Training & Education

The PCCSM Fellowship Program is designed to provide each trainee with a range of exposure to the diagnosis and management of pulmonary diseases, the experience and skills required of an intensivist and the opportunity to develop research interests. Seven new fellows are currently admitted to the program every year. Clinical and teaching responsibilities encompass most of the first and second years, with a significant part of the third year devoted to research activities. During the clinical phase of training, fellows devote their time to evaluation, diagnosis and treatment of patients admitted to Los Angeles General Medical Center, KH and Norris. Fellows assess problems, make appropriate diagnostic and therapeutic recommendations and perform specialized procedures, including fiberoptic and advanced bronchoscopy, percutaneous needle biopsy of the lung and pleura, thoracentesis and pleurodesis. Trainees receive instruction in pulmonary function testing, thoracic and critical care ultrasonography and x-ray interpretation, including high-resolution computerized tomography (HRCT), the principles and techniques of mechanical ventilation and inhalation therapy, and all aspects of tertiary pulmonary, critical care and sleep medicine.

Fellows are also exposed to a wide spectrum and volume of procedural skills training as part of their patient care duties, and have both fresh tissue and simulation skills sessions throughout their fellowship. All fellows are scheduled to attend bi-annual half-day skills workshops in which they practice such key procedures as central lines, chest tube insertion, intubation, percutaneous tracheostomy, intraosseus access, thoracentesis and management of difficult airways.

The Division has also been committed to providing essential teaching for the education of second-year medical students. Both current and former faculty members participate in lectures and small group discussions on various topics in respiratory medicine.

Division Teaching Conferences

Our strong commitment to teaching is evident in an extensive daily conference schedule, starting at 8:30 am and consisting of didactic lectures, multidisciplinary case conferences, grand rounds, morbidity and mortality conferences, and research seminars on various aspects of pulmonary, critical care and sleep medicine and related sciences. Combined thoracic surgery and thoracic oncology conferences (Tumor Board) are held every Wednesday from 5:00-6:00pm.

Monthly Journal Clubs stress the importance of evaluating, analyzing and presenting medical research literature. Guest lectures and both clinical and basic research seminars featuring nationally and internationally known physician-scientists are held bi-monthly. Daily rounds conducted in all the USC hospitals form the cornerstone of our clinical teaching program. These in-depth sessions ensure the highest quality patient care. Full-time faculty conduct bedside rounds as well as clinical discussions. House staff, medical students, fellows and attending physicians participate in these daily rounds.

Sleep medicine is a highly integrative, multi-disciplinary area of study, which draws on the expertise of specialists in pulmonology, neurology, otolaryngology, psychiatry, general medicine and pediatrics. Epidemiologic and clinical research has increasingly implicated sleep and sleep disorders in a wide array of long term health outcomes, and training in sleep medicine is highly relevant to a variety of medical and surgical settings. In collaboration with CHLA, Keck Hospital of USC is proud to offer a truly distinctive, one-year ACGME-accredited sleep medicine fellowship. Our program, which accepts two applicants per year through the National Resident Matching Program (NRMP), encompasses the full breadth of training in both adult and pediatric sleep medicine. Otolaryngologists who are sleep medicine fellows can tailor their experience to expand the training in advanced sleep surgery.

Overview

At the completion of this fellowship, our graduates will have acquired competency to practice in a variety of adult and child sleep medicine settings. In addition, our position at the forefront of biomedicine and technology allows our trainees to gain exposure to a wide range of novel, cutting edge medical and surgical modalities for the treatment of complex sleep disorders. Keck Hospital of USC was the first site in Southern California to offer the Inspire® hypoglossal nerve stimulation device for the treatment of obstructive sleep apnea (OSA). We also participated in the pivotal Phase III Respicardia® trial of the remede® transvenous pacing system for the treatment of central sleep apnea.

Our sleep medicine faculty is highly collaborative and distinctively collegial. Sleep fellows attend two half-day continuity clinics per week — one adult and one pediatric — in addition to weekly didactic sessions, supervised polysomnography review periods and sleep grand rounds. Fellows also rotate in otolaryngology, neurophysiology, and psychiatry outpatient clinics and have the opportunity to observe advanced sleep surgery procedures and participate in both clinical and research sleep data acquisition in our state of the art, four-bed hospital-based sleep laboratories at each institution. Inpatient sleep consultations are performed both at Keck Hospital of USC and CHLA.

Our faculty are actively involved in a variety of clinical research projects, including studies of positive airway pressure therapy adherence and surgical evaluation techniques and treatment outcomes. Ongoing collaborations with the USC Viterbi School of Engineering are using advanced imaging techniques to elucidate mechanisms of airway collapse in sleep apnea and examining modulation of sleep with transcranial magnetic stimulation in patients suffering chronic pelvic pain. We are also participating in a number of U.S. Department of Defense and National Institutes of Health-funded investigations in post-traumatic stress disorder and sleep associations with substance abuse in patients with severe mental illness.

The Sleep fellows are expected to complete at least one research project during the fellowship year. The Sleep fellows also have the opportunity to enroll in a clinical/translational research study design course in which they develop a research protocol in an area of their own interest. This protocol can serve as the basis for a research study that they conduct during the fellowship year or once they undertake the next step in their career. We believe that a deeper understanding of research study design provides useful skills for the conduct of research as well as the critical examination of published research studies for their application to patient care.

Sleep medicine resides in the division of pulmonary, critical care and sleep medicine in the Department of Medicine, under the leadership of Santhi Iyer Kumar, MD, at the Keck School and the division of pediatric pulmonology, under the direction of Sally L. Davidson Ward, MD at CHLA. Our combined dedication to excellence in patient care, teaching and research is expressed in every phase of the fellowship training program. Guest lectures and seminars with nationally and internationally known physicians and scientists are held frequently. Our sleep medicine fellows have unlimited access to the clinical, educational and research resources of two great institutions: The Keck School of Medicine and CHLA.

Facilities

The Keck School of Medicine of the University of Southern California (USC) is located on the 79-acre Health Sciences Campus (HSC), three miles northeast of downtown Los Angeles and seven miles from the USC University Park Campus. HSC is a focal point for students, patients and scientists from around the world. Both its clinical and research infrastructure is in the process of dramatic expansion and growth. The many clinical, classroom and laboratory resources of the campus combine to form a dynamic, interactive environment for learning, collaboration and scientific discovery.

Children’s Hospital Los Angeles (CHLA) is a 501(c)(3) nonprofit hospital for pediatric care. CHLA has been named the best children’s hospital on the West Coast and among the top five in the nation for clinical excellence, with selection to the prestigious U.S. News & World Report Honor Roll. CHLA is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. CHLA is also one of America’s premier teaching hospitals through its affiliation since 1932 with the Keck School of Medicine of the University of Southern California.

Eligibility Requirements

Applicants for the sleep medicine fellowship must have completed an ACGME-accredited core program in family medicine, internal medicine, neurology, otolaryngology, pediatrics or psychiatry. In addition, applicants must meet all requirements for eligibility set by the Los Angeles General Medical Center Office of Graduate Medical Education. Every fellow must have a California medical license by the beginning of the fellowship training program. Licensure in the State of California for international medical graduates can be especially time-consuming. If assistance is needed, candidates are advised to contact personally the Division of Licensing, Medical Board of California, 1426 Howe Avenue, Sacramento, California 95825-3236, (916) 920-6411.

Applicants to the fellowship must apply through the National Resident Matching Program (NRMP).