Section 2: Program Description, Curriculum & Goals

Introduction

The Naval Medical Center San Diego (NMCSD) Pulmonary Disease/Critical Care Medicine Fellowship Program provides comprehensive clinical training in pulmonary disease and critical care medicine for physicians already trained in general Internal Medicine. This three-year program adheres to the guidelines established by the American Thoracic Society/American Lung Association, the American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education (ACGME).

Core Competencies

In accordance with the ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease and Critical Care Medicine, this fellowship emphasizes six primary competency areas:

• Medical Knowledge
• Communication
• Patient Care
• Professionalism
• Systems-Based Practice
• Practice-Based Learning

Fellows acquire these competencies through a combination of formal instruction and clinical experience. A high-level overview of each core area is outlined below. Specific educational goals and detailed requirements can be found in Appendix 1: ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease and Critical Care Medicine, Section IV.B.

Pulmonary Medicine

The program provides an environment that fosters knowledge and skills in the diagnosis and management of pulmonary diseases, technical and procedural competence in pulmonary medicine, supervisory responsibilities, and a strong foundation in molecular biology, pulmonary physiology, and immunology.

Critical Care Medicine

The program ensures that fellows gain expertise in diagnosing and managing critically ill patients, developing technical/procedural competence in critical care, supervisory skills, and a comprehensive grasp of relevant basic science (molecular biology, pulmonary physiology, immunology).

Other Integrative/Cross-Disciplinary Competencies

Fellows also develop broader expertise in quantitative clinical reasoning, evidence-based medicine, practice management, legal medicine, medical informatics, preventive medicine, medical ethics, palliative care, and principles of diversity and inclusion.

The fellowship consists of 39 four-week rotations, with a minimum of 24 clinical rotations and 3–6 research rotations. There are nine months of electives, which may be used for additional research or clinical training. Actual rotation blocks and locations can be adjusted to meet individual trainee needs. Some electives may become required rotations in the future.

Below is a general outline of the rotations by year. Some times/days for continuity clinic, academic half-days, and conference schedules are shown for reference.

• Year 1: 4 weeks are dedicated to identifying a research focus and mentor.
• Year 2: 8 weeks for clinical or basic scientific research.
• Year 3: 8 weeks for clinical or basic scientific research.

Additional Notes

• If the research requirement is completed (or if the plan is deemed incomplete) after Year 2, the Year 3 research rotations may convert to clinical rotations at the discretion of the program director.
• An additional 4-week research block may be requested during Year 3 for ongoing projects, subject to program director approval.

Fellows are expected to attend and participate in the following conferences and lecture series:

• Pulmonary Evidence-Based Medicine Conference: Monday 07:30
• Pulmonary Case Conference: Friday 07:30
• Pulmonary Tumor Board: Wednesday 11:00
• Pulmonary Faculty-to-Fellow Lectures: Tuesday 07:30
• Fellow PD Meeting: 1st Wednesday 12:30
• Pulmonary Journal Club: 2nd & 4th Wednesday 12:30
• Research Conference: 3rd Wednesday 12:30
• Pulmonary Radiology Conference: Wednesday 14:30
• Pulmonary and Critical Care Core Lecture Series: Wednesday 13:30
• Internal Medicine Daily Conference: Daily 08:00
• ICU Core Lecture Series: Monday–Thursday, immediately following ICU rounds
• ICU Morbidity/Mortality Conferences: 4th Thursday 07:00
• Research Training Methods: Conducted via CID
• Annual Update Training: SEAT
• BLS, ACLS, ATLS, FCCS, TCCC: As required to maintain certification
• UCSD/NMCSD Introduction to Pleural Disease Hands-on Course (1st-year fellows)
• UCSD/NMCSD Introduction to Bronchoscopy Hands-on Course (1st-year fellows)
• Southern California EBUS Fellow Course (1st-year fellows)

Below are the primary tools and methods used to evaluate fellows’ progress and competency in the six ACGME core domains:

Medical Knowledge

• Morning Pulmonary Case Conference: Assesses ability to interpret imaging, synthesize data, and recommend treatment plans.
• Wednesday Radiology Conference: Evaluates knowledge of imaging interpretation for pulmonary diseases.
• Monthly Rotation Evaluations: Faculty assess the fellow’s synthesis of physical exam, laboratory, and imaging data, as well as procedural knowledge.
• Core Lecture Requirement: Fellows deliver four core lectures annually on pulmonary or critical care topics.
• APCCMPD In-Service Examination: Annual in-service exam for Pulmonary/Critical Care Medicine.
• Board Examinations: Pulmonary and Critical Care Medicine subspecialty boards.

