Mission

In a diverse and healthy atmosphere, we endeavor to grow our fellows into superior pulmonary critical care providers with unparalleled knowledge, skill, compassion, and experience. We prepare our fellows to practice the world over, anytime, anywhere and in any circumstance. Our dual mandate is to teach our fellows to be superior pulmonary critical care practitioners as well as Naval Officers and operational medical providers.

Vision

Our vision is to be the crucible for developing the world's most adept and versatile pulmonary and critical care physicians, who will lead the vanguard of military medicine. We are dedicated to forging clinicians with an unyielding commitment to excellence, capable of delivering top-tier medical care in any setting, from the most advanced healthcare facilities to the most challenging under-resourced environments across the globe.

We foresee our fellows becoming the epitome of medical leaders and innovators, proficient in the nuances of both military and civilian healthcare landscapes. By providing a rigorous and comprehensive training experience steeped in clinical complexity, academic rigor, and research innovation, we aim to equip our graduates with the skills to not only adapt to but also to transform the dynamic field of healthcare wherever their duty calls. It is our unwavering commitment to nurture physicians who will not just excel in their practice but will also continuously set new standards of care, embody the highest ideals of the military ethos, and impact global health through their expertise and humanitarian service.

Aims

Advanced Patient Care and Integrated Health Promotion

Foster the highest standards of compassionate, effective patient care and health promotion, addressing a wide range of health problems and preparing fellows for the unique challenges of both military and civilian healthcare environments.

Physiological Insight

Develop a profound knowledge of physiology in our fellows, empowering them to adeptly utilize and integrate data from diagnostic modalities like pulmonary function tests (PFTs) and radiological studies into comprehensive clinical care.

Procedural Proficiency

Ensure that our fellows attain proficiency in a wide array of diagnostic and therapeutic procedures across various settings, including outpatient clinics, procedural suites, and the ICU.

Adaptive Clinical Excellence in Diverse Settings

Equip fellows with the skills to deliver high-quality pulmonary and critical care in a variety of settings, from well-equipped medical facilities to resource-constrained environments.

Leadership, Education, and Interdisciplinary Collaboration

Cultivate the next generation of military medical educators and leaders, providing them with the skills to teach, guide, inspire, and collaborate seamlessly with an interdisciplinary team of healthcare professionals.

Operational Readiness for Deployment

Develop the operational skills and knowledge necessary for rapid deployment, enabling fellows to provide expert care in mobile units, field operations, and high-intensity environments.

Specialized Expertise in Thoracic Oncology

Build specialized expertise in the diagnosis and treatment of intrathoracic malignancies, preparing fellows to approach these complex conditions with advanced therapeutic strategies and interdisciplinary collaboration.

Focused Excellence in Critical Care Medicine

Strengthen fellows' capabilities to manage complex and urgent health crises in the ICU and similar high-intensity environments.

Outpatient Pulmonary Medicine Mastery

Emphasize the development of comprehensive skills in outpatient pulmonary medicine, involving the diagnosis, treatment, and ongoing management of a wide spectrum of pulmonary conditions.

Pulmonary Evidence-Based Medicine Conference: 7:30 - 8 a.m. (Monday)

During this conference, the fellow on the inpatient consultation service presents a patient case, either from inpatient or outpatient care, with a specific question and then presents an evidence-based answer using the PICO format. The conference is conducted collegially and non-threatening; however, fellows should expect intellectually challenging questions from the faculty to assess their medical knowledge and clinical approach. All available fellows and faculty not involved in other clinical activities should attend and actively participate in the discussion.

Fellow Program Director Meeting: 12:30 - 1 p.m. (1^st Wednesday of each month)

The program director uses this meeting to address administrative matters, and it also provides fellows with an opportunity to raise any issues or concerns regarding their fellowship.

Pulmonary Journal Club: 12:30 - 1 p.m. (2^nd and 4^th Wednesday of each month)

The Pulmonary Journal Club convenes twice a month. The inpatient consult fellow selects two articles from the Pulmonary or Critical Care literature to discuss, taking input from division members. The aim is to improve the ability to critically assess basic science and clinical research studies. Each journal club meeting should include one article pertinent to pulmonary medicine and another related to critical care. One of these articles will be replaced by a sleep medicine article once a month. Furthermore, a piece related to healthcare disparities in pulmonary or critical care will be included quarterly.

