Frequently Asked Questions

A list of common queries regarding the UofL Pulmonary/Critical Care Fellowship program.

What hospitals do you rotate in?

During fellowship the majority of the time will be spent amongst these three hospitals, approximately 33% of the time in each one. We do see some patients at Norton, UofL Health - Frazier Reheb Institute, and Kindred (long-term acute care) while on the UofL Hospital - Jewish Campus consult service.

What fellowships does the division offer?

The division houses three training programs (Pulm/CCM, IP, Sleep), which strengthens the teaching enterprise and provides diversity to the program. The division is also well known for excellence in teaching. One of our faculty members has received the "teacher of the year award" from the Internal Medicine Residency Program for the past three years.

How are didactics organized?

On Tuesdays we have an 18-month curriculum that covers the span of what is expected for Pulmonary/Critical Care boards in the context of recent literature. This way each fellow will hear the lectures twice before graduation. Thursdays we have an imaging conference where we review interesting chest x-rays and CT Scans with a chest radiologist and Pulmonary faculty. Fridays are for journal club, Pulmonary grand rounds, research discussion, and invited speakers.

Can you describe the ICU rotation at each hospital?

  • UofL Health - UofL Hospital – The MICU Service includes complicated patients who are referred for advanced consults, procedures, etc, and a very sick indigent population. This is a traditional MICU rotation with multiple residents, interns, one fellow, and one attending running the service. We also do ICU consults on the Bone Marrow Transplant patients when appropriate.
  • VAMC – Also a traditional MICU experience with a structured team of residents, interns, fellow, and attending. Different population than University. We see a lot of advanced COPD, CAD, GI bleed, sepsis, pancreatitis, etc. at this location.
  • UofL Health - Jewish Hospital – Great tertiary care experience. Team consists of attending, NP/PA, Fellow, Family Medicine Resident, and Medical Students. In addition to traditional MICU patients here we also manage transplant, neurosurgery, cardiac, and general surgery patients. Only facility in Louisville that offers ECMO.

Do you manage your own airways?

Yes. Fellows become experienced in all aspects of airway management including direct laryngoscopy, video laryngoscopy (we have both the glidescope and CMAC), use of the bougie, and fiberoptic intubation.

What do you use for hemodynamic monitoring?

We use the Flotrac/VIgileo and bedside ultrasound in addition to the usual measures (i.e. clinical exam, CVP, PCWP, etc).

What modalities are available to treat patients with severe ARDS?

We use inhaled Flolan, Rotoprone bed for prone positioning, and ECMO.

Do you have an Ultrasound curriculum?

Yes we do! Graduated fellows will be competent to perform basic abdominal, pulmonary, pleural, cardiac, and vascular ultrasonography as part the curriculum in critical care medicine. These goals are supported by the American College of Chest Physicians Statement on Competence in Critical Care Ultrasonography and Society of Critical Care Medicine guidelines. We have didactics, simulation lab sessions and bedside critical care ultrasound rounds as part of our ultrasound curriculum. 

What exposure is there to ECMO?

Fellows will have the option to rotate through the Cardio-Thoracic ICU (CVICU) at UofL Health - Jewish Hospital as part of one of the required non-medical ICU rotations. Here patients with appropriate indications are placed on veno-venous or veno-arterial ECMO. You will also have the opportunity to round on pre- and post-lung transplant patients who are placed on ECMO.

What is the structure of the call schedule?

We changed over to a 2-week rotation schedule this academic year and added Night Float to cover the night call. We do have a fellow on back up home call if needed.

What Pulmonary sub-specialty opportunities are available?

We have Lung Transplantation, Pulmonary Hypertension, Interstitial Lung Disease, Cystic Fibrosis, Sleep Medicine, and Interventional Pulmonology. Training in each of these disciplines is integrated into the fellowship. For additional experience, where there is interest, fellows can do clinics in these sub-specialties while on research/elective or a non-medical ICU month.

We also have a Transplant/Pulmonary Hypertension elective where the fellow will round on all the inpatient Transplant/PH patients, attend outpatient clinics, perform surveillance and acute bronchoscopies on transplant patients, and perform right heart catheters for the PH patients.

Do you have more information about the Pulmonary sub-specialties?

To name a few highlights:

  • The Lung Transplant program performs approximately 20 transplants per year and follows/evaluates hundreds of patients
  • The Pulmonary Hypertension program is completely managed by the Pulmonary Division including right heart catheters, and will soon be recognized as an accredited PH Center by the Pulmonary Hypertension Association (application is processing)
  • The ILD program is one of nine programs in the country sponsored by the Pulmonary Fibrosis Foundation
  • The CF program is sponsored by the CF Foundation
  • The IP program has two IP fellowship trained faculty and is the only program in the state of Kentucky
  • The Sleep program owns two sleep labs, one downtown and one at the VA

For more information:

Can you describe the Pulmonary consult service at each hospital?

