Residents and medical students will have patient care responsibility for inpatients with a wide variety of pulmonary disease with an educational emphasis on pulmonary physiology and its correlation with clinical disorders. Residents and medical students will have formal instruction, clinical experience, and demonstrate competence in a broad range of pulmonary diseases. Residents and medical students will develop skills in rounding and communicating with primary care physicians, other members of the healthcare team, and patient family members, under the supervision of an attending physician.
With almost no exception, all consults should be seen and staffed with the pulmonary consult attending on the same day that they are requested.
The pulmonary consult service is responsible for covering new consults Monday through Friday, from 7:00 a.m. until 6:00 p.m. Consults after 6:00 p.m. and during the weekends are covered by the ICU team, the pulmonary and critical care fellow on call, and attending on call. The pulmonary resident will be responsible for receiving the consultation and notifying the pulmonary fellow and attending. However, the fellow must see and evaluate those patients prior to presentation to the attending to help focus the efforts of the more junior members of the team, and to ensure familiarity necessary to perform procedures or dictate a letter for the referring physician. At the time of presentation, chest films should be physically in-hand and all other ancillary data readily available. The resident must remember that he or she is serving as the first-line representative for the Pulmonary and Critical Care Division. The reputation of the Division will, to a significant degree, rest upon your shoulders. When appropriate, a copy of relevant articles should be left in the chart.
The Pulmonary and Critical Care Fellow will be responsible for scheduling and preparing patients for fiberoptic bronchoscopy. In general, this will consist of discussing the procedure with the patient, obtaining informed consent, putting the preprinted pre-bronchoscopy orders in the chart, and notifying the bronchoscopy team. Depending on the individual case and at the discretion of the Pulmonary Consult Attending, residents and medical students may participate in the actual bronchoscopy. If you are particularly interested in this, you should spend some time practicing on the "bronchoscopy model" located in the pulmonary suite. An inpatient bronchoscopy outside of the ICU (3100) and CCU (4100) is scheduled through the Jenkins Endoscopy lab 449-4690. Bedside bronchoscopies in the ICU or OR will be assisted by a team of respiratory therapists trained in special procedures 449-4556. Outpatient bronchoscopy is usually scheduled through the PAC office 449-5446.
A major responsibility will be seeing all patients on daily rounds. All patients seen should have at least a brief note written. The initial consultation should be dictated after discussion with the attending. This is important for documentation purposes as well as for billing. Residents should dictate and write consults and notes with form and substance. Don't stress form versus substance, but don't let substance get lost in poor form. In general, communication should be face-to-face, as well as in written notes. If political problems arise, involve the attending at an early point. Please be sure that your notes reflect accurately the thoughts and plans discussed in attending rounds. Patients seen primarily for a procedure should be signed off relatively promptly. Routine consults called in the evening need not be seen that day; however, urgent consults are to be seen when called in. After 6:00 p.m. and during weekends, the ICU resident on call (beeper 978-1220) covers new pulmonary consults and cross-covers other pulmonary patients in the hospital and in the pediatric ICU. The Pulmonary Consult resident should sign out to the ICU resident on-call the pulmonary patients on the consult service for cross-coverage. Plan to pre-round on your patients before you meet with the attending every day. The Pulmonary and Critical Care Fellow and Attending will be on “at-home” call during this rotation.
1. Daily participation in Pulmonary Consult rounds.
2. Daily case presentation to the Pulmonary Consult attending physician.
3.
Active
participation in formal didactic sessions with discussion of interesting cases
and pertinent literature review.
4. Participation in Pulmonary Consult procedures.
5. Division-Wide Conferences: Attendance at the weekly Pulmonary & Critical Care Conference is mandatory. This conference is held EVERY Friday (September through June) at 12:00 p.m. in Dining Room D.