Pulmonary Research Conference: 12:30 - 1 p.m. (3^rd Wednesday of each month)

This research conference includes a review of current departmental research conducted by both faculty and fellows, as well as relevant didactic lectures. Reports on research progress, literature-based research ideas, formal proposals, and research findings are presented by both faculty and fellows. Fellows are expected to present planned publications or presentations for external meetings during this time.

Core Lecture Series: 1:30 - 2 p.m. (Wednesday)

A lecture series has been created to fulfill ACGME requirements. The series covers basic pulmonary physiology, pathophysiology, and disease over a 52-week cycle. The lectures are developed and delivered by staff and fellows, with possible guest speakers. Fellows are expected to perform considerable research on their chosen lecture topics.

Pulmonary Radiology Rounds: 2:30 - 3:30 p.m. (Wednesday)

These weekly sessions are held in the pulmonary conference room. Interesting cases from inpatient and outpatient services are presented by staff and fellows, focusing on radiological findings and clinical correlation. The discussion is meant to be collegial and non-threatening, but fellows should expect challenging questions from faculty aimed at assessing their ability to interpret imaging studies.

Pulmonary Faculty to Fellow Sessions: 7:30 - 8 a.m. (1^st, 2^nd, and 3^rd Thursday of each month)

In these sessions, faculty members present interesting cases, research papers, board review questions, and faculty-selected topics to enrich the fellows' knowledge and clinical experience. The consulting attending staff and junior consultation staff present a topic of their choosing.

Combined Pulmonary/Critical Care Morbidity and Mortality Conferences: 7 - 8 a.m. (4^thThursday of each month)

These conferences involve an analysis of cases that provide significant opportunities for improvement. The Pulmonary Consult and ICU Fellows will preside over the M&M. All attendings and on-site fellows are expected to attend.

Pulmonary Clinical Case Conference: 7:30 - 8 a.m. (Friday)

The resident from the inpatient consultation service will present a case that was encountered in the inpatient or outpatient service, which will subsequently be analyzed during a faculty-led discussion. This conference aims to maintain a respectful and non-intimidating environment; however, fellows should be prepared to be intellectually stimulated and questioned by the faculty to evaluate their medical knowledge and clinical approach. All available fellows and faculty not engaged in other clinical activities are expected to attend and participate in the discussion.

ICU Core Lecture Series: 10:30 - 11:15 a.m. (Monday, Wednesday, Thursday, Friday)

The ICU Core Lecture Series, running from Monday to Thursday, is delivered by the ICU fellow or the attending to interns and residents currently on rotation. This lecture series encompasses a range of crucial topics imperative for internists practicing in the ICU setting, including Mechanical Ventilation, Renal Failure, Nutrition for critically ill patients, and Bleeding Complications in the ICU.

ICU simulation sessions: 10:30 - 11:15 a.m. (Tuesday)

A simulation-based lecture is conducted at the simulation center, incorporating simulated patient scenarios or procedural skills. This lecture delivery forms an integral part of the training regimen for ICU fellows, helping them reinforce their knowledge and enhance their teaching skills.

Available electives include:

• Cardiology / Echo (NMCSD)
• Research
• Scripps Interventional Pulmonology
• Sleep Medicine
• UCSD ACCM
• UCSD ICU
• UCSD Interventional Pulmonology
• UCSD Pulmonary Vascular Disease
• UCSD Pulmonary Rehabilitation
• UCSD Transplant Medicine
• Veterans Administration Medical Center - Consult Services

The call schedule during our fellowship training is structured to ensure a balanced workload, with an emphasis on maintaining the well-being and work-life balance of our fellows.

Primary Site Call Duties

At the primary training site, the call requirements for fellows are notably infrequent, and there is no call during ICU rotations. This is due to the presence of in-house attending physicians who are available during the night, thereby eliminating the need for fellows to take night calls in the ICU. This approach allows fellows to focus more on their daytime learning and clinical responsibilities without the added stress of overnight calls.

Consult Service Call Responsibilities

While on the consult service, fellows are responsible for holding the duty phone during night-time and weekends, except for their designated 24-hour off period. However, these calls are relatively infrequent. Most issues that require pulmonary expertise after hours are typically managed by the in-house ICU team. It is a rare occurrence for consult service fellows to need to come into the hospital at night. When such situations do arise, they are generally for high educational value procedures or scenarios that the fellow opts to be present for, rather than out of necessity.

