Educational Purpose

This rotation is designed to provide the fellows with exposure to and experience with the diagnosis and treatment of patients with a wide range of pulmonary disease that is characteristically encountered at a tertiary referral center.

Teaching Methods

Attending Rounds consists of case presentations, extensive discussion of diagnostic approach and pathophysiology. These rounds include bedside teaching and review of diagnostic tests such as chest radiographs, computed axial tomograms, radionuclide scans, and pulmonary angiograms, often with a radiologist. The goal is to develop a meaningful, practical and cost-effective approach to diagnosis and treatment.

Interaction and communication with the primary care providers as a consultant are emphasized. Health promotion, preventive medicine, and cultural, socioeconomic, ethical, occupational, environmental, and behavioral issues are discussed with the attending physicians.

Procedures are performed under the supervision of the attending physician whose role gradually evolves to that of a critical observer as the fellows gain experience with fiberoptic bronchoscopy, bronchoalveolar lavage, bronchial and transbronchial biopsies, transbronchial aspiration, intrabronchial stent placement, thoracentesis, and tube thoracostomy.

Pulmonary Function Laboratory: The fellows learn how to perform and interpret pulmonary function tests under the supervision of the attending physician and the chief technician to assess respiratory mechanics, gas exchange and respiratory drive, including spirometry, flow-volume studies, lung volumes, diffusion capacity, arterial blood gas analysis, exercise, and inhalational challenge studies.

During this rotation, the fellows also develop competence in monitoring and supervising pulmonary function laboratories.

Sleep Center: The fellows care for patients with sleep disorders. They are expected to review, with a faculty member, the results of polysomnography and multiple sleep latency tests performed on their patients, and discuss the therapeutic options in detail.

Pathology: The fellows are expected to review the results of diagnostic studies that include bronchoalveolar, pleural fluid and tissue, and lung tissue specimens, with their attending physician and the pathology attending. Fellows are expected to review all deaths in detail. This includes obtaining and participating in the autopsy and questioning all aspects of the management of the case. There are several Pathology Conferences held during the year. Dr. Marin Sekosan, a Pulmonary Pathologist, holds a Pulmonary Pathology course (about 10 1-hour sessions on Friday AM) every fall for Pulmonary Fellows and Pathology residents. In addition, Dr. Schraufnagel reviews gross lung pathology at the autopsy conference when cases are available.

Case Conference: Diagnostic and therapeutic approach to pulmonary and critical care patients are discussed in detail along with the relevant literature on a weekly basis.

Disease Oriented Clinical Conference: Pulmonary, Critical Care, and Sleep Medicine diseases are covered in this weekly conference.

Principles of Practical Pulmonary Conference: Topics not identifiable as belonging a disease are covered in these weekly sessions. Subject matter includes physiology, procedures, and interpretations of tests.

Medical-Surgical Case Conference: Pulmonary, Oncology and Thoracic Surgery physicians attend this weekly conference where potential surgical candidates are discussed.

Mix of Diseases, Patient Characteristics, and Types of Clinical Service

The patients vary from primary care to referral patients and all diseases required by the curriculum are encountered at this site. Exposure to a large patient population with sleep disorders, tuberculosis, and the variety of common and rare diseases provides exceptional experience to the trainees. Immunocompromised patients and their related complications provide valuable experience to the fellows.

The fellows serve as consultants to the primary care teams and discuss the diagnostic and therapeutic approach to the patients’ problems along with the results of the diagnostic tests.

Fellow Evaluation Method

Fellows are evaluated by the attending physician who supervises them over the duration of the rotation. Verbal feedback is given is given on an ongoing basis. An ABIM-format evaluation is completed and reviewed with each fellow at the completion of the rotation. If an attending physician judges that a fellow is not performing adequately in any area of evaluation, he or she must explicitly provide constructive feedback sometime during the middle of the rotation.

Fellows in return, evaluate their attending physicians and the rotation in terms of patient mix, experience as well as the number of procedures by filling in an evaluation form at the end of the rotation.