Pulmonary and Critical Care Fellowship Program

Message from the Fellowship Program Director

Edward Kilb III, M.D.Welcome to the Pulmonary and Critical Care Fellowship Program at the Medical University of South Carolina (MUSC) in Charleston, SC. Thank you for you interest in our program and I hope that the pages of this website inform you of the robust training environment that our program has to offer.

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state’s only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Our campus is located along the Ashley River on the downtown peninsula of Charleston, SC. Our campus contains three separate hospitals where our pulmonary fellows provide in-patient and ambulatory services: MUSC University Hospital, MUSC Ashley River Tower, and the Ralph H. Johnson Veteran’s Affairs Medical Center.

The Pulmonary and Critical Care Fellowship Program was established in 1981 and has grown to a class size of five fellows yearly. The program has full ACGME accreditation and graduating fellows are eligible to sit for both the pulmonary medicine and critical care medicine board exams. Graduates from this program have gone on to very successful careers in academic practice, clinical research, and community based pulmonary and critical care throughout the United States.

Our training program features a strong diversity of clinical experiences with a first year focused on clinical evaluation and management, ambulatory practice, and procedural training. We have developed a structured research education and mentorship curriculum for our fellows that focuses the second and third years on participating in high quality and productive research with additional faculty mentor support for career development and preparation for the transition to the early career environment.

The MUSC Pulmonary, Critical Care, Allergy & Sleep Medicine Division houses 30 academic faculty members who are leaders in pulmonary and critical care, both nationally and internationally. Our faculty have countless years of experience teaching, training, and mentoring fellows to be leaders in our field. The division contains areas of clinical expertise, including but not limited to: lung cancer diagnostics and therapeutics, cystic fibrosis, NTM, ILD, Pulmonary Hypertension, Sarcoidosis, rare lung diseases, telemedicine and more.

Below you will find more information about our program and I strongly encourage you to explore the beautiful city of Charleston, SC.  Should you have additional questions regarding our fellowship program, please contact me at kilbiii@musc.edu or Sophia Zimmermann, program coordinator, at 843-792-7199 or zimmers@musc.edu.

Sincerely,

Edward Kilb III, MD
Assistant Professor of Medicine
Program Director, Pulmonary and Critical Care Medicine Fellowship

 

Application Process

Applications for the MUSC’s combined Pulmonary and Critical Care Medicine Fellowship Program are submitted through the Electronic Residency Application Service (ERAS).

We require that candidates have passed USMLE Step 3 exam (or the equivalent COMLEX Step 3 exam) before entering the fellowship on July 1 and, if applicable, have a current ECFMG certificate. Candidates for the one-year fellowship must be a graduate of a fellowship training program in an internal medicine subspecialty which is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Candidates for the two-year fellowship must be a graduate of a training program in either internal medicine or emergency medicine which is accredited by the Accreditation Council for Graduate Medical Education (ACGME).

We accept candidates who are US citizens or permanent residents (green card) and J1 visas.

The Fellowship Selection Committee reviews completed fellowship application packets which include:

  • Application
  • CV
  • Personal statement
  • Three letters of recommendation
  • USMLE transcript, and/or COMLEX, and ECFMG status report (if applicable)

All application materials, including supporting letters, must be received by Sept 15th for fellowship training to begin in July of the following year.

Each year, the division receives over 400 applications for fellowship training. Approximately 15% of the applicants are invited for formal interviews from mid-August through October. All Fellowship Selection Committee members including the Program Director interview the applicants.

Individuals are selected to interview based on their potential for a successful career in Pulmonary and Critical Care Medicine. Successful applicants demonstrate outstanding academic achievement, well-developed clinical and leadership skills, professionalism and collegiality during their previous training. The fellowship training program values diversity and encourages applicants from a wide variety of backgrounds.

We participate in the Medical Specialties Matching Program for fellowships in Pulmonary and Critical Care Medicine. For more information, see the ERAS website.

Clinical training comprises the entire first year and parts of the second and third years of the fellowship, in structured one-month blocks, under the supervision of designated attending physicians. All fellows with complete a minimum of 18 clinical months spread out over 3 years to contain the core requirements of 6 months Medicine-based ICU, 3 months non-Medicine-based ICU and 9 months Pulmonary core rotations. The remaining 18 months with be chosen by the fellow with guided faculty and research mentorship to develop a successful career pathway.