Outside Rotation Call Duties

During external rotations, such as in neuro-critical care, fellows may have call duties. However, the program is diligent in monitoring for any duty hour violations or excessive workloads that could lead to fatigue and safety issues. These instances are extremely rare, and the fellowship program is proactive in adjusting schedules to prevent such occurrences.

Feedback from fellows through annual surveys has consistently indicated that the call schedule is manageable and not excessive. This feedback is a testament to the program's commitment to ensuring that the training experience is both educationally enriching and sustainable in terms of workload. The call schedule is designed to prioritize the educational and personal well-being of the fellows, ensuring they have ample opportunity for rest and personal time, which are essential for a productive learning environment.

The fellowship program provides fellows with essential competencies for the practice of Critical Care Medicine, specially tailored for military contexts. It prepares them to manage various acute and critical conditions that are pivotal for maintaining operational readiness and delivering effective health care in military settings. Some of the distinct military-relevant opportunities offered include:

• Engaging in Trauma/Burn rotations, which, although not mandated by ACGME, are crucial for the expertise of military intensivists.
• Attending monthly tri-service operational grand rounds that encompass all military PCCM fellowship programs.
• Participating in the Tactical Combat Casualty Care Course.
• Receiving specialized training in procedures not typically included in standard PCCM fellowships, which may be necessary in resource-limited settings, such as balloon dilation for subglottic stenosis and airway clot removal using cryotherapy.
• Having the unique opportunity to assist with medical procedures performed on military dolphins, an experience exclusively available through our fellowship. Since 2019, every graduating fellow has been involved in at least one such procedure.

All Fellows are required to maintain certification in Basic Life Support (BLS) and either Advanced Cardiac Life Support (ACLS) or Advanced Life Support (ALS) throughout their fellowship trianing.  In addition, Fellows will complete the following training courses:

• UCSD/NMSCD Introduction to Pleural and Bronchoscopy hands-on courses
• Southern California Introduction to EBUS Course
• Tactical Combat Casualty Care

The Naval Medical Center boasts a cutting-edge simulation and bio skills facility seamlessly integrated into its main campus. This facility includes a cadaver lab outfitted with advanced features such as surgical lighting, high-definition monitors, Striker optical systems, and cameras linked to monitors for enhanced group learning. Adjacent to this lab is a spacious simulation center with three rooms equipped with a high-fidelity bronchoscopy/EBUS simulator and an ultrasound simulator with augmented reality features, alongside various airway, and vascular models. Notably, the Center uses innovative re-perfused cadavers with pulsatile blood flow, a rare feature available in only a few U.S. centers.

Additionally, the UCSD Center for Future Surgery, one of the world's most extensive surgical simulation facilities, collaborates with the Naval Medical Center. Together, they host introductory courses in bronchoscopy, pleural procedures, and EBUS at UCSD.

Simulation at NMCSD is multifaceted. Weekly ICU simulations are conducted for residents and fellows, primarily led by the on-service fellow. The Center also employs simulation for skill assessment, utilizing tools like B-STAT and EBUS-STAT to monitor trainees' progress and provide constructive feedback.

A core aspect of this leadership development is the participation in faculty development sessions conducted by the Uniformed Services University of the Health Sciences (USUHS). These sessions, accessible both locally and virtually, focus on nurturing leadership qualities tailored explicitly for medical education. This exposure allows fellows to learn and adopt leadership styles that are most effective in academic and clinical settings.

In addition to these sessions, the curriculum includes specialized lectures dedicated to leadership skills. These lectures are instrumental in preparing fellows for roles such as department heads or directors of specific services within military healthcare settings. The training covers a wide range of leadership aspects, including effectively managing diverse teams comprising trainees, nurses, technicians, and other ancillary staff. This holistic approach ensures that fellows are well-equipped to handle various administrative and managerial challenges that come with leadership positions.

Leadership in operational aspects of pulmonary and critical care medicine is also a focus of the combined military Pulmonary and Critical Care Medicine (PCCM) virtual grand rounds. These monthly sessions are pivotal in providing insights on leading effectively in dynamic and often challenging pulmonary and critical care environments. These grand round presentations provide opportunities for fellows to learn from experienced leaders and understand operational leadership's nuances in these specialized fields.

