The fellowship in Pulmonary and Critical Care Medicine at The Upstate Medical University Hospital at Syracuse utilizes four main institutions and several supporting institutions. The University Hospital, Crouse Hospital, Community General Hospital and the VA Hospital serve as referral hospitals not only for the Syracuse metropolitan area, but also for a wide area in New York State extending north to the Canadian Border and south to the Pennsylvania border. In addition, all of the institutions serve as primary care centers.
Upstate University Hospital, the primary facility, is a 409-bed institution that serves as both a primary care institution for Syracuse and a tertiary referral center for the Upstate New York region (catchment area - approximately 1.8 million people). Core rotations include a pulmonary inpatient/consultative service and two ICU inpatient services, providing opportunity for fellows to gain experience in managing primary patients and consultations. Internal medicine residents rotate on these services, providing fellows a supervisory role. On the pulmonary service residents, under the guidance of the fellow, evaluate the patients before faculty rounds. The medical intensive care units of University Hospital are closed units each with a team that is comprised an attending physician, a Pulmonary & Critical Care fellow, two residents, (either one from Internal Medicine and one from Anesthesia or two from Internal Medicine) and one Intern from Internal Medicine. The Pulmonary/Critical Care fellows function in a supervisory role for these residents. Work rounds are conducted each morning by the fellows and residents followed by attending rounds. Each fellow conducts afternoon work rounds as well. The fellows also participate in continuity clinic at UHCC (University Health Care Center) as part of the divisions group practice. Finally the elective rotations in thoracic surgery, cardiac surgery neurosurgical/neurology ICU, sleep/PFT/rehabilitation, cardiac ICU, anesthesia and radiology are based at University Hospital. University Hospitals Endoscopy suite provides both inpatient and outpatient bronchoscopy services.
Fellows also provide consultation services to patients at Crouse hospital. This is done during their pulmonary consultation services at Upstate University Hospital. The fellows are exposed to a variety of patients at Crouse, including obstetric patients while on an OB ICU rotation at Crouse. The Pulmonary attending at Upstate University Hospital provides supervision and education. Sometimes bronchoscopies are also performed at Crouse hospital.
The fellows also rotate at Community Campus of Upstate Medical University. This is community based hospital. The fellow on this rotation works directly with the attending physician in an open general ICU. The service has medical, surgical, cardiac and neurologic sub-specialty patients. The fellow rotating at Community General also does pulmonary consults on floor patients and performs bronchoscopies as needed. This rotation gives the fellow experience in Pulmonary and Critical Care in a community type practice. It gives the fellow opportunity to interact with multiple specialties as a consultant. The fellow also has the opportunity to admit patients to the Critical Care service as needed where they will have primary responsibility for that patient.
The Syracuse Veterans Administration Hospital, a 150-bed facility located across the street from the University Hospital, serves as a primary and tertiary care center for the regions veteran population. The VAH core rotation includes consultation services in pulmonary medicine and in critical care medicine. The ICU at the VA is closed unit for Medicine where 1 senior resident and 1 fellow provide coverage. The Division of Pulmonary and Critical Care provides primary care on all medical, neurology and cardiac ICU patients and consultations on surgical patients as directed by the patients primary attending. The attending, fellow and resident make morning ICU rounds. The team conducts afternoon rounds. A fellow is also assigned to the pulmonary consultation service in the VA. The fellow provides inpatient consultative coverage for the patients, provides interpretation of pulmonary function studies, performs bronchoscopy and pleural procedures for inpatient and outpatients pulmonary. The fellow works directly with the Pulmonary attending. The VA has a 6 bed sleep lab under the directorship of the Pulmonary division. Fellows have a significant interaction with the sleep lab and its personnel during a formal sleep rotation which is available upon request. All fellows get experience in the sleep outpatient clinic.
The Upstate Sleep center is a hospital owned twelve-bed sleep lab in Camillus that is staffed by the Departments of Medicine, Pediatrics and Neurology. The laboratory is under the medical co-direction of the Division of Pulmonary and Critical Care. Fellows who rotate here have a significant interaction with the sleep lab and its personnel during a formal sleep rotation which is available upon request.