The Chandler Hospital MICU serves as the quaternary referral center for the sickest patients in the Commonwealth of Kentucky. This nearly 1000-bed institution is also home to the region’s only NCI designated cancer center. The MICU is located on the 12^th floor, which opened for patient care in 2024 and which contains 48 ICU beds. MICU patient care is divided into three teams, each led by a fellow and an attending. Fellows serving MICU rotations here get excellent clinical experience performing procedures, managing complex critical illness, and teaching residents and students. Senior fellows rotate independently on service here, leading rounds for a team supported by APPs. MICU rotations are 2-week blocks with one weekend off and no night or from-home call. 

The Lexington VA Medical Center is home to a 13-bed Medical-Surgical ICU which provides a community-based ICU experience. Fellows on VA-MICU rotations do not serve nights or weekends.

The UKY- affiliated local Good Samaritan Community Hospital is home to an 18-bed MICU. Senior fellows rotate here during weekdays only to enhance opportunities for graduated autonomy and experience in secondary or tertiary-care ICUs. Fellows round independently and have access to on-site faculty for support when needed. A team of APPs assist fellows with the clinical tasks required for patient-care.

The PCCM and CCM fellowships share a night float system which covers the Chandler Hospital MICU overnight. Fellows on night service are supported by one APP and two resident/intern teams. Night schedules cover Sunday-Thursday, giving fellows on nights Friday and Saturday off. Overnight, fellows are responsible for hospital/ED triage, admitting, and resuscitating / stabilizing critically ill patients while supervising residents. An e-ICU attending as well as supporting airway and thoracic surgery teams are available as back-up if fellows require. This rotation is a fellow favorite, as it provides fellows with a sense of true supported independence.

Non-medical ICUs such as the Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU and Cardiovascular ICU at Chandler Hospital are also locations for fellow rotations. Fellows on non-MICU ICU rotations gain experience with diverse critically ill patients and gain proficiency in unique procedures (temporary pacing) and the management of advanced support devises (IABP, Impella, ECMO). Fellows also appreciate the opportunity of working with Trauma Surgeons, Cardiologists, and NeuroIntensivists. All fellows are offered ATLS certification as a part of fellowship training.

• Pulmonary Consults Rotations comprise two separate rotations; UK Chandler Consults and Good Samaritan Consults. These rotations only serve PCCM fellows. 
• On Chandler consults, fellows see inpatients with advanced pulmonary problems and perform procedures such as thoracentesis, chest tube insertion, and bronchoscopy (both basic and advanced procedures) while leading a team comprised of residents, interns, and medical students. Given the level of care at Chandler Hospital and the broad competence of the hospitalist and general medicine teams, the majority of consults in this environment are called for complex or rare lung disease. 

The Good Samaritan Pulmonary Consults Rotation serves the Good Samaritan Community Hospital. Consults here are often more straight-forward and reflect the community hospital experience. Given the smaller size of this site and the absence of other learners, fellows rotating here also read PFTs and supervise and interpret Cardiopulmonary Exercise Tests (CPETs).

This fellow-favorite rotation is open to PCCM and CCM fellows. The core experience takes place with Interventional Pulmonary Faculty in the Endoscopy suite and in the OR, where procedures performed include routine bronchoscopy (e.g. bronchoalveolar lavage, transbronchial biopsies), Endobronchial Ultrasound (EBUS) both Radial and Convex, and advanced procedures (e.g. Robotic Bronchoscopy, Navigational Bronchoscopy, cryotherapy, argon-plasma coagulation (APC), Medical pleuroscopy, and the placement of Tunneled Pleural Catheters). Fellows work with a dedicated IP fellow in a team-based model and graduate from fellowship with procedural numbers significantly higher than the national average. Those who seek out this experience often graduate with procedural numbers similar to those undergoing an additional year of Interventional Pulmonary training. 