Research Requirements

Our program, while primarily clinical in nature, places a significant emphasis on understanding research methodology and the critical evaluation of research. Engaging in research activities is a crucial aspect of this learning process, offering fellows hands-on experience in real-world settings. To fulfill this aspect of the fellowship, the following research activities are mandatory:

Scholarly Output

Fellows are required to produce a minimum of one scholarly work, such as a publication or a presentation (either poster or podium format) at a national conference. This requirement is integral to ensuring a comprehensive understanding and practical application of research concepts.

Integrity Training

Fellows must complete the CITI research integrity training within the first year of their fellowship. We recommend completing this training within the first six months to lay a strong foundation for subsequent research activities.

Research Education

Research Rotations

• Year 1: Four weeks dedicated to identifying a research focus and mentor.
• Year 2 and Year 3: Eight weeks each year allocated for research, either clinical or basic scientific. If the research requirement is complete or the plan is incomplete after Year 2, Year 3 rotations may shift to clinical, subject to the program director's discretion.
• Additional Research Time: An extra four weeks can be requested in the third year for ongoing projects, subject to approval.

Research Methods Training Program (optional)

Conducted by the Clinical Investigations Department, this eight-week course is offered twice a year. It covers critical aspects of research such as clinical research introduction, research funding, scientific data evaluation, ethical issues in human subject research, responsible research conduct, scientific literature review, biostatistics, protocol development, and the process of writing, illustrating, and publishing scientific research.

Monthly Research Conference

A platform for reviewing current departmental research by faculty and fellows, along with didactic lectures. Fellows present their research progress, ideas, formal proposals, and findings and discuss their planned publications or presentations for external meetings.

A key focus is placed on Quality Improvement and Practice Improvement (QI/PI) projects. These projects must follow a scientific approach, starting from identifying areas for improvement in practice, implementing relevant changes, and then evaluating the impact of these changes. Such projects not only fulfill scholarly requirements but also directly contribute to enhancing patient care based on established best practices. Completion and presentation of at least one QI/PI project is required before a fellow can graduate from the program.

Our fellowship program is dedicated to offering a comprehensive array of professional development opportunities. These initiatives are designed to equip fellows with a broad spectrum of skills and experiences, extending beyond clinical expertise to encompass leadership, academic involvement, and organizational participation.

Courses and Seminars

Fellows have access to a variety of courses that contribute significantly to their professional growth. Key among these are the Basic and Advanced Readiness Officer Course (AROC), which provide essential knowledge and skills in readiness and response. Additionally, fellows can participate in faculty development seminars offered by the Uniformed Services University of the Health Sciences (USUHS). These seminars are instrumental in honing teaching skills, understanding academic medicine dynamics, and developing leadership competencies.

Committee Involvement

The program encourages active involvement in hospital and Defense Health Agency committees. Serving on these committees offers fellows a unique perspective on healthcare management and policy-making. It also provides them with an invaluable opportunity to contribute to significant decisions that affect healthcare delivery and patient care at a broader level.

Departmental Representation

Fellows also play a crucial role as department representatives on root-cause analysis committees. This responsibility not only involves problem-solving and critical thinking but also provides insights into the systemic factors affecting patient safety and quality of care. It's an opportunity for fellows to directly contribute to improving healthcare practices and outcomes.

Junior Attending Rotation

A distinctive feature of our program is the junior attending rotation during the third year. In this rotation, fellows assume the role of consult staff for junior fellows, offering a transitional experience into independent practice. A senior attending provides guidance in a hands-off manner, allowing the third-year fellows to lead while still having support readily available. This experience is invaluable in building confidence, decision-making skills, and autonomy, preparing fellows for their future roles as attending physicians.

These professional development opportunities are integral to our fellowship program, ensuring that our fellows are not only clinically proficient but also well-rounded professionals equipped for diverse roles in healthcare leadership, education, and administration.