  • UofL Health - UofL Hospital – We tend to get consults for rare/unusual cases since there is a bone marrow transplant unit, oncology unit, labor and delivery, trauma, etc it creates opportunities to see a diverse range of pathology. Most of the true interventional procedures are performed here (rigid bronch, laser, stenting, pleuroscopy, etc). The fellow will have ample opportunity to participate in these.
  • VAMC – At the VA we have a lot of lung cancer and advanced COPD. We also see many patients with interstitial lung disease. The VA rotation is excellent for outpatient bronchoscopy. Here the fellow will become proficient in transbronchial biopsies, linear EBUS, and radial EBUS. They will also go to the VA IP clinic on Monday afternoons and the Lung Nodule Evaluation Team on Wednesday mornings. We are actively recruiting an anesthesiologist for the Endoscopy suite, once this occurs Navigational Bronchoscopy and more invasive IP procedures such as Rigid Bronchoscopy will become routine at the VA and will primarily be done by the general pulmonary fellows.
  • UofL Health - Jewish Hospital – We see traditional pulmonary consults in addition to the rare Pulmonary Diseases. This is also the center for Pulmonary Hypertension, Cystic Fibrosis, and Transplant. When there isn’t a fellow on the PH/Transplant service the consult fellow can see these patients, and do the associated procedures (bronchs and right heart caths). Finally, we see LTAC patients in Kindred hospital (which is physically attached to Jewish) to get experience with chronic respiratory failure, prolonged ventilator weaning, and tracheostomy management/decannulation.

What is the Pulmonary procedure experience like?

All general pulmonary fellows will get great experience with routine bronchoscopy, bronchoalveolar lavage, transbronchial biopsies, protected specimen brushings, linear EBUS, radial EBUS, percutaneous tracheostomy, thoracentesis, and chest tube placement. There is ample opportunity to get more experience with advanced IP procedures such as navigational bronch, rigid bronch, laser, stenting, tunneled pleural catheter, APC/electrocautery, cryotherapy/cryobiopsy, pleuroscopy, etc, especially if one chooses to do electives on the IP service.

How is the Pulmonary continuity clinic organized?

In the first and second years fellows spend half their time in the University associated clinic and half their time in the VA clinic. In the third year the fellows spend their continuity clinic in the faculty private clinic.

What about sub-specialty clinics?

When fellows are on research/elective or non-medical ICU they can rotate through a Pulmonary sub-specialty clinic of their choosing.

What research opportunities are available?

There are up to 7-10 months of research available. We require a minimum of 6 months of research. Division faculty are engaged in ~30 clinical trials at any given time in the areas of critical care, COPD, ILD/IPF, pulm HTN, CF, etc.als?

Critical Care Studies

Do you have a list of ongoing trials?

  1. PUD Prophylaxis in the ICU. A randomized Trial of PUD prophylaxis plus Enteral Feeding VS TF Plus Placebo.
  2. PAV Compared to Volume Assist Control after failed spontaneous breathing trial.
  3. Retrospective studies on outcome measures in the ICU.
  4. Carotid Doppler for fluid responsiveness.
  5. Randomized trial of Motilin agonist in critically ill patients.

For a more comprehensive list please see this webpage:

What about basic science/translational research?

The division houses scientists studying lung fibrosis, lung inflammation, neural control of lung function, fibroblast biology, oxidant stress, pulmonary hypertension, and other topics. Together with teams in clinical programs, this group supports clinical trials in idiopathic pulmonary fibrosis, cystic fibrosis, COPD, pulmonary hypertension, and critical care, among others. Currently, this work is supported by the National Institutes of Health, the Department of Veterans Affairs, Industry, and private foundations totaling over $1 million in yearly research funds. This program has also served as a catalyst for the submission of grants with other University programs such as Pharmacology/Toxicology, Hepatology, and Nephrology. Recently, the program joined forces with Infectious Diseases and obtained an NIH U01 grant to study the pulmonary complications of HIV.

Do the fellows have an opportunity to present in national meetings?

Yes, we require each fellow to present at a national or international meeting at least once during their training. Six of our fellows had presentations at ATS 2023.

Can I earn an advanced degree while in fellowship?

The University of Louisville offers a Masters or certificate program in Clinical Research, Epidemiology, and Statistics Training (CREST program). It is possible to do this during fellowship but requires advanced planning. Tuition is not covered by the fellowship.

Where can I get more information about the program?