Pulmonary Disease
and Critical Care Medicine
Training Program
Revised September 2001
(subject to change without notice)
Program Graduate Dr. Kristen Fless with Resident
Dr. Phung in the Uinversity Hospital Medical Intensive Care
Uint
I. Overview
Candidates for our program have usually completed training
in internal medicine and are eligible to take the American
Board of Internal Medicine certification examination in Internal
Medicine. By the time of completion of their training, fellows
will fulfill the requirements for certification by the ABIM
in Pulmonary Diseases and, if desired, in Critical Care Medicine.
Opportunities are also available to pursue training in sleep
disorders. To meet these goals, during the first year of training
fellows usually spend 3 to 4 months at each of the major teaching
hospitals of New Jersey Medical School (NJMS), i.e. University
Hospital, Hackensack University Medical Center and the New
Jersey Veterans Administration Hospitals (East Orange VA).
The training emphasis at each of these hospitals will be dictated
by the major teaching strengths of the individual programs
(see below) and, in sum, will include pulmonary consultation,
intensive care medicine, pulmonary function testing, evaluation
of sleep disorders, and all relevant pulmonary procedures.
The scheduling for the second and third years will depend
upon the specific career interests of the trainee. During
the 3 years of training leading to certification in both Pulmonary
Diseases and Critical Care Medicine a fellow is offered 9
months of research/elective time. Research is considered of
great importance in our program and every trainee is required
to devote a portion of time in the latter years of the program
to this activity. For those who also wish Critical Care sub-certification
additional time will be spent in the critical care units as
delineated below. Certification requirements in sleep medicine
are undergoing changes. It is likely that fellows interested
in achieving certification in sleep medicine, as well as pulmonary
and critical care, will be required to spend additional time
devoted to sleep medicine.
This brochure is provided for informational purposes only
to present an overview of our program. While it provides an
accurate description of the program at the present time, it
is not intended to constitute a contract or guarantee regarding
our program.
II. Facilities and Services
A. University Hospital
The primary teaching hospital of NJMS is University Hospital.
This 466-bed general hospital located in Newark, New Jersey,
was constructed in the mid-seventies. It is designated as
a Level 1 Trauma Center and has special units for diagnosis
and treatment of diseases in each of the subspecialties
in internal medicine, surgery, neurology, psychiatry, pediatrics,
obstetrics-gynecology, radiology, pathology, and rehabilitative
medicine.
1. Consultation Service
The Pulmonary and Critical Care Medicine Division
at University Hospital consists of both full-time and
part-time members. We maintain an active inpatient consultation
service. Our patients encompass a broad spectrum of
clinical problems. Trainees are responsible for the
evaluation and for provision of management recommendations
for these patients. We make daily teaching and service
rounds.
We have well-equipped pulmonary physiology laboratories
at the University Hospital. During the first year of
training while at University Hospital, the trainees
evaluate the patients referred to this laboratory. Each
day the laboratory work is presented to one of the senior
staff physicians. During the rotation through the consultation
Pulmonary Service, the trainee learns theory, techniques,
and maintenance of pulmonary function equipment including,
computerized spirometry, diffusion testing, inhalational
challenge, and exercise testing.
University Hospital has a procedure room for performing
fiberoptic bronchoscopy. Bronchoscopic techniques generally
include bronchoalveolar lavage, brush biopsies, transbronchial
forceps biopsies and Wang needle transbronchial biopsies
of mediastinal lymph nodes. This equipment can be moved
to the bedside or to the fluoroscopy suite, if necessary,
to monitor transbronchial biopsies. Fellows perform
bronchoscopy under the direction of the Pulmonary and
Critical Care staff physicians. Fellows also gain experience
in other special procedures such as pleural biopsies,
lung needle aspiration, Swan-Ganz catheterization, chest
tube insertion, intubation, and brachyradiotherapy.
The Medical Intensive Care Unit of University Hospital
consists of 15 beds with a companion Coronary Care Unit
of 15 beds. These combined units have a total of about
1800 admissions per year. The MICU provides a major
resource for teaching critical care medicine and pulmonary
disease in critically ill patients. Pulmonary and Critical
Care Unit faculty members participating in this Unit
include Drs. Matthew Marin, Al Cuyjet, Stasia Jastrzembski,
Robert Fede, and Kristin Fless. This unit has state-of-the-art
monitoring facilities, ventilators, and a nurse-to-patient
ratio of between 1:3 and 1:1. As a first-year fellow,
you will be a frequent rounder, and consultant for the
house staff assigned to this unit. Additionally, you
will participate in resident teaching and have direct
involvement with pulmonary artery catheter placement
and interpretation of data, pleural biopsies, and therapeutic
and diagnostic bronchoscopies performed in the MICU.