• Arrowhead Regional Medical Center (Colton, California)
• Intermountain Health (Murray, Utah)
• National Jewish Health (Denver, Colorado)
• Scripps Healthcare - multiple locations in San Diego, California
• University of California San Diego (UCSD)

Pulmonology Rotation

For medical students at the MS3 and MS4 levels, the Internal Medicine/Pulmonology rotation provides a blend of inpatient and outpatient experiences. This rotation, operational from Monday to Friday between 7:30 a.m. and 4:30 p.m., does not require any call duties. Students predominantly interact with fellows and faculty, gaining hands-on experience in patient care. The program emphasizes the evaluation, diagnosis, and management of various pulmonary disorders, offering a comprehensive view of Pulmonology. Key learning components include conducting pulmonary function tests, interpreting pulmonary imaging studies such as chest x-rays, CT scans, and PET scans, and understanding the intricacies of diagnosing pulmonary conditions. An essential aspect of this rotation is the participation in inpatient consults and the Internal Medicine academic conference, fostering a deeper engagement with the academic aspects of the specialty. Students are expected to deliver a 30-minute presentation on a Pulmonology topic of their choice, enhancing their research and presentation skills.

Critical Care Sub-internship

The Critical Care Sub-internship is tailored for MS4 students, focusing exclusively on inpatient care within the medical ICU. This demanding rotation follows a rigorous schedule from 6:00 AM to 6:00 PM daily, with one day off per week and an every-other-day call system, including optional overnight shifts. The structure of the rotation allows students to work closely with residents, fellows, and faculty, immersing them in the critical care environment. As sub-interns, students undertake significant responsibilities in patient management, including interviewing, examining, and evaluating patients. There are opportunities for procedural experience and training in critical care techniques, such as managing mechanically ventilated patients and using vasopressors. The rotation takes place in a mixed ICU, exposing students to a wide range of medical and surgical critical care scenarios. Daily academic conferences are a vital part of this rotation, providing an intellectual space for discussing complex cases and current research. Students conclude the rotation with an informal 20-minute presentation on a critical care topic, encapsulating their learning and insights.

Please visit our Medical Student Rotation informational page to see a listing of available medical student rotations offered at NMCSD.

Every applicant to our program undergoes an interview as a crucial part of the selection process. Here is a breakdown of the interview procedure:

Interviewer Assignment

Applicants will be matched with specific interviewers as part of the MODS application process. This ensures a structured and fair assessment for each candidate.

Mandatory Interviews

It's essential for all applicants to have interviews with both the program director and the specialty leader. These interviews are pivotal in evaluating the suitability of the applicants for the program.

Scheduling Interviews

Applicants can email the program to request an interview using this address: dha.san-diego.San-Diego-NMC.list.nmcsd-pulmccm@health.mil

Pre-Interview Preparation

Applicants are required to submit a copy of their Curriculum Vitae (CV) and personal statement to the program director prior to the interview. This allows the director to familiarize themselves with the applicant's background and qualifications ahead of the interview.

Interview Format and Duration

Interviews can be conducted either in person for local applicants or virtually for those who are not local. Each interview is designed to be approximately 30 minutes long, ensuring ample time for a thorough evaluation while respecting the applicant's time.

Candidates seeking dual certification in pulmonary disease and critical care medicine must complete a minimum of three years of accredited combined training, 18 months of which must be clinical training. During the third year of fellowship (PGY-6), fellows sit for the Pulmonary board exam. Following completion of the training program, graduates take the critical care board exam. These exams are offered annually. Only candidates certified in a subspecialty requiring at least two years of accredited fellowship training (three years for cardiovascular disease and gastroenterology) are permitted to take the critical care medicine examination after completing 12 months of accredited clinical critical care medicine fellowship training.

To become fully board certified, applicants are eligible to take board certification exam for seven years following graduation. To be eligible to take specialty board exams, graduates must complete all prerequisites required by the American Board of Internal Medicine by October 31st. Prerequisites for pulmonary medicine eligibility can be found at https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/pulmonary-disease/ and for critical care at https://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/critical-care-medicine/.

Integral to the fellowship program is the role of fellows as educators. Given their status as board-certified internists, fellows are positioned not only as learners but also as key educators for junior trainees. This dual role is instrumental in honing their teaching abilities and leadership skills.

The program actively encourages fellows to engage in teaching opportunities, allowing them to impart their knowledge and clinical experience to less experienced trainees. This teaching role is pivotal in fostering a comprehensive educational environment where knowledge transfer occurs seamlessly between different levels of trainees.

Fellows are involved in various teaching scenarios, from formal lectures to bedside teaching in clinical settings. This hands-on approach in teaching allows them to refine their communication skills, learn how to present complex medical concepts in an understandable manner and adapt their teaching styles to cater to diverse learning needs.

