Interventional Pulmonology Fellowship

Trainees are expected to develop competence in procedures essential to the diagnosis and management of complex airway problems, benign and malignant central airway obstruction, and pleural diseases. In addition to development of procedural skills, trainees must gain an understanding of the indications, contraindications, complications, and interpretation of various tests and treatment strategies common to an Interventional Pulmonologist.

Trainees are expected to present a comprehensive review of the following core topics during the course of their fellowship:

1. Endobronchial ultrasound
   2. Thermal Therapy:
       - Argon plasma coagulation
       - Endobronchial Laser therapy
       - Cryotherapy
   3. High dose endobronchial brachytherapy, PDT and cryotherapy
   4. Endobronchial stents
   5. Management of endobronchial lesions:
       - Evaluation of endobronchial lesions
       - Use of rigid bronchoscopy vs. flexible bronchoscopy
       - Multimodality treatment and palliation of advanced lung cancer
   6. Hemoptysis
   7. Early detection of lung cancer
   8. Management of early lung cancer (metaplasia, dysplasia, CIS, AAH)
   9. Evaluation of pleural diseases
   10. Management of malignant pleural effusions
   11. Bronchoscopic therapy for asthma and emphysema
   12. Bronchoscopic management of benign airway strictures and obstruction

In addition to expanding their clinical experience of Pulmonary Medicine, subspecialty trainees are expected to develop, hone and exhibit scholarship by participating in research activities of the Department of Pulmonary Medicine under the supervision of George A. Eapen, M.D., at MD Anderson Cancer Center. Opportunities for investigation will focus on clinical research projects related to diagnosis and management issues in Thoracic Oncology.

Participant’s Supervisory and Patient Care Responsibilities

Trainees are expected to attend in outpatient clinics on weekdays, where they will participate in the provision of consultative services to all referred patients, both inpatient and outpatient under the direct personal supervision of a staff Interventional Pulmonologist. Trainees are also expected to participate in a call duty schedule for emergencies. Maximum duty hours will be tracked and not exceeded. Faculty members of The University of Texas MD Anderson Cancer Center will supervise trainees during rotation and for procedures. All supervising faculty involved in Interventional Pulmonology rotations are Board-certified in Internal Medicine and Pulmonary Diseases. Faculty supervision includes but is not limited to the following: approval of procedures to be performed after discussion of the indications, contraindications, and possible complications of each specific case; close assistance during performance of procedures; aid in interpretation of results of procedures as indicated, as well as further treatment planning.

Procedural Requirements

Trainees are expected to develop competence in procedures essential to the diagnosis and management of complex airway problems, benign and malignant central airway obstruction, and pleural diseases. In addition to development of procedural skills, trainees must gain an understanding of the indications, contraindications, complications and interpretation of test results to attain mastery of Interventional Pulmonology. Fundamental procedural competence should include therapeutic bronchoscopy, electrocautery, argon plasma coagulation, cryotherapy, airway stent insertion, balloon bronchoplasty and dilatation techniques, endobronchial radiation (brachytherapy), bronchoscopic resection and dilatation, endobronchial ultrasound, transbronchoscopic needle aspiration and biopsy, percutaneous dilatational tracheotomy, and transtracheal oxygen catheter insertion. Pleural procedures include thoracentesis, chest tube placement, pleuroscopy, pleural biopsies and pleurodesis.

During rotations in Interventional Pulmonology, trainees will be taught by their supervising attending. Teaching styles are unique to each attending, but typically learning occurs through “hands-on” and “patient-directed” avenues based upon topics suggested by clinical consultations. Attending will provide trainees with pertinent bibliography and printed materials as appropriate in illustrating important teaching points for cases. To augment this experience-based learning, the trainees will be provided with a pertinent reading list to cover essential topics in Interventional Pulmonology.

Didactic Components

Additional teaching occurs through a didactic series of multidisciplinary lectures occurring in the Texas Medical Center. Weekly sessions include MD Anderson Pulmonary Conference, MD Anderson Thoracic Oncology Conference, MD Anderson Thoracic Surgery Conference, Combined Modalities Oncology Conference at UT Medical School at Houston, Pulmonary Fellows Journal Club, Pulmonary Oncology Journal Club and Pulmonary and Critical Care Medicine Grand Rounds. These conferences include a broad array of subject matter and diverse speakers both intramurally and from institutions outside the program. Conferences are considered an integral component of the educational process for fellowship training, and attendance is mandatory for these seminars.

Evaluation

Fellows will be evaluated by supervising faculty at the conclusion of each rotation using the web-based graduate and undergraduate eedical education software, New Innovations. Employing the standard 9-point ABIM evaluation form, faculty will complete timely assessments in writing for submission to the fellowship program director. To provide feedback to trainees, faculty members are encouraged to verbally review performance during and at the conclusion of each rotation. In addition, fellows undergo periodic performance reviews at least semiannually with the program director.

Fellows are expected to complete an evaluation form at the conclusion of each rotation to assess both supervising faculty and the rotation itself. In addition, the program director solicits input from the trainees regarding the quality of rotations and means to improve the academic character of the Interventional Pulmonology fellowship program.

Training/Selection Criteria (Prerequisite Training)

Physicians who satisfactorily complete at least a two-year fellowship in Pulmonary Medicine; following completion of training in Internal Medicine; can be considered for admission to the one-year Interventional Pulmonology fellowship. Pulmonary specialty training should take place in a pulmonary fellowship program accredited by and in good standing with the Accreditation Council for Graduate Medical Education. Alternatively, foreign medical graduate physicians can be considered for entry after completing four years of training abroad specifically in Pulmonary Medicine. International Medical School graduate candidates must also have a valid permanent ECFMG certificate.

Application Process:

We require all applicants to apply via the electronic AIPPD application system.  After review of the provisionally acceptable application, a decision to interview the applicant is made, and a one-day virtual interview itinerary is arranged, which includes appointments with the program training director, principal fellowship training faculty personnel and selected other clinical faculty from the Department of Pulmonary Medicine. Evaluations are obtained from each interviewing representative.

Based on the supplied application materials, evaluations and any necessary personal, professional or solicited references, a decision is made to either provide an informal offer or to reject a candidate.

Each accepted applicant is supplied a copy of the Interventional Pulmonology Fellowship orientation manual, conference schedules, general fellowship guideline brochure and the MD Anderson Trainee Survival Guide.