University of California, San Francisco
San Francisco, CA
Stephen C. Lazarus, MD
The Fellowship Training Program in Pulmonary and Critical Care Medicine at the University of California San Francisco began in the 1950s as a research training program directed by Julius Comroe. In 1966 John Murray and Jay Nadel added a rigorous clinical training program. Since the Program began nearly 50 years ago, approximately 80% of our graduates have chosen careers in full-time academic medicine and research. In addition to academic appointments in Pulmonary and Critical Care Medicine, many of our graduates have been Division Chiefs, Department Chairs, and Deans.
Key components of our training program include a clinical program shared equally by 3 different hospitals (UCSF Moffitt-long, San Francisco general hospital, SF VA hospital) with 3 very different patient populations, a weekly Tri-hospital Clinical Case Conference, and a weekly Fellows’ research Conference. We believe, however, that the success of our Program and of our graduates is due in large part to our efforts to tailor each individual’s training program to their specific interests and needs. The key components of the clinical training program are dictated by the ACGME, but we attempt to allow each fellow to design the rest of their training in accordance with their individual specific goals. All fellows complete 18 months of clinical training. The remaining 18 months of ACGME training and any additional training focus on scientific investigation. Research time is protected, and except for Clinics and Conferences, fellows are guaranteed time for research and career development. Specific research tracks are available for Clinical, Translational, and laboratory-based research. We require all fellows to write an individual NIH NRSA grant within 6 months of beginning their research training. This process helps them focus their research objectives, and provides critical training in grant writing. Whatever the outcome of these grant applications, we commit to supporting fellows for as long as it takes for them to establish independence and obtain their own career development funding.
Before the first day of fellowship training, each Fellow is assigned an Advisor who serves as a guide both professionally and personally during the course of the Fellow’s training. This is especially important during the first year when fellows are adapting to a new role, often in a new city, and are trying to identify a career focus. In addition to helping the Fellow navigate the transition from resident to Fellow, the Advisor helps the Fellow explore research pathways and select a research mentor. Thereafter, every fellow is required to form a research Advisory Committee (RAC), comprised of the lead mentor and 3-4 additional UCSF faculty members. Faculty are chosen (by the fellow) who can complement the lead mentor’s research mentorship by providing scientific expertise in fields related to, but distinct from, the primary mentor’s research program. RAC members can also be chosen because they can provide career mentorship and key guidance about publication and presentation of findings, extramural funding, participation in the American Thoracic Society activities, and plans to transition to a faculty position.
Beginning in the 2nd year, the RAC along with the Fellow and mentor meet at least 1-2x/year to ensure that academic goals, research objectives, and/or clinical work is progressing appropriately with the future success of the Fellow in mind. After each meeting the fellow provides a written report and Career Development Plan to the appropriate research Training oversight committee and to the Program Director, who interact with the Fellow and her/his research mentor to facilitate and ensure progress.
Much like “personalized medicine”, we believe that a training program that is personalized to include the specific clinical, research, and career interests of each trainee stacks the odds in favor of success.
