Training & Curriculum
The program currently has three tracks designed to meet the needs of our fellows' career paths.
Clinical track: This track is intended for those interested in careers in clinical education or as master clinicians. Our fellowship provides the opportunity for those interested in specific specialties to gain needed experience and expertise. Specialties include lung transplantation, pulmonary hypertension, interstitial lung disease and interventional pulmonology.
Research track: Fellows with aspirations for careers in academics can opt for our research track, in which fellows spend a substantial portion of their training time in basic or clinical research without sacrificing clinical training.
Cardiac Critical Care track: Additionally, we offer a one-year critical care-only fellowship for fellows who have completed a cardiology fellowship. This program is run jointly between our division and Cardiology.
Medical Intensive Care Unit
Fellows in the Cedars-Sinai Pulmonary and Critical Care Fellowship supervise medical house staff members and students assigned to the units. Emphasis is placed on learning evidence-based principles of management and on highlighting the pathophysiologic aspects of conditions or treatment modalities.
Fellows will learn both the theoretical and practical aspects of all procedures relevant to the care of critically ill patients (including ICU ultrasounds) and will gain strong experience in neurological, trauma and general surgical ICU care. Participants can also rotate through a variety of other critical care units—including the Cardiac ICU, Cardiac-Surgical ICU, Anesthesiology, Pediatric ICU, Dialysis Unit, etc. During their monthlong Medical ICU rotation, the fellows spend one week working one-on-one with a full-time faculty at Marina Del Rey Hospital MICU.
Procedures
Fiberoptic bronchoscopy is performed by the fellow under the supervision of one of the staff members. Fellows perform more than 200 bronchoscopies during their fellowship. These procedures, as well as needle aspiration biopsies, are performed in the pulmonary/critical care division procedure rooms. In addition, Cedars-Sinai is a major center for yag laser resection therapy, insertion of stents, use of brachytherapy and other state-of-the-art devices, such as navigational bronchoscopy, EBUS and percutaneous tracheostomy.
Cardiac Surgery Intensive Care Unit
This is an intense, one-month rotation intended for second- and third-year fellows. During this rotation, fellows will be part of a multidisciplinary team consisting of faculty from anesthesia critical care, pulmonary and critical care, and cardiothoracic surgery. In addition to actively managing patients undergoing traditional cardiac surgery, fellows will gain exposure and experience in ECMO, heart/lung transplant, ventricular assist devices, total artificial heart, TAVR, Impella and intra-aortic balloon pumps.
Pulmonary Vascular Disease
Fellows on this rotation experience a well-rounded rotation encompassing both inpatient and outpatient management of patients with various types of pulmonary vascular disease. The inpatient component of the rotation involves the active management of newly diagnosed patients with pulmonary hypertension as well as adding consultative services for those with a known diagnosis. In addition to extensive exposure into the use of PH-specific medications, fellows gain experience with echo interpretation and placing right heart catheters. Fellows on this rotation will also run our pulmonary embolism response team (PERT) which provides urgent consultative and management support for patients with known or suspected pulmonary embolism. Fellows will gain experience and familiarity with various types of anticoagulation, thrombolytics, clot retrieval devices, ECMO and clinical trials.
Ambulatory Care
Our fellows work in a variety of outpatient clinical settings. These include a meaningful weekly continuity clinic held at the Kaiser Permanente Los Angeles Medical Center location and through various Cedars-Sinai ambulatory facilities. Specialty clinics include lung transplant, cystic fibrosis, pulmonary hypertension, interstitial lung disease and sleep clinics.
Consultation
Fellows provide pulmonary consultation for the Cedars-Sinai medical and surgical teaching services, as well as other participating hospitals when rotations are held there. During this period, our fellows will supervise medical house staff and students in the pulmonary elective.
