Clinical Training

Fellows rotate on the Pulmonary Medicine Service at all three of our sites. The diverse patient populations and training experiences are a highlight of the program. At UCSF-Parnassus, fellows manage a busy service, seeing quaternary referral patients, immunocompromised patients, and general pulmonary cases and procedures. The VA provides more in-depth exposure to lung cancer and end-stage lung disease patients with considerable outpatient clinical time included in the rotation. Fellows also hold the pulmonary embolism response team pager, round with the anticoagulation team and do pulmonary procedures for inpatients and outpatients. At ZSFG, the hospital for the city and county of San Francisco, fellows manage complex pulmonary cases with an emphasis on infectious diseases, pleural disease, asthma and COPD. Fellows receive comprehensive training in pulmonary function testing during their time on the Pulmonary Physiology rotation. Fellows also receive dedicated training in interventional pulmonary and pleural procedures, including chest tube placement. Another highlight of pulmonary training is the Advanced Lung Disease and Transplant Service. During this rotation, fellows manage end-stage lung disease patients pre- and post-transplant. Fellows receive intense training in the management of patients with interstitial lung disease, COPD, cystic fibrosis, among many others. Fellows also receive extensive training in pulmonary procedures during this rotation.

Training in critical care spans the 18-month clinical program with rotations in ICUs at all three sites. In the first year, fellows spend time in the MICU at the Zuckerberg San Francisco General Hospital and in the Med/Surg/Cardiac ICU at the San Francisco VA. Fellows also spend time in the operating room gaining experience in airway management. In the second year of training, fellows spend additional time in the MICU at the ZSFG Hospital, and also rotate in the Surgical/Trauma ICU there. The critical care experience also includes 2-3 months in the closed-format MICU at UCSF Health-Parnassus as well as rotations in the Neuro-ICU, Surgical ICU, and Cardiac ICU. As a major referral center and active transplant center, fellows will see patients on ECMO and other advanced life support during this experience. Critical care training across the sites includes time in clinical simulation, dedicated point-of-care ultrasound training, and a simulation-based training in code blue response and airway management.

Sleep training occurs during the pulmonary rotations in two formats. First, fellows spend time in dedicated sleep clinics, working with sleep specialists and interpreting studies. This teaching includes a case-based curriculum spanning the 8-10 sleep days spread over the year. In addition, fellows will see some sleep patients in their continuity clinics.

Continuity clinics occur at each of the three hospitals and our Mt. Zion campus. Each clinic is staffed by pulmonary faculty who facilitate a pulmonary outpatient curriculum for the fellows. In general fellows will see between 4 and 6 patients in a clinic half-day at each site. Fellows maintain the same continuity clinic throughout the first three years of training.

Elective clinics are available in the second and third years of fellowship. These clinics provide fellows with the opportunity to gain highly specialized experience in any of 11 elective clinic experiences. This includes Allergy, Severe Asthma, Cystic Fibrosis, HIV, Interstitial Lung Disease, Transplant, Pulmonary Hypertension, Sleep, Thoracic Oncology, Tuberculosis, and ALS Clinic

Boot Camp. This is a packed one-week curriculum to help fellows start the year off right. This curriculum includes essential orientation to our three sites and focused, practical talks on clinical issues most relevant to new fellows.

Summer Series. This is an extension of the Boot Camp curriculum and includes additional practical sessions on clinical pulmonary medicine along with an introductory session on quality improvement during fellowship training. Each weekly session generally includes two topics.

Monday Conference. Our main clinical and research conference, Monday Conference is a time when faculty from all campuses get together to hear about clinical cases and ongoing research. First-year fellows present cases for discussion in first half of the conference. Following a refreshment break, research fellows present their work in the second half of the conference.

Friday Series. This series of lectures, small group exercises and practical training is designed as a foundational experience in pulmonary and critical care medicine. Over the course of the year, fellows will take a more in-depth look at the physiological basis or disease, the hows and whys of pulmonary and critical medicine and clinical problem solving. The series also includes dedicated time for diversity, equity and inclusion learning experiences, and time for work on quality improvement projects.

Radiology Conference. The weekly radiology conference is led by chest radiologists and focuses on helping fellows gain independence in reading CXRs and chest CTs.

ICU Curriculum. Each ICU rotation has a standing didactic curriculum focused on core critical care topics. Some rotations also include ICU report and ICU M&M, in which residents and fellows present cases. The ICU experience at the VA includes a weekly clinical simulation session that focuses on team engagement, interprofessional team work and ICU clinical topics.  

