Sakshi Dua, MBBS, FCCP, ATSF, has two goals for graduates of the Pulmonary and Critical Care Fellowship Program she leads at The Mount Sinai Hospital. She wants them to look back on their time within the training program as the best three years of their entire medical careers, and she wants at least a few to become physician-scientists.
“Traditionally, 50 percent of pulmonary and critical care fellowship graduates have gone into private practice, with fewer than 50 percent staying in academia,” says Dr. Dua, Fellowship Director of the training program since 2014.
“Science will not advance unless more researchers are coming out of this program. We decided to leverage Mount Sinai’s extensive resources and opportunities available for training in research and buck that trend,” says Dr. Dua.
Working with Charles A. Powell, MD, MBA, Florette and Ernst Rosenfeld and Joseph Solomon Professor of Medicine at the Icahn School of Medicine at Mount Sinai and Chief of Pulmonary, Critical Care and Sleep Medicine for the Mount Sinai Health System, Dr. Dua has made significant progress in achieving that goal. She estimates that 20 percent of program graduates become physician-scientists and more than 50 percent go on to other academic roles, such as clinician-educators, training program directors, or leaders of health care practices.
Dr. Dua has consistently sought to refine the program and its focus to maximize outcomes. The criteria for assessing applicants favor candidates who have demonstrated scholarly accomplishments and an interest in academics during residency. Those who are accepted into the three-year program participate in 12 months of dedicated research training—an immersive experience during which they have minimal clinical responsibilities. Moreover, the research training curriculum is developed in collaboration with an associate program director, who also oversees the training of fellows.
“The associate program director is a career researcher who is a funded physician-scientist,” says Dr. Dua, who is also Medical Director of the Fellows’ Ambulatory Care Clinic at The Mount Sinai Hospital. “It is relatively rare among fellowships to have a program leader who is dedicated to training fellows on how to perform research. By having that oversight, we believe we can increase the likelihood that our fellows will stay in academia.”
Dr. Dua adds that the program takes a more structured approach to matching trainees with research mentors to further encourage them to choose careers as physician-scientists. Pairings are also subject to approval by program leadership to ensure that the mentors chosen are able to deliver appropriate training.
“In some programs, the trainees are responsible for finding someone who is interested in taking them on, which does not always produce the best results,” she says. “Through our approach of mentor-mentee matching, we are reducing the likelihood of trainees being paired with mentors who are not career researchers and thus unable to train them on related methodology.”
From left: Yekaterina Sherman, MD (PGY-5, clinical track); Sefah Sarpong, MD (PGY-5, clinical track); Jimmy Zhang, MD (PGY-5, research track); Dr. Dua; Jeremy Mudd, MD (PGY-7, research track); Yutong Dong, MD (PGY-4, clinical track)
Research training begins 18 months into the program, followed by six months of clinical training at the end, right before graduation. This, Dr. Dua says, ensures that the fellows’ clinical skills do not atrophy, enabling a more successful transition into practice. It also reflects the program’s holistic approach to training, which offers fellows the advantage of exposure to both the department’s deep expertise in pulmonology, critical care, and sleep medicine, and to other specialties through collaborations with divisions such as cardiology and rheumatology.
“Our faculty, in particular, are our gold mine, because they are able to treat our trainees as apprentices,” she explains. “Our fellows learn the art, and the science, of pulmonology, critical care, and sleep medicine from our expert faculty. That is a key strength of our program.”
Although the fellowship’s evolution by and large reflects the vision of Drs. Powell and Dua, ongoing surveys of trainees have resulted in refinements to the curriculum and research programming. For example, Dr. Dua says a statistical modeling course was made optional after several trainees indicated it was not required for their research projects.
Eleven years after stepping into her role, Dr. Dua remains as dedicated to advancing the caliber of training as ever, even as she devotes herself to advancing medical education in other ways. She delivers workshops and didactics to teaching faculty across the entire Mount Sinai Health System as one of two faculty development experts with Mount Sinai’s Institute for Medical Education. She is overseeing programming focused on leadership and professional development for early- and mid-career professionals as co-chair of the American Thoracic Society’s Professional Development Committee. She is also overseeing publications for program directors, teaching faculty, and fellows in her role as Chief Editor with apccmpdscholars.org.
But Dr. Dua stresses that the fellowship and its future are her priority. That is reflected by a five-year vision she has developed to advance training and research while fostering a more supportive and innovative learning environment. Plans include expanded simulation-based training for procedures; increased opportunities for fellows to present at national conferences; leadership training in administration, policy, and advocacy; and wellness check-ins and peer support programs.
“This is more than a job to me,” says Dr. Dua, who was recently named Mount Sinai's Associate Dean for Graduate Medical Education Well-Being. “It is my ikigai—my purpose for being. I cannot see myself ever leaving this fellowship or Mount Sinai.”