Additionally, by taking on the role of educators, fellows learn to balance the responsibilities of being both learners and teachers. This experience is invaluable in preparing them for future roles where they will be expected to lead educational initiatives and mentor the next generation of healthcare professionals.

Through these teaching opportunities, fellows not only reinforce their own knowledge and skills but also contribute significantly to the professional growth of junior trainees. This aspect of the program underscores the importance of continuous learning and teaching in the journey of medical professionals, particularly in specialized fields such as Pulmonary and Critical Care Medicine.

Fellows have additional opportunities to teach in the following ways:

• They can become teaching faculty at the Uniformed Services University of the Health Sciences (USUHS).
• They have the option to serve in leadership roles on the house-staff council.
• They have the chance to become certified instructors or faculty members for several specialized courses, including the Fundamentals of Critical Care course, Advanced Life Support, and the Fundamentals of Disaster Medicine course.

The program's pulmonary and critical care faculty includes members with additional fellowship training in Sleep Medicine and Interventional Pulmonology. In addition to these areas, our faculty includes board-certified intensivists with additional board certifications in Infectious Disease and Cardiology.

Mentorship is a cornerstone of our fellowship program, designed to foster professional growth and provide comprehensive support to our fellows. The program emphasizes two key aspects of mentorship: faculty mentorship and peer mentorship.

Faculty Mentorship

Faculty mentors play a crucial role in guiding and supporting fellows throughout their training. Fellows are offered faulty mentors and are matched with faculty mentors based on their career interests, educational needs, and compatibility, ensuring a personalized mentorship experience. These mentors provide invaluable insights and guidance in clinical practice, academic pursuits, and career development. They are instrumental in helping fellows navigate various challenges and opportunities within the fellowship. Additionally, faculty mentors provide expert guidance on research projects and quality improvement or performance improvement (QI/PI) initiatives. This mentorship is critical to developing fellows' research skills and enhancing their ability to contribute to advancements in medical practice and healthcare quality.

Peer Mentorship

Peer mentorship is another vital component of our program, particularly for first-year fellows. First-year fellows receive collective support from senior fellows. This group mentorship approach allows first-year fellows to benefit from the collective experiences and knowledge of their more experienced peers. Senior fellows provide system-based guidance, share practical tips on managing clinical responsibilities, and offer strategies for balancing the rigorous demands of the fellowship. This peer support system fosters a collaborative and supportive learning environment, helping new fellows to adapt more quickly and effectively to the program.

Through this structured mentorship approach combining faculty guidance and peer support, our fellowship program ensures a nurturing and enriching environment. It aims to cultivate skilled, knowledgeable, and well-rounded professionals equipped to excel in their future roles in clinical medicine and leadership positions.

Our fellowship program is deeply committed to the well-being of our fellows, offering a comprehensive approach to manage and mitigate burnout. This approach includes both program-specific initiatives and additional support through offerings administered by the Graduate Medical Education Committee (GMEC) and the Wellness Committee.

Program-Specific Well-Being Initiatives

A pivotal aspect of our program’s well-being support is the monthly meetings conducted between the program director and the fellows. These meetings provide a platform for fellows to openly discuss their concerns and challenges in a supportive environment. The program director actively addresses these issues, with follow-up actions and solutions presented in subsequent meetings. This ensures a consistent and empathetic response to any difficulties faced by the fellows.

Additionally, our program includes a robust system for monitoring fellow well-being through semi-annual surveys specifically focused on burnout. The results of these surveys are reviewed during semi-annual performance evaluations with the program director, offering an opportunity to identify and address burnout symptoms that may not be immediately apparent. This dedicated focus on burnout helps ensure that fellows receive the support they need when they need it.

GMEC and Wellness Committee Offerings

In addition to the initiatives within our fellowship program, fellows also have access to broader well-being resources provided by the GMEC and the Wellness Committee. These offerings are designed to complement the program-specific support, providing an additional layer of care and resources. They include various programs and interventions aimed at promoting mental and emotional health, managing stress, and preventing burnout. These resources are available to all fellows and provide a wider network of support beyond the fellowship program itself.

Together, these program-specific initiatives and the additional resources from the GMEC and Wellness Committee create a comprehensive well-being support system. Our commitment to these initiatives reflects our understanding that maintaining the mental and emotional health of our fellows is crucial for their success and fulfillment both during the fellowship and in their future medical careers.