PCCM fellows enjoy one half-day of continuity clinic alternating between two environments with very different referral populations: the UK Kentucky Clinic and the Lexington VA Clinic. Both sites are served by fellow-favorite dedicated clinic faculty and encourage the development of longitudinal relationships with patients experiencing a mix of common pulmonary problems as well as more rare lung diseases. Fellows have ownership of their patients’ cases and can assign patients met while on consults to their own clinics. For this reason, scheduled clinic visits per fellow per half-day are limited to six, so that two slots can be added to each clinic at the discretion of the fellow.

UKY has a robust Lung Transplantation Program featuring dedicated faculty with extra fellowship training in Lung Transplant. On the transplant service, fellows take part in pre-transplant assessment, attend Transplant Committee meetings, andcare for post-transplant patients in both outpatient and inpatient settings. Fellows look forward to a one-time on-call experience: a call that an organ has become available.. Fellows accompany the lung explant team to the donor’s site and experience the entire process of lung harvesting from the donor to transplantation into the recipient. A helicopter ride is common as a part of this process. This rotation is open to both PCCM and CCM fellows.

UK boasts a state-of-the-art Sleep Center with multiple sleep medicine physicians from different backgrounds, APPs, and a dedicated sleep lab. On this rotation PCCM fellows assess patients with sleep apnea and other sleep disorders, interpret polysomnography tests, and prescribe Non-Invasive and invasive support devices for sleep and neuromuscular disorders. This rotation features a “haircut half day”, our term for a free half-day in which fellows can get things done that require business hours.

As a part of our division’s collaboration with the Gill Heart Center, our institution is home to the only multidisciplinary center for excellence in PH. PCCM Fellows on PH rotation work with dedicated PH faculty in both outpatient and inpatient settings, performing Right Heart Catheterizations, interpreting VQ and angiography studies, and prescribing inhaled, oral, subcutaneous, and IV and therapies for PH with the assistance of a dedicated member of the faculty of the UKY School of Pharmacy This rotation features a “haircut half day”, our term for a free half-day in which fellows can get things done that require business hours.

This rotation allows PCCM fellows to attend a wide variety of subspecialty clinics, where they work closely with dedicated faculty to learn the nuances and multidisciplinary approach to referral populations in our quaternary center. UKY’s subspecialty referral clinics for patients with Interstitial Lung Diseases, Sarcoidosis, Advanced COPD, Advanced Asthma, Cystic Fibrosis, Allergy &Immunology, and Otolaryngology. This rotation features a “haircut half day”, our term for a free half-day in which fellows can get things done that require business hours.

PCCM fellows in their third year and CCM fellows in their 2nd year travel to Rockcastle General Hospital in Mount Vernon, one of the largest free-standing Long-Term VentilatorUnits in the country. A small amount of time at this unique site allows senior fellows togain experience holding multidisciplinary rounds for long term ventilated patients and to gain skills in chronic ventilator weaning techniques, nutritional rehabilitation, tracheostomy tube care, advanced management of airway complications, and tracheostomy decannulation and exchange.

During research blocks PCCM and CCM fellows focus solely on their chosen research and QI projects, learning how to frame research questions, prepare IRB submissions, working on data collection and analysis, and writing manuscripts. Fellows are expected to present their progress in dedicated research conferences throughout the year. Fellows on Research Rotation are supported by dedicated members of the PCCM, KRALD, and Biostatistics and Informatics faculty, and have access to large databases at the regional and national level. 

Research Goals for PCCM Fellows by PGY-Level:

• PGY-4: Define and refine a hypothesis and determine the methods for testing it. Ensure that a literature review is completed and that program leadership have approved the project. This important step protects fellows from having to change their projects after their first year.
• PGY-5: Obtain IRB approval and carry out data collection and interpretation.
• PGY-6: Reach the dissemination phase: submit your abstract to the ATS (around October) or CHEST (around March) and write your manuscript. Present abstracts and posters to the pre-conference sessions to get local feedback before printing!