MUSC MAIN Hospital Core Rotations:

Pulmonary Consultation: The fellow supervises a team of medical residents and/or students in providing inpatient consultation. The fellow will receive training from expert faculty in a wide variety of common and rare pulmonary syndromes. Fellows will get training in pulmonary physiology, interpretation of Pulmonary Function Testing, pulmonary radiology and common pulmonary procedures.

Medical Intensive Care Unit: The fellow supervises a team of medicine residents and interns in the care of critically ill medical patients in this large, closed ICU setting. MICU is a major referral center for state and region.

Procedures: During the procedure rotation in the first year, fellows will gain experience with wide range of cutting-edge interventional technologies, including rigid bronchoscopy, Endobronchial ultrasound (EBUS), Navigational bronchoscopy, Endobronchial brachytherapy, airway stents, Bronchial Thermoplasty and ultrasound guided pleural procedures such as placement of PleurRx® and pigtail catheters. Throughout the rotations, fellows will gain extensive experience with fiber optic bronchoscopy, thoracic ultrasound, pleural manometry, chest tube insertion (surgical and modified Seldinger), tunneled pleural catheters, airway management/endotracheal intubation, ultrasound guided central line placement, bronchial thermoplasty, pulmonary artery catheters, and critical care echocardiography.

ART Core Rotations:

Pulmonary Consultation: The fellow supervises a team consisting of a medical resident and medical student(s) in performing in-patient and occasional emergent out-patient pulmonary consultations. Also attends one half-day pre-op pulmonary clinic. The patient population is largely tertiary care with significant medical complexity.

Lung Transplant:
MUSC is the only lung transplant center in the state and the lung transplant program currently has three dedicated faculty. The program averages approximately 15 transplants per year. The fellow sees and manages pre and post lung transplant patients in both in-patient and outpatient settings gaining exposure to a wide variety of end-stage lung diseases and management of immunosuppressive and prophylactic regimens.

Medical/Surgical Intensive Care Unit: The fellow supervises anesthesia and emergency medicine residents in providing intensive care to patients in the MSICU (closed unit) including general oncology and bone marrow transplant patients, GI and liver patients, transplant recipients. MSICU patients are often transferred in from outside hospitals.

Ralph H. Johnson VA Medical Center Core Rotations:

VA Medical Intensive Care Unit: The pulmonary and critical care fellow leads a team of internal medicine residents in the care of medical ICU patients. The fellow also joins the anesthesia team in the operating room for early cases in order to gain experience with airway management.

VA Pulmonary Consultations: The pulmonary and critical care fellow provides inpatient pulmonary focused consultation for veterans. The fellow also provides all ambulatory pulmonary procedures for the veteran population including, bronchoscopy, EBUS, navigational bronchoscopy and ultrasound guided pleural procedures such as placement of PleurRx® and pigtail catheters.

Ambulatory Training:
Fellows maintain a weekly half day continuity clinic at either the Ralph H. Johnson VA Medical Center or the MUSC East Cooper Clinic for the first 2 years of fellowship training. During the final year, fellows can choose a faculty member to work with for 6 month intervals in subspecialty pulmonary clinics. Subspecialty clinics include cystic fibrosis, ILD, sarcoidosis, pulmonary vascular disease, lung transplantation, lung cancer, rare lung diseases, NTM, sleep, and asthma/allergy clinic.

Additional rotations:

Clinical electives include:

  • Anesthesia
  • Cardiac intensive care unit
  • Surgical intensive care units
  • Trauma intensive unit
  • Cardiothoracic intensive care unit
  • Neurosurgical intensive care unit
  • Pathology
  • Radiology

 

Interpersonal Skills:

All trainees are taught and counseled regarding personal interaction with other members of the health care team, patients, and their families. The attending physicians in the division serve as role models for the trainee. This experience is fostered in the intensive care units, the hospital inpatient services, and the ambulatory care setting. If areas of deficiency are noted in the trainees' interpersonal skills, they are counseled by the attending physician and the Program director.

Professional Attitudes:

Professionalism is expected of all trainees at all times. This includes proper appearance, treating all patients and their families with respect and dignity, treating all other physicians and medical personnel as colleagues, and performing medical duties at the highest level.

