Fellowship Program in Heart-Lung and Lung Transplantation

The Transplant Team
Clinical Responsibilities
Teaching Responsibilities
Research

The training program is a special postdoctoral fellowship within the Division of Pulmonary and Critical Care Medicine at Stanford University Medical Center. The fellowship is devoted exclusively to clinical training and research in heart-lung and lung transplantation and is designed to prepare trainees for academic careers in transplantation. Direct supervision and teaching is provided by the medical and surgical faculty of the Heart-Lung and Lung Transplantation Program.

The duration of the fellowship is one to two years. Applicants must have completed a residency in Internal Medicine and fellowship in Pulmonary and Critical Care Medicine. Equivalent experience in related areas may also be given consideration. Information regarding salary and benefits is available separately.

The Transplant Team

The Heart-Lung and Lung Transplantation Program is a complex medical-surgical collaboration between the Department of Cardiothoracic Surgery and Division of Pulmonary and Critical Care Medicine. The program is under the general directorship of Robert Robbins, M.D. (Director, Stanford Cardiovascular Institute and Chairman, Department of Cardiothoracic Surgery), Bruce Reitz, M.D. (Norman E. Shumway Professor and Former Chairman, Cardiothoracic Surgery), and David Weill, M.D. (Medical Director of Heart-Lung and Lung Transplantation). The functioning of the transplant team depends critically on a close alliance between the physicians and the pre- and post-transplant nurse coordinators. The coordinators are the "front line" for outpatient referrals, follow-up, education, and administrative and financial issues. They organize the clinics, orchestrate the complex task of bringing pre-transplant candidates to formal listing, and coordinate organ procurement. The team’s designated clinical social worker plays a critical role in the initial and ongoing psychosocial assessment of transplant patients and shares the role of patient education with the rest of the transplant team.

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Clinical Responsiblities

The clinical service includes:

1. Evaluation, education, and selection of candidates for heart-lung or lung transplantation, and the follow-up of patients awaiting transplantation. These functions are performed principally at the weekly pre-transplant clinic and at weekly conferences attended by the medical, surgical, radiology, psychiatric, and social services staff. Patients are referred from across the nation and represent an exceptional variety of lung and heart pathophysiology.

2. Inpatient and outpatient management and long term follow-up of transplant recipients. Key components of this include the management of multi-drug immunosuppressive regimens, and surveillance for and treatment of infection and allograft rejection. Specific actitivities include:

• Two outpatient adult and two outpatient pediatric post-transplant clinics per week, through which the transplant medical team provides both primary and transplant- related care.
• Inpatient management, including critical care and ward management of transplant recipients. The transplant fellow plays a consultative role during the initial transplant admission, but is the primary physician for subsequent admissions, under faculty supervision.
• Frequent bronchoscopic examinations for diagnosis of infection and allograft rejection.
• Interpretation of frequent pulmonary function tests.
• Interpretation of daily radiographic studies.
• Review of all heart and lung biopsy specimens.
• Supervision and teaching of the Pulmonary and Critical Care Medicine fellow rotating on the transplant service.
  
  

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Teaching Responsibilities

Fellows encounter teaching opportunities with residents and fellows in a number of disciplines, including Cardiovascular Surgery, Thoracic Surgery, Otolaryngology, Radiology, Pathology, Pediatrics and Internal Medicine. Obviously, the educational arrows are bidirectional.

Fellowship trainees are expected to participate in the educational activities of the Division of Pulmonary and Critical Care Medicine, selected educational activities of the Department of Cardiothoracic Surgery, and other conferences and teaching rounds associated with their patients.

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Research

The research component of the fellowship largely depends on the trainee’s interests and level of experience. Opportunities for both bench and clinical research are ample. Research collaboration between the Division of Pulmonary and Critical Care Medicine and the Department of Cardiovascular Surgery is now well established, and is strongly encouraged. Areas of current interest include:

• Pathogenesis, markers, and management of rejection in the transplanted lung.
• Pathophysiology of the respiratory and circulatory systems following heart-lung and lung transplantation.
• Management of both infectious and non-infectious complication of transplantation.

Research opportunities are not limited to this list. Individuals with advanced research training are particularly encouraged to pursue their own work in addressing questions relevant to transplantation.

The fellowship is an intensive academic experience in the management and study of transplant candidates and recipients. Applications must be committed to managing a fast-paced, busy clinical service and to dedicating additional time to scholarly activities.

Dr. David Weill and all other members of the transplant team are pleased to answer any inquiries.