2. Outpatient Clinical Service
Throughout their training, fellows participate in a
weekly outpatient clinic. Emphasis in this clinic is placed
on teaching rather than providing primary care for a large
number of patients. Fellows also use this clinic to follow
selected inpatients after discharge from the hospital.
This design provides fellows with the opportunity to see
unusual cases, as well as the chance to gain experience
in the long-term management of selected patients with
chronic respiratory diseases.
3. Other Clinical Opportunities
The division maintains a close association with the New
Jersey Medical School National Tuberculosis Center, directed
by Dr. Lee Reichman. This nationally recognized facility
provides a unique opportunity for the fellow to learn
about the diagnosis, treatment, and research related to
Mycobacterium tuberculosis. Additionally, fellows have
the opportunity to provide consultations on the Surgical
and Neurological Intensive Care Units. The flexibility
of the program permits fellows to arrange for elective
rotations on Cardiology (including the catheterization
laboratory), Infectious Diseases, Immunology and Allergy,
other medical subspecialties, the Cardiothoracic Surgery
Division, the Cystic Fibrosis Service, Pediatric Allergy,
and the Neonatology Division.
During subsequent years, fellows with interest in certification
in Critical Care Medicine spend the requisite clinical
time in the MICU of University Hospital and in the Intensive
Care units of East Orange VA Medical Center, and/or Hackensack
University Medical Center.
4. Conferences at University Hospital
Our conference schedule is listed below. In addition
to didactic teaching, these conferences provide an opportunity
for fellows to learn the techniques of effective scientific
communication, including public speaking and the proper
use of audio-visual aids.
a. NJMS-Wide Clinical Pulmonary and Critical Care
Conference (weekly):
This conference presents a review of clinical disorders
and concepts focused on patients seen in our teaching
hospitals. In addition to our full-time attendings,
community physicians actively participate in this conference.
The fellows are exposed to a variety of ideas and perspectives.
Fellows, visiting faculty, and University faculty members
present clinical topics and cases of special interest.
b. Tuberculosis Conference (weekly):
This conference is held in conjunction with the National
Tuberculosis Center. Cases, topics, and research related
to tuberculosis are presented.
c. Core Curriculum in Pulmonary Function Testing,
Pathology, and Pulmonary Diseases:
During weekly conferences, senior faculty members
conduct a core curriculum in pulmonary function testing.
Further, staff lung pathologists present core curricular
materials on lung pathology. These sessions are supplemented
by individual discussions with the lung pathologists
throughout the academic year regarding pertinent biopsy
specimens from fiberoptic bronchoscopy, as well as,
interesting surgical pathology and autopsy material.
Additionally, didactic sessions covering basic issues
regarding pulmonary diseases are presented. Once per
month recent journal articles or on-going research of
faculty, fellows, or visitors relating to pulmonary/critical
care medicine are covered.
d. Clinical Pulmonary Function Laboratory Review
(each week day):
Patients evaluated in the Pulmonary Laboratory are
reviewed in this conference with one of the staff physicians.
e. Pulmonary/Thoracic Surgery/Oncology Conference
(weekly):
This interdisciplinary clinical conference reviews
management of oncological diseases involving the thorax
and the lungs.
B. Department of Veteran Affairs Medical Center, East
Orange and Lyons Campuses
The Department of Veterans Affairs New Jersey Health Care
System consists of two medical centers, East Orange and
Lyons. The East Orange VA Medical Center is a 500-bed tertiary
referral facility within the Department of Veterans Affairs.
VA hospitals and outpatient facilities from eastern Pennsylvania,
New York and New Jersey utilize the cardiac catheterization,
medical and surgical oncology and radiation therapy services
of the East Orange VA Medical Center in care of their patients.
In addition, the East Orange VA Medical Center serves as
a referral center for a variety of medical and surgical
problems. The Lyons VA Medical Center is a general medical
and neuropsychiatric facility.
1. Consultation and Inpatient Service
Three full-time attending physicians staff the Pulmonary/Critical
Care Section. The section has primary care responsibility
for an eight bed chronic ventilator care area. A pulmonary
attending and fellow manage patients in this ventilator
area. Fellows assist in the overall supervision of the
care of these patients. Patients are also admitted to
the pulmonary section for both diagnostic and therapeutic
interventions.
The division provides pulmonary consultation for the
entire medical center, both on an inpatient and outpatient
basis. Pulmonary malignancies, chronic obstructive lung
disease, interstitial diseases, sarcoidosis, tuberculosis
make up the majority of the referrals to this center.
Fellows gain experience in the performance of fiberoptic
bronchoscopy with transbronchial lung biopsy, thoracentesis
with closed pleural biopsy, transbronchial lung aspiration
and biopsy and percutaneous needle aspiration (in conjunction
with diagnostic radiology).