Humanistic Qualities:

The trainee is expected to treat all patients and families respectfully and be empathetic with their situation despite the demands placed on their time by patients and their families. The role of the attending physicians is to provide exemplary behavior and serve as role models for the trainee.

MUSC Simulation Center:

Fellows receive central line training at the MUSC Simulation center, in addition to Code Simulation training each month fellows rotate to the MICU. The MUSC Simulation Center is an excellent training resource for fellows. Visit the Health Care Simulation Center website for more information.

Educational Conferences

Core Pulmonary and Critical Care Conferences

Our critical care conference series unites critical care fellows from pulmonary, surgery, anesthesia and neurology fellowship programs to learn from a wide range of critical care faculty with different critical care training and expertise. This conference provides comprehensive critical care education and content is based on the ABIM core curriculum for Critical Care Medicine. Additionally, critical care fellows are able to attend a pulmonology-focused clinically-oriented didactic series by the faculty with content based on the ABIM core curriculum for Pulmonary Medicine. This series complements the pulmonary pathophysiology training of critical care fellows.

Pulmonary and Critical Care Case Conferences and Grand Rounds

This is an hour-long conference in the style of a morning report where recent, interesting cases in ambulatory and inpatient pulmonary and critical care are presented to discuss evaluation, diagnosis and management. Faculty are heavily involved in case discussions. Once monthly, conference is converted to a divisional grand rounds presented by in the fellows on topics in pulmonary and critical care. Fellows perform a literature review of interesting clinical questions on patient diagnosis and management from cases seen on the floor.

Research Conferences and Career Development Series

This conference is a showcase for education and career development in the areas of clinical, translational and educational research. The conference features presentations on anything from completed research by faculty and fellows, to research work in progress, to speakers from other divisions and departments within the University and guest speakers from outside MUSC. The conference brings together colleagues and career scientists in order to convene in an environment that is supportive and with feedback that is constructive. The one-hour meeting typically includes presentation of research results, discussions of experimental design and methods, and suggestions from the audience for future studies. Critical care fellows in the two-year program will have the opportunity to present their work and receive constructive feedback on methodology, data analysis and presentation skills. Additionally, the embedded career development series focuses on developing careers in academic and community medicine. Topics focus on a range of important career skills from manuscript and grant writing to billing and contract negotiations. This focus is on career readiness and development as young professionals.

Journal Club

This is a once monthly conference to discuss influential articles both new and historical in both pulmonary and critical care medicine. Fellows will work with a mentor to select important papers and discuss design, analysis and impact of paper on practice. Statisticians are available to further discuss statistical analysis. This series is designed to teach trainees methods for evaluating scientific literature.

Multidisciplinary Educational Conferences:

Critical Care Grand Rounds

This is a monthly conference attended by a variety of critical care disciplines including surgical, medical, anesthesia, neuro-critical care, and different members of the ICU care team, including nurses, respiratory therapists, physical therapists, and pharmacists. Topics surrounds evidence-based medicine and advanced therapies in critical care.

Interstitial Lung Disease Case Conference

This is a monthly conference attended by ILD pulmonologists, medical transplant, thoracic radiology, pathology and thoracic surgery to discuss work-up and management of ongoing clinical cases of various interstitial lung diseases.

Morbidity and Mortality

This conference addresses cases from the medical and critical care services in which there may be potentially avoidable adverse outcomes. The goals of this conference are to identify medical error, modify future behaviors, and prevent repetition of errors in the future.

Thoracic Tumor Board

This is a weekly conference with medical oncology, radiation therapy, radiology and thoracic surgery held at the Hollings Cancer Center, where case management decisions are discussed regarding potential and confirmed lung and mediastinal malignancies.

Sleep Case Conference and Journal Club

This is a monthly conference with sleep medical, otolaryngology, dental medicine, psychiatry where interesting sleep medicine cases are presented to discuss patient evaluation and management decisions. Recent journal articles are often presented by pulmonary fellows rotating on the sleep medicine service.

 

Research Training & Mentorship

The primary goal of our fellowship programs is to train the future thought leaders of academic pulmonary, critical care and sleep medicine. Rigorous training and in-depth experience in research are central features of the pulmonary and critical care and two-year critical care training programs for all accepted applicants. We recognize that many fellows enter fellowship with limited research experience. Thus, we have established a system to assist each fellow in finding the overall career track, subject area, and career mentor best suited for them.  For more information visit our Research Training and Mentorship website.