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Education and Training

Fellowship Program
Pulmonary Disease - Critical Care Fellowship Program

The Fellowship Program in Pulmonary Disease and Critical Care at the State University of New York at Buffalo (SUNYAB) is accredited by the ACGME and is designed to provide thorough clinical training as well as research experience in Pulmonary and Critical Care Medicine. Sanjay Sethi is Division Chief of the Division of Pulmonary and Critical Care Medicine. M. Jeffery Mador, M.D. serves as Program Director for the Pulmonary Disease/Critical Care Fellowship.


The program utilizes two major teaching hospitals affiliated with SUNYAB School of Medicine and Biomedical Sciences (SMBS). These are:

  • Buffalo Veterans Affairs Medical Center (VAMC)
  • Buffalo General Hospital (BGH)

The SUNYAB Internal Medicine Residency Training Program utilizes these hospitals and all house staff at these institutions are part of SUNYAB training programs. All full-time faculty at the hospitals have University appointments. There are a total of nine full-time pulmonary faculty members. In addition, intensivists from within the university anesthesiology department participate in teaching. Interventional bronchoscopy experience is available through Roswell Park Cancer Institute - our affiliated comprehensive cancer institute. Three part-time faculty also participate in fellowship teaching (Dr Mishra, Schwartz and Saltzman).


At both institutions, the Pulmonary Laboratories and Respiratory Therapy Departments are under the direction of the Pulmonary Disease Division. Both pulmonary function and ICU monitoring equipment have been updated at each hospital, ensuring state-of-the-art facilities at all training program sites.


A maximum of three fellowship positions are available for each year of the three-year training program. Ample time for clinical training in all areas of pulmonary medicine and critical care is scheduled. A dedicated research experience is scheduled and, if desired, limited elective time may also be available. Flexibility is maintained in scheduling fellow assignments in order to meet individual needs. The fellow's schedule is divided into 13 four-week modules each year. During the three-year training program, approximately half of the time is spent on clinical service. In addition, there are three modules for vacation (one/year). The first module of the first year is spent in an introduction to the principals of pulmonary disease and critical care medicine. The remaining time is dedicated to research and elective rotations. A general description of fellow responsibilities during the various rotations is listed below.


Summary of the Unique Features of the Fellowship Program

  1. The fellows are exposed to a diverse population of patients. Buffalo General Hospital is a private non-profit institution.The Veterans Affairs Medical Center is a federally owned facility and Roswell Park Cancer Institute is a state-owned facility. Because of the wide variation of funding, each facility attracts different populations of patients.
  2. There is diversity among the faculty. While all are trained in the United States, some were initially trained in Canada, Lebanon, and India, which provides an array of approaches to clinical problems that is valuable for the fellows to compare and useful for international medical graduates.
  3. The fellowship program provides interactions with pulmonary and critical care physicians in the community through our volunteer faculty program that operates at Buffalo General Hospital.
  4. There is a wide range of research experience available to fellows in our program. The disciplines include molecular biology (Drs. Sanjay Sethi, Ali El-Solh, Karin Provost), pathogenesis of COPD (Sethi and Provost), role of infection in COPD (Sethi), sleep physiology and clinical epidemiology (Drs. Ali El-Solh , M. Jeffery Mador), cellular mechanisms and asthma in the inner city (Dr. Lwebuga-Mukasa), and research in respiratory and skeletal muscle and pulmonary rehabilitation (M. Jeffery Mador).
  5. A core curriculum has been developed for all fellows in internal medicine that covers subjects of mutual interest such as health care economics, medical statistics, medical decision making, clinical epidemiology, ethics, and an introduction to molecular biology.
  6. The fellowship is fortunate to be able to provide fellows experience in a variety of special clinical services such as interventional bronchoscopy at Roswell Park Cancer Institute, sleep laboratories at the Sleep and Wellness Centers of WNY and Veterans Affairs Medical Center, cardiopulmonary exercise testing at the Buffalo General Hospital and Veterans Affairs Medical Center, and pulmonary rehabilitation at Veterans Affairs Medical Center.
  7. The Division of Pulmonary and Critical Care Medicine has a long-standing relationship with the University Departments of Physiology and Biophysics, Microbiology, and Social and Preventive Medicine.

Introduction

During the first year of fellowship, the initial module is spent introducing the basis and basics of both pulmonary disease and critical care. During this time, the fellow receives extensive training in the performance and interpretation of pulmonary function tests. Didactic sessions with various faculty members are held daily. Pertinent physiologic and clinical literature related to pulmonary function and critical care is reviewed. In addition, an introduction to techniques of pulmonary flotation catheter insertion, cardiopulmonary exercise testing, polysomnography and bronchoscopy is also presented at this time. Respiratory Therapy techniques and ventilator management are presented. Core issues in pulmonary critical care medicine are reviewed. Also included is an introduction to pulmonary pathology.

