Educational Purpose:

The field of Pulmonary Medicine involves the diagnosis and management of diseases of the lungs, pleura, mediastinum, chest wall, and upper airways.  The residents training as a general internist should be able to know when to order and understand the expectations of the following tests:  bronchoscopy with BAL and transbronchial biopsy, cardiopulmonary exercise testing, chest CT, diagnostic studies for deep venous thrombosis, mediastinoscopy, pleural fluid analysis, pulmonary angiography, sleep studies and ventilation perfusion scans. 

Goals and Objectives:

PGY-1-

1.  Evaluate and manage patients with cough, dyspnea, febrile patients with pulmonary infiltrates, pleurisy and pleural effusions.

2.  Diagnose and manage respiratory infections.

3.  Diagnose and provide initial management of patients with respiratory failure and initiate a diagnostic evaluation of patients with suspected lung neoplasms.

4.  Diagnose and evaluate patients with obstructive and restrictive lung diseases.

5.  Understand pulmonary function testing, including spirometry, lung volumes, diffusing capacity, and flow volume loop.

PGY-2-3-

1.  Evaluate and manage patients with cough, dyspnea, febrile patients with pulmonary infiltrates, pleurisy and pleural effusions.

2.  Diagnose and manage respiratory infections.

3.  Diagnose and provide initial management of patients with respiratory failure and initiate a diagnostic evaluation of patients with suspected lung neoplasms.

4.  Diagnose and evaluate patients with obstructive and restrictive lung diseases.

5.  Understand pulmonary function testing, including spirometry, lung volumes, diffusing capacity, and flow volume loop.

6.  Develop short term and long term plan of care as well as supervising and facilitating education of interns and medical students.

Teaching Methods:

Residents are taught during attending teaching rounds which occur daily on the Pulmonary Ward Service.  They learn from caring for and reading about the patients admitted to the service.  Attendings also conduct didactic sessions throughout the month.

Mix of Diseases and Pathological Material:

The residents provide direct patient care to patients with a number of respiratory illnesses including asthma, COPD, pulmonary fibrosis, pulmonary emboli, community-acquired pneumonia, hospital-acquired pneumonia, cystic fibrosis, hemoptysis, sarcoidosis, and pulmonary hypertension.

Patient Characteristics:

The patients on the pulmonary ward service range in age from teenage to elderly.  They come from all race, religious, and socioeconomic backgrounds and come from all over the world.  The patients in general are acutely ill when they arrive on the ward service from the clinics, emergency room, or the intensive care unit.  A certain portion of the patients requires mechanical or non-invasive ventilation.  The majority of the patients are receiving oxygen or respiratory therapies during their stays.

Types of Clinical Encounters:

The patients are admitted from the emergency room, pulmonary clinics, transferred from the intensive care unit or from outside hospitals for specialty care.  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.

Supervision:

Residents are directly supervised in their patient care duties by the Pulmonary fellow and the Pulmonary attending physician.  The PGY 2 or 3 resident on the service supervises the PGY 1 resident.

Educational Resources to be Used and Reading Lists:

The primary educational resource on the Pulmonary Ward Service is a syllabus containing recent articles deemed relevant by the Pulmonary faculty, which can be obtained in the Department.

Method of Evaluation of Resident 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 Skills and Communication is assessed by observing the resident’s interactions with patients, families, and staff.  Systems-Based Practice is evaluated based on the resident’s ability in the team setting, including interactions with the Pulmonary discharge planner.  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.