Pulmonary Physiology Laboratory
Working in the Pulmonary Laboratory at participating institutions under the supervision of the full-time lab director, fellows learn performance, calculation and interpretation of pulmonary function tests. The physiologic evaluation of patients includes spirometry, lung volumes by dilution and plethysmographic techniques, diffusion, mechanics and blood-gas analysis. In addition, the lab is equipped for sophisticated exercise and other special studies.
Lung Transplantation
Fellows will see patients during the biweekly lung transplant clinic. Patients are evaluated as possible candidates for lung transplantation or treated for care following a lung transplant. Fellows are primarily responsible for transplant patients admitted to the medical center, and each fellow is trained in all aspects of pre-transplant, perioperative transplant and transplant management. They'll also be able to participate in procurement procedures.
Clinical Programs
- Alpha-1 antitrypsin deficiency
- Asthma
- Chronic obstructive pulmonary disease
- Cystic fibrosis
- Interstitial lung disease
- Interventional pulmonology
- Lung cancer
- Lung transplantation
- Pulmonary function and exercise testing
- Pulmonary hypertension
- Pulmonary rehabilitation
- Sleep medicine
- Thromboembolic disease
Our program offers exposure to the full spectrum of pulmonary diseases via the following experiences:
- Inpatient Pulmonary Consult Service: Our teaching pulmonary consult service provides expert guidance to primary medical, surgical and oncology teams on complex pulmonary issues. Consultation requests on ventilator management and procedures may also come from other specialty ICU teams.
- Pulmonary Embolism Response Team (PERT): Fellows coordinate multidisciplinary care with interventional radiologists and cardiologists to manage intermediate- and high-risk pulmonary emboli.
- Lung Transplant: We provide experience along the entire transplant journey, from pre-transplant evaluation, multidisciplinary listing meetings, organ procurement, perioperative management and long-term care.
- Bronchoscopy: Over the course of their fellowship, our fellows perform well over 200 bronchoscopies, including advanced procedures such as endobronchial ultrasound (EBUS), navigational bronchoscopy, lasering and stenting.
- Pulmonary Physiology Lab: Under the supervision of physiology experts, fellows gain proficiency in the interpretation of pulmonary function tests and cardiopulmonary exercise tests, and fellows also have the option to complete a combined inpatient and outpatient elective in Pulmonary Vascular Disease, which includes exposure to performance and interpretation of right heart catheterizations, as well as echocardiograms.
Outpatient pulmonary training includes continuity clinics that range from general pulmonology to subspecialty clinics, such as those focusing on interstitial lung disease, sleep medicine and pulmonary vascular disease.
Fellows rotate through the Cedars-Sinai Medical Intensive Care Unit all three years, with increasing autonomy and educational roles as they progress in their fellowship. In the second or third year, fellows complete a two-week rotation in the Neurology Critical Care Unit. All fellows participate in the care of post-transplant patients in the Cardiothoracic Surgical ICU, and an optional elective may be dedicated to the Cardiothoracic ICU per individualized goals.
In addition to the plethora of procedures that fellows complete on their clinical rotations, we also provide structured education via focused bootcamps:
- First-Year Fellows’ Bootcamp: A practical introduction to common pulmonary and critical care procedures in our state-of-the-art simulation center. These include central venous and arterial catheterization, lumbar puncture, thoracentesis, paracentesis, and introduction to bronchoscopy and orotracheal intubation.
- Airway Series: A collection of didactics and hands-on sessions to foster competence and confidence in management of airways.
- Bronchoscopy: Fellows participate in a yearly multi-institutional, hands-on course focusing on advanced bronchoscopic procedures.
- Ultrasound: We present a monthly longitudinal didactic and practical series to promote facility with use of beside ultrasound.
We hold noon conferences for fellows every day, Monday through Friday. These conferences are structured to provide fellows the opportunity to serve as both learner and teacher.
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
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Fellow-Led |
Radiology Conference |
PFT Conference |
Core Curriculum Didactics |
Core Curriculum Didactics |
Scholarly work tailored to meet specific career goals is an expectation of all fellows in our program. Projects may revolve around quality improvement, medical education or clinical problems.