  • VA - Clinical Pulmonary Service
    During this rotation, the fellow's main responsibility involves evaluating inpatient consults at the VAMC. Approximately 40 to 50 consults will be seen during the four-week period. Medical residents and fourth-year students are also assigned to the Consultation Service. All cases are presented to an attending physician during daily consultation rounds. The fellow, under supervision of the attending physician, performs all procedures such as bronchoscopy, thoracentesis, and other diagnostic tests. The fellow also sees new pulmonary patients in consultation in the ambulatory clinic two times a week.
  • VA - Critical care
    The VA ICU is a 15-bed combined surgical/medical ICU. Medical patients, patients from ENT, urology and orthopedics are managed directly by the ICU team (closed unit model). Patients undergoing cardiac surgery are co-managed with the cardiac surgeons. General surgery, vascular and thoracic surgery are managed by the surgical housestaff with ICU consultation as needed. Internal medicine residents and one anesthesia resident provide 24/7 coverage in the ICU. The pulmonary fellow supervises the housestaff and is in turn supervised by a faculty member.
  • BGH - Clinical Service
    During this rotation the fellow will be involved in the evaluation of 40 to 50 inpatient consults per month. All cases are presented to an attending physician during daily consultation rounds. The fellow, under supervision of the attending, performs invasive procedures such as bronchoscopy and thoracentesis. The fellows can also gain experience in evaluation and management of patients with advanced lung disease and pulmonary hypertension.The fellow supervises medical residents and fourth-year medical students rotating on the pulmonary service.
  • BGH - Critical Care
    The Buffalo General is an 18-bed medical unit run by the pulmonary-intensivist service. Although the unit is an open unit, the vast majority of medical ICU patients are under the direct care of the ICU team (over 80%). Medical housestaff provide 24/7 coverage. The pulmonary fellow supervises the housestaff and is in turn supervised by a faculty member.
  • ICU non-medical
    Fellows rotate for one month in the trauma unit run by the surgery department. Surgical patients are also seen at the VAMC. Fellows have the option to rotate in the coronary care unit, burn unit, neurology-neurosurgical ICU, or the surgical unit at the BGH. Fellows also rotate in anesthesia for two weeks to provide additional experience in endotracheal intubation and thoracic surgery to provide additional experience in chest tube insertion.

Research

The program is designed to provide an intensive research experience. Research activities take place at both hospitals as well as the basic science departments of the SMBS. Current areas of interest include asthma, infections in chronic obstructive pulmonary disease, respiratory muscle and skeletal muscle function, sleep medicine, and a variety of clinical research projects, particularly in sleep medicine, pulmonary rehabilitation, and clinical epidemiology.


Research activities are supported through grants from federal funding and other sources. Potential areas for research participation are discussed in detail with each fellow and arranged on an individual basis. Research opportunities are not limited to the Division of Pulmonary, Critical Care and Sleep Medicine, but can be arranged with other Divisions or Departments in the university, if appropriate and mutually acceptable.


Elective Time

Elective time, if requested, reduces the number of modules available for research, but elective time is available during the third year of training to address areas of individuallized interest.


Vacation

One module (four weeks of vacation time) is available each year. It is taken either as a block or split into several periods. This is usually done in conjunction with elective or research time.


Clinic

In addition to the other responsibilities listed above, each fellow has one weekly pulmonary continuity clinic. These continuity clinics are held at either the VAMC or UB|MD offices at the Dent Tower in Amherst, N.Y. Pulmonary attendings are present in clinic to discuss findings and review plans.


Conferences

Conferences are held during a weekly conference block lasting from 8:00 - 10:00 on Wednesday mornings:

  • Sleep Medicine Conferences and Case Conferences are held the 1st Wednesday of each month
  • Fellows’ Conferences and Case Conferences are held the 2nd Wednesday of each month
  • Pulmonary Medicine Review Conferences and Case Conferences are held the 3rd Wednesday of each month
  • Critical Care Conferences and Case Conferences are held the 4th Wednesday of each month
  • Research Conference is generally held on the 1st Monday of each month.
  • Journal Club is held once per month.

A variety of formats are used, including lecture, small group discussion, and case presentations. In addition to these conferences, the Department of Medicine runs a full complement of teaching sessions at all hospitals as well as a City-Wide Grand Rounds.


For details of our conferences, visit the Calendar Page


Stipend

Fellowship applicants are normally required to have three years of postgraduate training in an accredited Internal Medicine Program. Fellows are paid at a salary level of fourth, fifth, and sixth year graduate trainees. Candidates with h1 and j1 visas are eligible for our program.