Airway Course/OR. Fellows spend time in the operating room to gain experience in airway management and procedural sedation. OR training is coordinated with a clinical simulation-based ICU airway management curriculum that focuses on ICU-specific issues.

Clinics Didactics. Each of the continuity clinics has a longitudinal curriculum centered around outpatient pulmonary topics. Clinic didactic sessions generally begin one hour before the start of clinic.  

At the main UCSF Medical Center – Parnassus Campus, affectionately called “Moffitt” after the Moffitt-Long Hospital, fellows rotate through a variety of core rotations – the Pulmonary consult service, the Advanced Lung Disease service focusing on lung transplantation, and the Pulmonary Physiology rotation, in addition to having 5 unique ICUs, with ICU rotations on the MICU, SICU, Neuro-ICU and Cardiothoracic ICU. Some fellows will also have their outpatient clinic at Parnassus, with dedicated Pulmonary Faculty Practice teaching attendings.  

In addition to being home to the world-class lung transplantation program, UCSF also is home to our dedicated Interventional Pulmonology program.

Our pulmonary fellow-focused tri-hospital case conference is held every Monday from 3:00-5:00 PM. This is an educational conference drawing faculty from all of our sites to come and learn about interesting cases. The multidisciplinary interstitial lung disease conference also draws rave reviews and faculty from all sites as well as the community come to present challenging cases to a team of world-class UCSF ILD experts.

Located a short stroll from Golden Gate Park, UCSF also houses the School of Medicine, Pharmacy, Nursing, and Dentistry, and UCSF medical students and internal medicine and anesthesia residents rotate at this hospital.

Overall, fellows rave about the experience at Parnassus for the complexity of patients at this quaternary care center, the breadth and depth of faculty research - ranging from basic science to clinical to educational to global health to implementation science - and the feeling of being part of the larger UCSF community. Read more

UCSF Mount Zion Medical Center provides a continuity clinic experience for some of our fellows as well as dedicated sleep experience. It is also the site of our regionally-renowned pulmonary rehabilitation program. The teaching faculty at Mt. Zion participate in a joint outpatient pulmonary clinic curriculum with Parnassus, as part of a national 2-year educational research study. Read more

UCSF Mission Bay is a brand-new hospital focusing on the care of women and children, but also houses several brand-new state-of-the-art laboratory facilities for many of our research faculty. UCSF Mission Bay Consults are covered by the Parnassus Pulmonary consult team, and consults from the Obstetrics team are always high-yield learning opportunities. Robots provide 21^st century ways to practice telemedicine and e-consults, while an in-person consultation can also be a short drive through the city away. Read more

Located in the city’s vibrant Mission district, ZSFG is our county hospital and the only Level One Trauma Center in the city, a place where faculty members and staff alike are driven by their mission to take care of underserved populations. Boasting a newly-renovated state-of-the-art ICU (with over 31 beds), ZSFG has world-renowned faculty focusing on TB, health disparities, HIV lung, and lung biology. Fellows who have their continuity clinic at ZSFG love the chance to work with ZSFG faculty passionate about advocating for their patients, both through their clinical work as well as through their research. Fellows rotate here for Pulmonary Medicine, a dedicated airway/OR rotation, and the highly-rated MICU and Trauma ICU experiences. Moreover, fellows get to attend weekly multidisciplinary TB conferences with the California Department of Public Health as well as participate in procedures. Just like at UCSF, fellows will interact with and teach internal medicine residents and medical students rotating at ZSFG. Read more

With stunning views of the Golden Gate Bridge, the SFVAMC is one of the largest VAs on the West Coast and is a dedicated site for Lung Cancer Screening and ALS care. Fellows rotate through the VA Pulmonary Medicine service and the VAICU, taking care of MICU, SICU, and CCU patients during their first year. Fellows hone their skills in work-up and management of pulmonary nodules and lung cancer by working with VA faculty who have research and clinical expertise in this area. Fellows also lead the Pulmonary Embolism Response Team and Pleural Service. Moreover, the VA is home to many of our pulmonary clinician-educator faculty, who provide mentorship in a variety of projects ranging from medical education research to quality improvement to implementation science. The VA is also the home to our Clinician-Educator track, and provides dedicated funding for interested fellows to do in-depth medical education research. Many of our fellows also have continuity clinic at the VA and continue to work with this special patient population in more detail as well as gain expertise in sleep medicine and ALS. Read more