The Pulmonary Section supervises and works closely
with the Respiratory Therapy Section. Pulmonary fellows
are active in providing in-service programs on the operation
of ventilators and in the basic aspects of respiratory
therapy. A fully equipped Pulmonary Function Laboratory
is available. Measurements of lung volumes, flow rates,
diffusion capacity, body plethysmography, methacholine
challenge and pulmonary exercise stress testing are
all performed. There is also a sleep laboratory for
the evaluation of sleep apnea. The ICU is a combined
eight bed MICU/CCU.
2. Outpatient Clinics
The Pulmonary Section conducts two outpatient clinics
weekly. The Section provides sub-specialty, consultative
care for the outpatients. This outpatient experience
allows fellows to follow patients longitudinally who
are being treated for tuberculosis, acute lung interstitial
illnesses, as well as chronic respiratory problems.
3. Conferences
In addition to the above, the following conferences
are presented at the East Orange VA Medical Center.
a. Admission/Case Review Conference
This weekly conference reviews inpatient admissions
and interesting consultations.
b. Pulmonary/Thoracic Surgery Conference
This weekly conference allows discussion of potential
surgical cases with the thoracic surgery physicians.
C. Hackensack University Medical Center
Hackensack University Medical Center has 619 beds. Recently,
its pulmonary program was cited as one of the 50 best in
the country by US News and World Report. It boasts the largest
number of admissions in the State of New Jersey. The hospital
provides a level II Trauma Center, cardiac surgery, bone
marrow transplantation and a full range of acute medical,
surgical, pediatric and obstetrical and gynecological services.
1. Consultation and Inpatient Service
The Pulmonary Section has 3 full time and 6 part time
members. They provide a full range of Pulmonary and
Critical Care services, including consultations, pulmonary
function and cardio-pulmonary exercise testing, pulmonary
rehabilitation, and a fully accredited sleep/wake disorders
center. The bronchoscopy service averages 600 bronchoscopies
per year. Transbronchial biopsies, Wang needle aspiration
biopsies, and laser bronchoscopies are all available.
The Section also participates in providing Critical
Care and Respiratory Care Services for the 10 medical,
7 respiratory, 14 surgical, 10 cardiac care and 18 cardiac
surgery beds.
2. The Breath and Lung Institute
This is a regional outpatient multidisciplinary service
for the diagnosis and treatment of disorders related
to breathing or chest medicine. The team includes Pulmonary,
Allergy, Otorhinolaryngology, Cardiology, and Gasteroenterology.
Fellows have an opportunity to participate in the care
of patients evaluated in the Institute. Also, available
is an extensive pulmonary rehabilitation and smoking
cessation program.
3. Conferences and Teaching Rounds
Faculty members of the Section make daily rounds with
the Fellows on both the Pulmonary and Critical Care
Services. In addition the following conferences take
place:
a. Morning Report
The attendings, fellows and residents meet each
morning to review active cases.
b. Journal Club
Fellows and faculty meet each week to review critically
articles in the scientific literature, which are of
relevance to Pulmonary and Critical Care Medicine.
c. Pulmonary Function Tests and Exercise Study
Review
Fellows meet on a daily basis with faculty to review
these tests.
d. Sleep Medicine Conference
Fellows meet on a weekly basis to review interesting
patients with sleep/wake disorders. Interpretation
of sleep studies is emphasized.
III. Research Opportunities
It is our feeling that both clinical and basic research
activities are extremely important in developing critical
thinking. Therefore, we require all fellows to participate
in a research project. Skills acquired during research training
are the fundamental tools for careers in academic medicine,
as well as, clinical practice. Most fellows initially have
insufficient background to know precisely what type of investigation
they wish to do. We frequently suggest participation in ongoing
projects. However, we also encourage fellows to develop well-conceived
projects of their own which seem likely to lead to fruitful
conclusions. We encourage our fellows present their original
work at national meetings and publish their findings in peer-reviewed
journals. We encourage interdisciplinary research that takes
advantage of the extensive research resources available in
other clinical departments, as well as basic science departments.
IV. Supplementary Training
We believe fellows can receive valuable supplementary training
from educational opportunities outside the University. Therefore,
each fellow is provided with funds to attend at least one
national thoracic meeting per year during their second and
third years, as well as special conferences and meetings related
to their research.
V. Certification
Our program is certified by the American Board of Internal
Medicine to provide subspecialty training in Pulmonary Diseases
and in Critical Care Medicine. With three years of training,
fellows are then eligible to take both the Pulmonary and Critical
Care board examinations.
VI. Location
All of the participant hospitals are located in northern
New Jersey, either in or adjacent to Newark. The northern
New Jersey metropolitan area offers virtually unlimited opportunities
to enjoy cultural, recreational and educational pursuits.
