Current Pulm/CC Fellows

[VJWDO]

Just curious how many bronchs you all expect to have done by the time you leave your fellowship.
Thanks!
Vjwdo

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[LukeWhite]

I'm on pace for ~70 in the first year. I expect it to slow down 2nd/3rd year (without dedicated bronch months). Anticipating ~150.

 

[jdh71]

Just curious how many bronchs you all expect to have done by the time you leave your fellowship.
Thanks!
Vjwdo

With all the transplant patients, I should easily have over 300

 

[PilonDoc]

In the first year recorded around 150-200, and then stopped counting. Same goes for most procedures.

Exceptions: Navigation Cases, EBUS, and Trachs. I keep track of every single one of them!

I'm looking at credentialing at most hospitals and anything beyond 50-100 for bronchoscopies, and 20-30 for most other procedures is all you need. The only issue may be if they require them to have been performed in the last 1-2 years.

 

[PMPMD]

In the first year recorded around 150-200, and then stopped counting. Same goes for most procedures.

Exceptions: Navigation Cases, EBUS, and Trachs. I keep track of every single one of them!

I'm looking at credentialing at most hospitals and anything beyond 50-100 for bronchoscopies, and 20-30 for most other procedures is all you need. The only issue may be if they require them to have been performed in the last 1-2 years.

Is it common for intensivists to be credentialed for (perc) trachs? If so, is the requisite number for credentialing in the 20-30 ballpark you mention?

 

[VJWDO]

I am 4.5 months in and just hit 100. I was just curious if this was the norm. I feel like we do an obscene amount of bronchs cuz of the transplant bronchs so i was just curious what you all were doing.

 

[gutonc]

I am 4.5 months in and just hit 100. I was just curious if this was the norm. I feel like we do an obscene amount of bronchs cuz of the transplant bronchs so i was just curious what you all were doing.

Transplant centers will do a ridonkulous amount of bronchs. Just like cards fellows at heart transplant centers will have more right heart caths at the end of their first year than they will ever do in the entire remainder of their careers. It's just part of the bidness.

 

[jdh71]

I am 4.5 months in and just hit 100. I was just curious if this was the norm. I feel like we do an obscene amount of bronchs cuz of the transplant bronchs so i was just curious what you all were doing.

Nice.

Bronchs don't really excite me though so I'm not feeling all that left out.

Haven't done a ton yet, but I've not been over at the U (transplant) or the VA (cancer) yet.

Are you guys still trying to win the lung transplant "numbers game" over there?

 

[jdh71]

Transplant centers will do a ridonkulous amount of bronchs. Just like cards fellows at heart transplant centers will have more right heart caths at the end of their first year than they will ever do in the entire remainder of their careers. It's just part of the bidness.

I wish they'd get us in on some of that right heart cath biznus. Outside of training programs the cardiologists NEVER want to do them in the unit, and bitch and moan if we'd like them done in the cath lab. You know what the winning idea is? Let the pulm fellows do them some!!

 

[gutonc]

I wish they'd get us in on some of that right heart cath biznus. Outside of training programs the cardiologists NEVER want to do them in the unit, and bitch and moan if we'd like them done in the cath lab. You know what the winning idea is? Let the pulm fellows do them some!!

I will tell you that the cards fellows at my joint pretty much feel the same way.

 

[VJWDO]

Nice.

Bronchs don't really excite me though so I'm not feeling all that left out.

Haven't done a ton yet, but I've not been over at the U (transplant) or the VA (cancer) yet.

Are you guys still trying to win the lung transplant "numbers game" over there?

Yeah we are pretty crazy with our transplant program. Just came off of my transplant rotation. Not something I am even remotely interested in. And I am pretty sure they are gonna win the numbers game. We just transplant people other places reject ( sometimes a good thing, sometimes a bad thing). I think we have a pretty great transplant team though. It is amazing seeing the people who do well after transplant. It downright sucks taking care of those who don't. It is basically my definition of hell!

 

[Moozy]

We don't have transplant or VA.. but did 75 in my 4 months of Pulm so far. Hoping to reach 120.... After 20 bronchs; they all seem the same to me now. The requirement per ACGME has recently been increased to a 100 for garduation. We dont count are MICU bronchs on new innovations ( department policy).

perc. trachs are not a requirement but total of 10 are needed for credentialing in most places.

I wonder how much EBUS does one have to do for credentialing in future?

 

[Moozy]

With Vigilio out there... do we even need Swans?!!

I will tell you that the cards fellows at my joint pretty much feel the same way.