Communication

• Morning Pulmonary Case Conference
• Outpatient Clinic (case presentations, record reviews)
• Core Lectures
• Presentations at National Meetings

Patient Care

• Morning Pulmonary Case Conference
• Monthly Rotation Evaluations
• ICU Rounds
• Pulmonary and Critical Care Procedures
• Outpatient Clinic (case presentations, record reviews)
• Morbidity and Mortality Conferences

Professionalism

• Active Medical License
• Valid BLS/ACLS Certification
• Up-to-date R-Status
• Conference Attendance
• 360 Evaluations and ICE Comments
• Observed Interactions with Subordinates and Staff

Practice-Based Learning

• Morning Pulmonary Case Conference
• ICU Rounds
• Outpatient Clinic

Systems-Based Practice

• Monthly Rotation Evaluations
• Root Cause Analysis (RCA)
• QI/PI Project

Overview

A QI/PI project involves identifying a practice gap, implementing an intervention to address that gap, and measuring the impact of the intervention. Fellows must complete at least one QI/PI project during their fellowship and present it to the department prior to graduation. Institutional policies for resident and faculty engagement in Quality Improvement (QI) and Patient Safety (PS) are detailed in the “NMCSD GMEC Policy for Faculty and Resident Engagement in QI”, which outlines requirements such as completing IHI Open School Basic Curriculum and accumulating QIPS points.

How to Start a QI/PI Project

Identify the Problem

• Problems may surface via external audits, internal reporting, or personal observation.
• The quality and safety officer (e.g., Linda Coleman) can provide insight and data relevant to recognized challenges.
• Choose a project with a meaningful impact that is achievable within the institution’s resources.
• Note: Participating in a Root Cause Analysis (RCA) or simulated activity is a fellowship requirement but does not by itself fulfill the QI/PI project requirement. An RCA, however, can inspire the creation of a QI/PI project.

Organize a QI Team

• Project Leader: The fellow initiating the project.
• Project Assistants: Additional fellows/residents to share responsibilities.
• Project Sponsor/Principal Investigator: A faculty member offering guidance throughout the QI process.
• Safety Officer/QI Officer: Individuals overseeing infection control or patient safety.
• Patient Care Providers: Nurses, physicians, and other staff who can implement and champion proposed changes.

Develop a Project Plan

• Several models exist, including Plan-Do-Study-Act (PDSA), Lean, and Six Sigma (DMAIC).
• Choose a framework that best suits your project’s scope and objectives.

Obtain Project Approval

• Present the plan to the program director for approval.
• Large-scale changes may require IRB review and approval before implementation.

Implement the Project

• Carry out the plan in collaboration with your multidisciplinary team.
• Overcome administrative and resource challenges by seeking guidance from your sponsor or institutional safety officers.

Evaluate and Reflect

• Perform regular self-assessments (as recommended by the chosen QI model).
• Conduct a final evaluation to see if goals were met, identify lessons learned, and plan for sustaining improvements.

Requirements for Project Completion

Final Presentation

• Present the completed project to the PCCM department before graduation.
• If the project fails due to external factors, discuss the barriers and lessons learned; “I got too busy” is not acceptable.

Potential Publication

• Publication is encouraged if the project design, impact, and reproducibility have broader relevance.

Sustainability

• Ensure that training, resources, and protocols remain in place after project completion, to maintain and build on the improvements achieved.

• Section 2 Appendix 1: ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease and Critical Care Medicine
• Section 2 Appendix 2: NMCSD GMEC Policy for Faculty and Resident Engagement in QI (01 July 2025)