas City, KS and then Temple University, Philadelphia, PA where he obtained his fellowship in Sleep medicine. Dr Junqueira joined the Parkview Medical Staff in July, 2012 and works with Pueblo Pulmonary Associates. Dr Junqueira will sit for his BC in Sleep Medicine Fall 2013.
Dr Junqueira has special interests in Sleep, Asthma, Pleural Lung Disease and ILD.