Curriculum | Pulmonary & Critical Care Fellowship

Preparing clinicians for independent practice in pulmonary and critical care medicine

Our three-year program is built around a structured curriculum with clearly defined goals and objectives. Our curriculum is informed by ACGME requirements and designed to produce clinicians who are fully prepared for independent practice in pulmonary and critical care medicine.

Maine Health Maine Medical Center (MHMMC) is the largest hospital in Maine, a Level I Trauma Center, and the major referral center for pulmonary disease and critical illness across northern New England. Fellows train in a rich, high-acuity environment that provides breadth of exposure — from common presentations to rare and complex disease — in a program where fellows are known by name and mentored individually.

Clinical exposure spans the full spectrum of pulmonary and critical care medicine, including:

• Critical care medicine
• Neurocritical, cardiovascular and surgical critical care exposure
• Interstitial lung disease and pulmonary vascular disease
• Lung cancer and thoracic oncology
• Cystic fibrosis
• Mycobacterial disease and pleural disease
• Sleep medicine and airways diseases

Subspecialty clinics include cystic fibrosis, pulmonary hypertension, mycobacterial diseases and sleep medicine. Fellows gain experience managing clinical problems on both inpatient and outpatient bases throughout their training.

ECMO program

MHMMC is the only ELSO-certified ECMO center in northern New England. Our ECMO program offers fellows direct exposure to venoarterial and venovenous ECMO in a high-volume, academically active center that participates in multicenter ECMO research. 

Our program provides extensive exposure and mentored training in the many procedures required for competency in pulmonary and critical care medicine. Core procedures include:

• Endotracheal intubation, including difficult airway management 
• Central venous catheter placement
• Arterial line placement
• Ultrasound-guided thoracentesis
• Chest tube placement
• Pulmonary artery catheter insertion and waveform interpretation
• Percutaneous tracheostomy
• Flexible bronchoscopy 
• Paracentesis, lumbar puncture and dialysis catheter placement

Advanced bronchoscopy

Second- and third-year fellows rotate on a dedicated advanced bronchoscopy procedure service with a dedicated OR room and high procedure volume for training in endobronchial ultrasound (EBUS) and robotic bronchoscopy

Our fellowship emphasizes training in ultrasound and echocardiography led by dedicated faculty with deep experience and clinical expertise. Ultrasound and echocardiography training includes:

• Structured didactic curriculum with simulation-based skill building
• Monthly ICU ultrasound rounds led by faculty
• Individual QPATH ultrasound portfolios with attending overread and QI review
• Opportunity to work towards the CCEeXAM® Examination of Special Competence in Critical Care Echocardiography

Fellows have an extensive and well-defined simulation curriculum to supplement clinical experience. All incoming fellows complete a week-long boot camp at the Hannaford Center for Safety, Innovation & Simulation. Boot camp combines morning didactics with afternoon simulation sessions covering airways, central venous access, echocardiography and advanced CCM scenarios (shock, ARDS, brain herniation).

Monthly simulation sessions continue throughout the three years, providing ongoing practice in procedural skills, clinical decision-making and team communication. Fellows also have opportunities to contribute to simulation as teachers and researchers, including simulation-based educational scholarship.

Our fellowship offers a robust didactic program including protected Tuesday afternoon teaching sessions, a Summer Lecture Series for incoming fellows, Pulmonary Grand Rounds, Critical Care Grand Rounds, and a rich array of multidisciplinary conferences. Learn more about our didactic curriculum and conference schedule.

Our fellowship has a defined research and quality improvement (QI) curriculum, and provides the structure, mentorship and environment to support fellows in creating an individualized research and QI program. QI training is integrated throughout the fellowship and fellows participate in ongoing departmental QI initiatives. 

Structured mentorship and support

Each fellow is paired with a dedicated Scholarly Activity Advisor who meets with them regularly throughout their first and second years. Together they identify a research mentor, define a project, and set milestones for completion.  Fellows are encouraged to develop original projects — and many do — with mentorship from faculty who are themselves active investigators.

Individual faculty mentors are drawn from our 22-member faculty, which spans clinical educators, clinician-researchers, and subspecialty experts in both pulmonary and critical care medicine. Mentors work closely with fellows on project design, data analysis, abstract submission, and manuscript preparation. Fellows also have access to dedicated biostatistics and research support through the MaineHealth Institute for Research (MHIR), located just minutes from campus.

Critical care opportunities

MHMMC is an active clinical trial network site with a robust critical care research program. Faculty investigators are engaged in multicenter randomized trials, observational studies and translational research across a range of critical care topics including cardiac arrest and resuscitation, neurocritical care, sedation and analgesia, ARDS and tracheostomy. A weekly critical care research meeting gives fellows ongoing exposure to active studies, trial methodology and faculty investigators across disciplines.

Pulmonary medicine opportunities

MHMMC is a CFF Therapeutic Development Network (TDN) center, participating in sponsored clinical trials and registry-based outcomes research in cystic fibrosis. There are active research opportunities in pulmonary vascular disease, interstitial lung disease, advanced bronchoscopy and interventional pulmonology, and pleural disease. 

Board certification

Upon successful completion of the fellowship, (including twenty-four months of clinical responsibilities, of which twelve months are specifically devoted to critical care medicine), fellows are eligible to take the American Board of Internal Medicine subspecialty certification examination in pulmonary diseases and in critical care medicine.