Pulmonary and Critical Care Fellowship
Loma Linda University's Pulmonary/Critical Care Fellowship is a three year ACGME-accredited program, accepting two fellows per year. It is a part of the Loma Linda University School of Medicine, which graduates approximately 140 medical students annually, and the Department of Medicine, which trains about 80 Internal Medicine residents.
The fellowship utilizes two major teaching hospitals: Loma Linda University Medical Center (LLUMC) and the VA Loma Linda Healthcare System (VAMC). Together, they account for over 700 beds, and are conveniently located less than one mile from one another. LLUMC is about 60 miles east of downtown Los Angeles, in a part of Southern California known as the greater Inland Empire. The area has a population of about seven million people, and Loma Linda University Medical Center is its major teaching and referral hospital.
Over the three-year fellowship, Pulmonary/Critical Care fellows split their clinical training time about evenly between the LLUMC and the VAMC. The Pulmonary Division provides routine pulmonary function and cardiopulmonary exercise testing, inpatient general pulmonary consultation services, and directs the medical intensive care units at both hospitals. In addition, the Division offers an Interventional Pulmonology service, a busy Hyperbaric Oxygen Therapy practice, and outpatient Pulmonary Vascular Disease and Sleep Medicine clinics.
Inpatient clinical duties:
The pulmonary/critical care fellows spend two-thirds of their training period on a clinical service. Almost all of the first year, and the final six months of the fellowship, is largely dedicated to clinical rotations.
The fellowship offers a broad experience in intensive care through rotations on the medical intensive care unit (MICU), coronary care unit (CCU), surgical intensive care unit (SICU), and cardiothoracic intensive care unit (CTICU). During these months, fellows gain experience in the evaluation and management of a wide variety of advanced critical disorders, typical of a tertiary care referral center. They become versed in delivering advanced mechanical ventilation, interpreting non-invasive hemodynamic parameters, and routinely utilizing critical care ultrasound. In addition, fellows become adept at various advanced procedures required of an intensivist, including, but not limited to, endotracheal intubation, central venous and arterial catheterization, basic flexible bronchoscopy, percutaneous dilational tracheostomy, tube thoracostomy (chest tube) and PA-catheter placement.
The inpatient General Pulmonary Consultation services at both LLUMC and VAMC develop the fellows’ acumen in evaluating and managing a myriad of both common and advanced pulmonary disorders requiring hospitalization. Fellows become proficient at basic and advanced diagnostic bronchoscopy (including EBUS), endobronchial and transbronchial tissue sampling, and pleural evaluation and management, including thoracentesis and placement of chest tubes and chronic indwelling pleural catheters. The fellows also learn to utilize transthoracic lung and pleural ultrasound in daily consultative care, and participate in our busy Hyperbaric Medicine practice at LLUMC.
Outpatient clinical duties:
1- General Pulmonary Continuity Clinic: Throughout the three-year training period, fellows follow their patients in continuity clinic, under the supervision of Pulmonary faculty at both the VAMC and LLUMC locations.
2- Subspecialty clinics:
a. Thoracic Oncology Clinic (TOC): Fellows gain experience in evaluating and managing lung nodules, masses, thoracic adenopathy, and lung cancer. A substantial portion of referrals from this clinic require advanced bronchoscopy.
b. Pulmonary Hypertension Clinic (PHC): Fellows gain experience in diagnosing, grading, and managing complex pulmonary vascular disease of various causes. Fellows perform right heart catheterization and pulmonary hemodynamic assessment.
c. Sleep Clinic: An accredited sleep disorders center is directed by the Pulmonary/Critical Care Division and provides an opportunity for fellows to gain experience in sleep disorders medicine.
About one-third of the fellow’s training period is spent in various research activities. Halfway through the first year, the fellows identify at least one area of interest for investigation, and corresponding mentor(s). With guidance, they develop a specific study plan soon thereafter, and by the latter half of the second year have implemented the core portion of the research project(s). Completion and analysis is expected by the end of fellowship.
Our fellows are frequently involved in multiple research endeavors, appropriately balanced with clinical and educational responsibilities. Consequently, they routinely participate in posters, abstracts, and lecture presentations at major regional and international conferences. Annual fellow attendance of the American Thoracic Society (ATS) conference is mandatory, and financially supported by the Division.
Fellows participate in a core curriculum of Pulmonary and Critical Care topics. They lead discussions in various basic science, histopathology, radiology, and clinical conferences. A sample schedule will be made available online soon.
Additional scheduled conferences include:
1- A weekly multi-disciplinary Thoracic Tumor Board (LLUMC) and Pulmonary Nodule Conference (VAMC).
2- A weekly MICU Morbidity and Mortality Conference (LLUMC).
3- A monthly Journal Club.
4- A monthly Pulmonary Consultation Conference (PCC), in which complex Pulmonary cases are discussed within the Division faculty.
5- A quarterly Interventional Pulmonology Conference (IPC).
Further education and simulation:
1- ‘Fundamentals of Critical Care Support (FCCS)’ training. LLUMC is licensed to provide this widely popular course standardized by Society of Critical Care Medicine. Fellows attend, and may volunteer as instructors; given on-campus twice yearly.