Newark is an active business and industrial center with a
population of approximately 350,000. It has two large educational
complexes composed of several adjacent universities and schools
of higher education. Smaller urban and suburban communities
offering a full spectrum of suitable housing surround the
city. New York City is only minutes away and is easily accessible
by both public and private transportation. The area hosts
major and minor sport teams. There is also a broad range of
recreational areas within easy reach, including the shore
areas of New Jersey, and the lake and mountain areas of northwestern
New Jersey.
STAFF PULMONARY DISEASES AND CRITICAL CARE TRAINING PROGRAM
Director, Pulmonary Disease/Critical Care Training Program:
Matthew G. Marin, Professor of Medicine. University Hospital.
A.B., University of Rochester, 1965; M.D., University of Rochester,
1969, M.P.H., Columbia University, 1999; Medical House Staff,
University of Michigan, 1969-1972; Clinical and Research Trainee
in Pulmonary Diseases, Cardiovascular Research Institute, University
of California at San Francisco, 1972-1976. Member of the Faculty
of the University of Rochester 1976-1994. Director, Respiratory
Intensive Care Unit, 1989-1993; Associate Director, Medical
Intensive Care Unit, 1989-1993, Member of the Faculty of University
of Medicine and Dentistry-New Jersey Medical School 1994-present.
Director of Division of Pulmonary and Critical Care Medicine,
University of Medicine and Dentistry--New Jersey Medical School.
Associate Director: Hormoz Ashtyani, Clinical Assistant Professor
of Medicine. Hackensack Medical Center. M.D., Tehran University
Medical School, 1970; Medical House Staff, Hackensack Medical
Center, New Jersey Medical School, 1974-1977; Teaching Fellow,
Internal Medicine, Hackensack Medical Center, New Jersey Medical
School, 1977-1978; Pulmonary Fellow, Norwalk Hospital, 1978-1980;
Staff Associate and Visiting Fellow, Columbia Presbyterian Medical
Center, 1980-1982; Attending Physician, Hackensack Medical Center,
1983-present; Chief Pulmonary Division, Bergen Pines County
Hospital, 1983-1992; Director Institute for Sleep/Wake Disorders,
Hackensack Medical Center, 1992-present; Chief of Pulmonary
Section, Hackensack Medical Center, 1994-present.
Associate Director: Aloysius Cuyjet, Assistant Professor of
Medicine. University Hospital; B.A., Brandeis University, 1968,
M.D., New York University, 1972, M.P.H., Columbia University,
1998, Internal Medicine Internship and Residency, Harlem Hospital
Center, 1972-1975; Cardiology Fellowship, Harlem Hospital Center,
1975-1977, Attending and Director of Adult Cardiac Non-Invasive
Laboratory Harlem Hospital, 1977-1980, Director of Medicine
and Critical Care Medicine, United Health Care System, 1980-1997,
Director of Critical Care, University Hospital, 1997-present.
Associate Director: Walter Strauss, Clinical Assistant Professor
of Medicine. East Orange Veterans Administration Medical Center;
B.A., Clark University, 1974; M.D., Albert Einstein College
of Medicine, 1978, Internal Medicine Internship and Residency,
UMDNJ/New Jersey Medical School, 1978-1981; Pulmonary Fellowship,
Albert Einstein College of Medicine, 1981-1983, Staff Physician
Pulmonary Section, East Orange VAMC, 1983-present.
Other Faculty Members
Ashtyani, Fariborz, M.D., Clinical Assistant Professor of Medicine,
Hackensack University Medical Center
Aurora, Rashmi, M.D., Staff Attending Physician, East Orange
VA Medical Center
Bolanowski, Paul, M.D., Associate Professor of Surgery, University
Hospital
Carilli, Albert, M.D., Clinical Professor of Medicine, Hackensack
Medical Center
Chinard, Francis, M.D., Distinguished Professor of Medicine,
University Hospital
Fede, Robert M., M.D., Assistant Professor of Medicine, University
Hospital
Fennelly, Kevin P., M.D., M.P.H., appointment pending to University
Hospital
Fless, Kristin, M.D., appointment pending to University Hospital
Gbayisomore, Akingboju, M.D., Assistant Professor of Clinical
Medicine, University Hospital
Jastrzembski, Stasia, M.D., Assistant Professor of Medicine,
University Hospital
Johanson, Jr., W. G., M.D., Professor of Medicine, Chairman
of Medicine, University Hospital
Lardizabal, Alfred, M.D., Assistant Professor of Medicine,
University Hospital
Lavietes, Marc, M.D., Associate Professor of Medicine, University
Hospital
McDonald, Reynard, M.D., Professor of Medicine, University
Hospital
Park, Maryann, M.D., Staff Attending Physician, East Orange
VA Medical Center
Polkow, Melvin, Clinical Assistant Professor of Medicine, Hackensack
Medical Center
Reichman, Lee B., M.D., Professor of Medicine, University Hospital
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