Fellows interested in a career as a physician-scientist should declare so during the application process. Research fellows will be matched with a research mentor to define projects and productivity to work toward independent funding. These research fellows are supported through both intra- and extramural funding or enter our program through the internal medicine Physician Scientist Training Program (PSTP).
For those interested in a clinical, translational and basic research career, our fellowship offers an academic track, which includes a third year of fellowship training and participation in the Clinical Scholars Program, which provides education, career guidance, pilot study funding, and promotes skill acquisition for aspiring clinician-scientists. In addition, through Cedars-Sinai's partnership in the UCLA Clinical and Translational Science Institute (CTSI), there is the possibility to apply to a master’s in clinical research with tuition support.
Fellows also have the opportunity to enroll in the Cedars-Sinai Master of Science in Health Systems led by Brennan Spiegel, MD, MSHS. It is an accredited 20-month program designed to train tomorrow's healthcare leaders. The program's unique curriculum prepares graduates for a successful career in emerging healthcare fields, including digital health science, mobile health, health technology assessment, big data analytics, quality and performance improvement and health economics.
As a Cardiac Critical Care fellow, you will train and learn alongside other critical care fellows while on rotation through the different ICUs. Our fellowship is designed to provide intense hands on clinical training for those interested in clinical ICU care. The fellows will rotate through Cedars-Sinai Medical Center (CSMC) and Cedars Sinai Marina del Rey Hospital (MDR). Unit rotations include the Medical ICU, Cardiac Surgical ICU, Cardiac ICU, Neuro ICU, and elective time.
Medical ICU
Fellows will spend four 1 month rotations in the Medical ICUs. Three weeks during the block will take place at CSMC where there are two 12 bed medical ICUs. The fellow will supervise medical house staff and students assigned to the units. One week will take place at MDR where fellows will work one on one with intensivists overseeing a 12 bed general ICU. The rotation emphasizes evidence-based principles of management and on highlighting the pathophysiologic aspects of conditions and treatment modalities such as ventilator management, renal replacement therapy, delirium/agitation management and prevention as well as procedural competencies such as bronchoscopy, thoracentesis, airway management.
Cardiothoracic Surgical ICU
Fellows will spend three 1 month rotations in the Cardiac Surgical ICU. There are two 12 bed cardiac surgical ICUs where the fellow will work alongside anesthesia house staff, advanced practice providers and intensivists. Emphasis is placed on learning evidenced-based principles of management of post cardiac surgical procedures including post cardiac surgery, mechanical circulatory support such as ECMO, orthotopic heart and lung transplants.
Cardiac ICU
Fellows will spend four 1 week electives in the Cardiac ICU. There is one 12 bed cardiac ICU where the fellow will work alongside medical house staff and students assigned to the units. Emphasis is placed on learning evidence-based principles of management and on highlighting the pathophysiologic aspects of conditions such as cardiogenic/mixed shock, advanced valvular heart disease, post procedural management of complex coronary disease, malignant arrhythmias, and mechanical circulatory support devices such as intra-aortic balloon pump and impella catheters.
Neuro ICU
Fellows will spend one 1 month rotation in the Neuroscience ICU. There is a 24 bed unit where the fellow will work alongside house staff, advanced practice providers and intensivists. Emphasis is placed on learning evidenced-based principles of management of acute neurological conditions such as acute ischemic stroke, intra-parynchemal hemorrhage, status epilepticus, as well as exposure to modalities of neurological imaging such as CT/MRI and procedures such as EEG and lumbar puncture.
Elective time
Elective time may include airway management on the airway service, bronchoscopy performed in the bronchoscopy lab, rotations in infectious disease or nephrology or dedicated research time with a pre-specified project.
Have Questions or Need Help?
Contact us if you have questions or would like to learn more about the Fellowship at Cedars-Sinai.
8700 Beverly Blvd., Room 6735
Los Angeles, CA 90048