2- A yearly Critical Care Ultrasound Symposium, provided by ultrasound experts from various disciplines at LLUMC.
3- A seven-session ‘Lung Cancer Curriculum’ (LCC), designed specifically for our Pulmonary fellows.
4- Fellows learn pulmonary function testing methodology, calibration of equipment, and quality control in both the routine and specialized pulmonary laboratory areas.
5- Fellows learn bronchoscopic anatomy and troubleshooting, and coordinate with our Respiratory Care Practitioners to help set up cases and process sampled tissues.
6- Monthly ‘vent lab’ which reviews basics of mechanical ventilator care delivery.
7- Advanced interventional therapeutic ‘dry lab’ is offered once a year.
8- An annually reviewed and updated reference list, made available to everyone by the ATS Training Committee can be found at http://www.thoracic.org/go/atsreadinglist.
Fellow integration into the Pulmonary Division and mutual camaraderie:
Our fellows are involved in many Division activities, and are encouraged to participate in quality improvement projects and several community outreach programs. In addition, many social events, both planned and impromptu, help build a mutual professional and personal comradeship between the fellows and faculty, which often lasts well beyond the training period.
Learn about the program's stipends and benefits.
A number of board-certified pulmonary and critical care specialists serve as faculty in the Pulmonary and Critical Care Medicine Division at Loma Linda.
James D. Anholm, MD FCCP
Chief, Pulmonary/Critical Care Section, VA Loma Linda Healthcare System; Associate Professor of Medicine, School of Medicine, Loma Linda University
David K. Bland, MD, FCCP
Head, Division of Pulmonary and Critical Care Medicine; Associate Professor of Medicine, School of Medicine, Loma Linda University; Medical Director, Medical Intensive Care Unit, Loma Linda University Medical Center; Medical Director, Cardiopulmonary Department, Loma Linda University East Campus Hospital.
Gregory A. B. Cheek, MD, FCCP
Associate Professor of Medicine, School of Medicine, Loma Linda University; Attending Physician, Loma Linda University Medical Center.
Ara A. Chrissian, MD, FCCP
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Medical Director of Interventional Pulmonology and Attending Physician, Loma Linda University Medical Center.
Nagamani Dandamudi, MD, FCCP
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Medical Director, Sleep Center, VA Loma Linda Healthcare System.
Ramiz Fargo, MD, FCCP
Medical Director, Loma Linda Sleep Disorders Center
Paresh C. Giri, MD
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Associate Medical Director for Quality, Medical Intensive Care Unit and Attending Physician, Loma Linda University Medical Center.
Philip M. Gold, MD, MACP, FCCP
Professor of Medicine, School of Medicine, Loma Linda University; Director, Pulmonary Fellowship Program; Medical Director, Respiratory Care Department, Loma Linda University Medical Center.
Takkin Lo, MD, MPH
Associate Professor of Medicine, School of Medicine, Loma Linda University; Director, Hyperbaric Medicine and Wound Service and Attending Physician, Loma Linda University Medical Center.
Kanwaljeet Maken, MD
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Attending Physician, Loma Linda University Medical Center.
H. Bryant Nguyen, MD
Professor of Emergency Medicine, Medicine-Critical Care, and Basic Science; Vice Chair of Research, Department of Medicine, School of Medicine, Loma Linda University; Attending Physician, Loma Linda University Medical Center.
Philip J. Roos, MD
Chief, Medical Service, VA Loma Linda Healthcare System; Associate Professor of Medicine, School of Medicine, Loma Linda University; Assistant Professor, Physiology, Loma Linda University.
Katja Ruh, MD
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Medical Director, Pulmonary Hypertension Service and Attending Physician, Loma Linda University Medical Center.
N. Lennard Specht, MD
Assistant Professor of Medicine, School of Medicine, Loma Linda University; Medical Director, Pulmonary Function Laboratories, VA Loma Linda Healthcare System.
Please make note that we do not accept paper applications. They will only be received through the ERAS program. For submission of letters, CV, and all other paperwork, you will need to visit ERAS. For information on fellowships, click the link that reads, "For Fellow Applicants."
ERAS will allow you to begin your registration process around late spring, such as registering and completing your personal profile, etc. ERAS Mailbox will open in July. Our deadline for accepting the application packets will be August 31st. Interviews for those selected will be scheduled for early October (dates TBA, subject to change).
When submitting your application packet, please make sure it consists of the following:
- CV (must account for all time periods since medical school enrollment)
- Personal statement
- Dean's letter (MSPE)
- Medical school diploma
- USMLE scores (all three must be together, if any pending, please attach
- ECFMG standard certificate (if applicable)
- Three to four letters of recommendation
- If previous training in pulmonary and critical care, letter from "program director" stating dates and location
- Copy of VISA (if applicable)
For questions regarding the pulmonary and critical care fellowship program, please feel free to contact Dottie Acosta, Fellowship Coordinator, at firstname.lastname@example.org.
Please send application packets through ERAS. For other correspondence, please mail to:
Loma Linda University Medical Center
Pulmonary and Critical Care Medicine, Fellowship Program
Attn: Dottie Acosta
11234 Anderson Street, Room 1533
Loma Linda, CA 92354