Clinical Training

The MICU rotation offers comprehensive training in medical and neurological critical care. Fellows work closely with a Pulmonary/Critical Care attending, three to four house officers, and a fourth-year Tufts University medical student as part of a closed ICU service. Care is provided in the MICU and in overflow units when needed.

During this rotation, fellows:

• Manage a wide range of critical illnesses with emphasis on pathophysiology and diagnosis
• Perform procedures such as bronchoscopy, central line placement, pulmonary artery catheterization, ultrasonography, and mechanical ventilation
• Develop teaching skills by supervising and instructing residents and medical students

In the CCU, fellows focus on the care of critically ill cardiac patients. This rotation emphasizes the management of cardiogenic shock and the use of mechanical circulatory support devices.

Fellows also:

• Collaborate with cardiology teams to manage acute coronary syndromes and arrhythmias
• Gain experience integrating pulmonary and cardiac critical care for complex cases
• Learn the principles and application of mechanical circulatory support technologies

Fellows on this rotation work with an attending and a fourth-year medical student to evaluate and manage consults across the hospital.

Key features of this rotation include:

• Daily consult rounds with in-depth discussion of new and follow-up cases
• Review of imaging (X-rays and CT scans), pathology, and pulmonary function tests
• Procedural experience with advanced bronchoscopic techniques, including EBUS and robotic bronchoscopy
• Primary responsibility for communication with consulting teams and educational guidance for medical students

Tufts Medical Center is a Pulmonary Hypertension Center of Comprehensive Care, performing more than 300 right heart catheterizations each year. While we offer a separate fellowship in pulmonary hypertension, our pulmonary and critical care fellows benefit from structured exposure to this field. Fellows train alongside PH faculty in the catheterization lab and participate in the inpatient management of individuals with complex pulmonary vascular disease.

Fellows manage critically ill adults receiving multiple forms of mechanical circulatory support, including veno-venous (V-V) ECMO and veno-arterial (V-A) ECMO. These therapies are used in a range of conditions such as:

• Acute cardiogenic shock
• Acute hypoxemic respiratory failure
• Post-operative care for heart transplant recipients

This rotation provides a strong foundation in advanced critical care and multidisciplinary collaboration.

Our interventional pulmonology (IP) service is one of the busiest in the region, offering fellows hands-on experience with a wide range of diagnostic and therapeutic procedures involving the airways, lung parenchyma and pleura.

Fellows gain proficiency in:

• Endobronchial ultrasound (EBUS)
• Ion Robotic Bronchoscopy
• Pleural procedures including chest tube placement and tunneled pleural catheter management

By the end of training, fellows have the option to be certified in EBUS and are well-prepared to pursue additional IP training or integrate these skills into general pulmonary practice.