In addition, residents and medical students are strongly encouraged to attend the following conferences:
1. Thoracic-Oncology Conference. Every Tuesday at 4:00 p.m. in Morrison Seminar Room
2. Medical Grand Rounds. Every Wednesday at 12:00 p.m. in Morrison Seminar Room.
Residents and medical students will have formal instruction, clinical experience, and will be able to demonstrate competence in the evaluation and management of inpatients with the following:
1. Obstructive lung diseases, including asthma, bronchitis, emphysema, bronchiectasis
2. Pulmonary malignancy – primary and metastatic
3. Pulmonary infections, including tuberculous, fungal, and those in the immuno-compromised host, e.g., human immunodeficiency virus-related infections
4. Diffuse interstitial lung disease
5. Pulmonary embolism and pulmonary embolic disease
6. Pulmonary vascular disease, including primary and secondary pulmonary hypertension and the vasculitis and pulmonary hemorrhage syndromes
7. Occupational and environmental lung diseases
8. Iatrogenic respiratory diseases, including drug-induced disease
9. Acute lung injury, including radiation, inhalation, and trauma
10. Pulmonary manifestations of systemic diseases, including collagen vascular diseases that are primary in other organs
11. Pulmonary physiology and pathophysiology in systemic diseases
12. Disorders of the pleura and the mediastinum
13. Sleep disorders, including the recognition and differential diagnosis of common sleep symptoms, the effects of sleep on pulmonary diseases and treatments, the utility and interpretation of cardiopulmonary monitoring, critical review of polysomnographic reports, and management of sleep-disordered breathing
14. Management of the immuno-suppressed patient
15. Genetic and developmental disorders of the respiratory system, including cystic fibrosis
16. Pulmonary rehabilitation
17. After discharge from the critical care unit
18. Biochemistry and physiology, including cell and molecular biology and immunology, as they relate to pulmonary disease
Residents and medical students will learn professional skills in:
1. Psychosocial and emotional effects of acute and chronic illness on patients and their families
2. Management of end of life issues and palliative care
3. Quality improvement and patient safety activities
Residents and medical students will learn technical and procedural skills in:
1. Flexible fiberoptic bronchoscopy procedures
2. Pulmonary function tests to assess respiratory mechanics and gas exchange, including spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis, and exercise studies
3. The examination and interpretation of sputum, bronchopulmonary secretions, pleural fluid
4. Chest tubes and drainage systems
5. Nutritional support
6. The examination and interpretation of lung tissue for infectious agents, cytology, and histopathology
7. Imaging techniques commonly employed in the evaluation of patients with critical illness and/or pulmonary disorders
Residents and medical students will be given the opportunity to assume continuing responsibility for both acutely and chronically ill inpatients for which pulmonary consultation is requested in order to learn both the natural history of pulmonary disease as well as the effectiveness of therapeutic programs.
Residents and medical students will have experience in coordinating ancillary services through nursing, social services, language interpreters, and dietitians such as pulmonary function testing, pulmonary rehabilitation, and home health.
Residents and medical students will find pertinent reading lists, power point presentations, and articles in the Pulmonary Consult Rotation Syllabus at the following website: http://medicine.creighton.edu/medschool/medicine/educational.html
Residents and medical students will follow-up on pathological materials sent on their patients including blood specimens, sputum specimens, thoracentesis specimens, bronchoscopy specimens, and other tissue specimens.
Residents and medical students have ready access to pertinent textbooks and journals in our Division Library and in the Creighton University Health Sciences Library.
Residents and medical students will be evaluated by faculty monthly through the online New Innovations program. Evaluation will include the following six ACGME Competencies which define the specific knowledge, skills, behaviors, and attitudes required for this educational experience:
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health.
2. Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care.
3. Practice-Based Learning and Improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care.
4. Interpersonal and Communication Skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.
5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
Residents and medical students will also receive face-to-face feedback from faculty throughout their CUMC Pulmonary Consult rotation.
Residents and medical students will be closely supervised by the Pulmonary and Critical Care Medicine Fellow and Pulmonary Consult Attending Physician who will round daily and be available by beeper at all times during the rotation.
(7/19/05)