 

[PMPMD]

With Vigilio out there... do we even need Swans?!!

Yes PACs can still be helpful if the pt is in AFib or has a low EF.

 

[mrpankration]

For the current fellows, how much research is customary to land a spot at a solid program? Would presenting an abstract at ATS be sufficient or do people usually have multiple publications/abstracts? Of course I know that other factors in the application play a part but I'm just wondering how much research you all have done. Thanks.

 

[BuenoMK]

I want to do Pulm/CC and am currently preparing my rank list for IM residency. I want to train at the IM program that will best prepare me for fellowship. My top 4 (in no particular order) are Vanderbilt, Wash U (STL), Mayo, and Yale. I am leaning towards putting either Vandy or Wash U at the top. I want strong pulm/CC research and clinical training. Any thoughts on how to rank these 4 programs?

Thanks, I really appreciate it!

 

[jdh71]

I want to do Pulm/CC and am currently preparing my rank list for IM residency. I want to train at the IM program that will best prepare me for fellowship. My top 4 (in no particular order) are Vanderbilt, Wash U (STL), Mayo, and Yale. I am leaning towards putting either Vandy or Wash U at the top. I want strong pulm/CC research and clinical training. Any thoughts on how to rank these 4 programs?

Thanks, I really appreciate it!

Pulm/crit isn't that competitive and any of those places would be fine for eventually getting into pulmonary and critical care. I'd rank them for Pulm/crit like this:

WashU
Vandy
Mayo
Yale

If you like critical care more then rank vandy higher.

 

[BuenoMK]

Thanks so much, I really appreciate your input!

 

[jdh71]

Went over 100 last week. So I've got enough per ACGME now. I mat stop counting the lookie-lou's and the lavages and only document the procedural stuff going forward.

What's the coolest thing you guys have fished out?

 

[Hernandez]

Went over 100 last week. So I've got enough per ACGME now. I mat stop counting the lookie-lou's and the lavages and only document the procedural stuff going forward.

What's the coolest thing you guys have fished out?

Nothing too exciting, a tooth and an almond. my last month of IM I got a pt who's dental drill broke and she aspirated the drill bit, I still have that X-ray but alas we shipped her out for a rigid bronch.

 

[souljah1]

For the current fellows, how much research is customary to land a spot at a solid program? Would presenting an abstract at ATS be sufficient or do people usually have multiple publications/abstracts? Of course I know that other factors in the application play a part but I'm just wondering how much research you all have done. Thanks.

I think it really depends. ATS does not turn down abstracts. You could take a picture of grandma holding an inhaler the proper way and have it accepted for a poster. The quality of the research is equally, if not more, important than the fact that you present something. This is definitely true for fellowships that are heavily research intensive. For solid community programs, an ATS abstract on anything is probably solid. For competitive academic PCCM fellowships that provide opportunities for formal research training (i.e. Master's degrees), it matters more that: (1) the research is good, and (2) that you demonstrate that you can carry something through to publication. Bonus points if you have an oral presentation as opposed to a poster. Number 2 is often not done by the time interviews are granted, but it provides lots to talk about on the interview trail. The other nice thing a research project provides you with (possibly) is a letter of rec from someone ideally well-known in the field.


For fellowships that care about research:
no research < collaborated on some research < first author on project presented at conference < first author on project presented and now with manuscript submitted for review < first author published < already with formal research training and multiple publications


I agree with others that PCCM is not as competitive as some others. In considering my own experience and those of my co-fellows, none had earth shattering first author publications, but almost all had presented an abstract or something at a conference. Most of them at ATS and then some at SCCM or Chest.

Hope this helps.

 

[souljah1]

Pulm/crit isn't that competitive and any of those places would be fine for eventually getting into pulmonary and critical care. I'd rank them for Pulm/crit like this:

WashU
Vandy
Mayo
Yale

If you like critical care more then rank vandy higher.

If you like critical care, I'd put:
Vandy
Wash U
Yale
Mayo

Mayo is in the middle of nowhere and barely has an emergency department. Most of what they get are referrals, which would be a very limited critical care training. You need some man found down smelling like cheap wine to round things out 🙂

 

[jdh71]

If you like critical care, I'd put:
Vandy
Wash U
Yale
Mayo

Mayo is in the middle of nowhere and barely has an emergency department. Most of what they get are referrals, which would be a very limited critical care training. You need some man found down smelling like cheap wine to round things out 🙂

Yeah, you're probably right about Mayo in the grand scheme of critical care.

 

[mrpankration]

Souljah,
Thanks for your reply. I appreciate your insight.