Department of Internal Medicine
Pulmonary, Critial Care, and Occupational Medicine Fellowship Program
Pulmonary Medicine
Educational Purpose
To provide the environment, resources, and patient population to teach Internal Medicine residents and Pulmonary/Critical Care fellows how to diagnose and treat pulmonary disorders.
Sites of Instruction
Inpatient: Inpatient Pulmonary Ward at University Hospitals and at the VA Hospital
Outpatient:
- University Clinics - Multidisciplinary Lung Cancer Clinic, General Pulmonary Clinic (F2, F3), Interstitial Lung Disease Clinic, Occupational Medicine Clinic, Tuberculosis Clinic.
- VA Clinic : General Pulmonary Clinic(F1, F2, F3)
Pulmonary Physiology: Pulmonary Function Laboratory and Exercise Laboratory
Teaching methods
Inpatient and outpatient rounds with attending physician and fellows, bibliography related to pulmonary problems, and teaching conferences (10 teaching conferences).
Educational Content
The goal in each of the areas outlined is to provide the fellow experience in diagnosing and managing pulmonary disease processes, to provide them background for appropriate use of laboratory testing in diagnosis and management, and to help them learn when it is appropriate to seek consultative assistance and how to provide consultative services.
Obstructive Airways Disease
Recognition and management of chronic bronchitis, emphysema, asthma, bronchiectasis, and cystic fibrosis. Interpretation of pulmonary function testing, use of bronchodilators and antiinflammatory medications, appropriate use of oxygen therapy, and management of acute exacerbations.Interstitial Lung Disease
Recognition and management of sarcoidosis, interstitial pulmonary fibrosis, ILD associated with collagen vascular disease, drug-induced lung disease, and organic and inorganic dust-associated disease. Interpreting PFT for restrictive lung disease, appropriate use of antiinflammatory medications, identifying contributing environmental causes of lung disease, and managing acute disease exacerbation.Malignant Lung Disease
Appropriate diagnosis and staging of bronchogenic carcinoma, use of invasive diagnostic procedures (bronchoscopy and tranthoracic needle biopsy) to accomplish tissue diagnosis, use of noninvasive procedures in staging bronchogenic carcinoma, and identifying treatment strategies in collaboration with oncology, radiation oncology, and thoracic surgery. Appropriate evaluation for metastatic disease to the chest and for mediastinal malignant disease.Pleural Disease
Recognize and manage pleural disease; gain experience in thoracentesis, closed pleural biopsy, and tube thoracostomy; learn the appropriate management for pleural effusions; and appropriate use of surgical consultation in diagnosis and management.Pulmonary Infections
Initial management and diagnosis of community-acquired pneumonia, hospital-acquired pneumonia, typical and atypical tuberculosis, and lung disease in immunocompromised hosts. This includes initial antibiotic selection and appropriate use of ancillary diagnostic procedures and consultation.Pulmonary Vascular Disease
Recognition, diagnosis and management of pulmonary embolism and pulmonary hypertension (both primary and secondary). This includes interpreting lung ventilation-perfusion scans, appropriate use of pulmonary angiography, and principles of anticoagulation.Common Pulmonary Complaints
Develop experience and skills in approaching common pulmonary complaints including cough, dyspnea, and chest pain of unclear etiology.Occupational Lung Disease
Recognize and amange airway and parenchymal disease caused by occupational exposure. These include occupational asthma, interstitial lung disease, and pleural and bronchogenic malignancies. Gain experience in obtaining an occupational history, assessing patients for impairment, and understanding medico-legal issues related to occupationla lung disease.Use of Pulmonary Diagnostic Testing
Within each of these disease categories, residents and fellows will gain experience in using and interpreting static pulmonary function testing (spirometry, diffusing capacity, and lung volumes), arterial blood gases, chest radiography, chest CT scanning, cardiopulmonary exercise testing, and disability evaluations.
Ancillary Educational Materials
We maintain a complete lung pathology slide collection, basic chest radiography teaching file, and a bronchoscopy videotape library for fellow use. In addition, we are developing a complete World Wide Web-based database for instruction and reference.
Evaluation of Residents and Fellows
The fellows are evaluated monthly by the attending physicians on the inpatient and outpatient services. We use evaluation forms patterned after those used by the American Board of Internal Medicine. Residents also evaluate the pulmonary fellows using similar forms.
Evaluation of Rotation
Each resident submits a written evaluation of the rotation and the teaching of the pulmonary faculty and pulmonary fellows using forms supplied by the Department.