Pulmonary Consult Rotation
Educational Purpose and Goals:
The field of Pulmonary Medicine involves the diagnosis and management of diseases of the lungs, pleura, mediastinum, chest wall, and upper airways. The resident training as a general internist should be able to evaluate and manage patients with cough, dyspnea, febrile patients with pulmonary infiltrates, pleurisy and pleural effusions. The resident should also be able to diagnose and manage respiratory infections, diagnose and provide initial management of patients with respiratory failure, and initiate a diagnostic evaluation of patients with suspected lung neoplasms. The resident should be able to diagnose and evaluate patients with obstructive and restrictive lung diseases.
The resident should have a complete understanding of pulmonary function testing, including spirometry, lung volumes, diffusing capacity, and flow volume loop.
The resident should know when to order and understand the expectations of the following tests: bronchoscopy with BAL transbronchial biopsy and other bronchoscopic procedures, cardiopulmonary exercise testing, chest radiographic studies including chest radiograph and chest CT, diagnostic studies for deep venous thrombosis and pulmonary embolism, mediastinoscopy, pleural fluid analysis, and sleep studies.
1. Residents are expected to evaluate new consults and develop a plan of care which is then discussed with upper level residents, fellows, and attendings.
PGY-2 and 3
1. Residents supervise and facilitate the education of interns and medical students on the consultative service.
Residents are taught during attending teaching rounds which occur every weekday on the Pulmonary Consult service. They learn from consulting on and reading about the patients followed by the service. Attendings also conduct didactic sessions throughout the month.
Mix of Diseases:
The residents provide consultative care to patients with a number of respiratory illnesses including asthma, COPD, pulmonary fibrosis, pulmonary emboli, community-acquired pneumonia, hospital-acquired pneumonia, interstitial lung disease, pulmonary hypertension, respiratory failure, adult respiratory distress syndrome, sarcoidosis, and difficulty weaning from mechanical ventilation.
The patients on the pulmonary consult service range in age from teenage to elderly. They come from all race, religious, and socioeconomic backgrounds and come from all over the world.
Types of Clinical Encounters:
Consults are received from a variety of specialty care services, including medical and surgical. The clinical encounters range from basic COPD exacerbation admissions to complicated management of pulmonary hypertension or failure to wean patients.
Procedures and Services:
Procedural skills for the internist that are frequently required for pulmonary patients include: arterial blood sampling, endotracheal intubation, monitoring of oxygen therapy, tuberculin skin testing, pulmonary function testing, and thoracentesis.
Residents and medical students are directly supervised in their patient care duties by the Pulmonary Fellow and the Pulmonary Consult Attending Physician.
Educational Resources to be Used and Reading Lists:
The primary educational resource on the Pulmonary Consult Service is the syllabus of references provided. Residents should consult the literature and obtain pertinent articles for each consult.
Method of Evaluation of Competence:
Residents are evaluated by the Attending with the assistance of the Fellow each month using the standard Departmental Evaluation form for each competency. Patient Care is assessed based on direct observation and chart review. Medical Knowledge is assessed through direct questioning on rounds. Professionalism is assessed based on observation of the resident’s demeanor and behavior on this rotation. Interpersonal and Communication Skills are assessed by observing the resident’s interactions with consulting team, patients, families and staff. Systems-Based Practice is evaluated based on the resident’s ability to function in the team setting, including interactions with the consulting service. Practice-Based Learning is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study and literature review.