Goals and Objectives

GOALS AND OBJECTIVES – GENERAL COMPETENCIES
PULMONARY/CRITICAL CARE FELLOWSHIP

The educational experience includes inpatient care, outpatient care, conferences, didactic sessions, and research projects.  The three-year period of training is designed to ensure each fellow obtains competence to the level expected of a new practitioner of pulmonary and critical care medicine.

Pulmonary and Critical Care fellows will be evaluated in the Six General Competencies of the ACGME Outcomes Project as applied to the specialty of Pulmonary and Critical Care Medicine.  There will be subspecialty related competencies for each subspecialty rotation as well.  These six competencies are:

  • Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
  • Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
  • Practice-Based Learning and Improvement that involves investigation and evaluation of the fellow’s own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
  • Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
  • Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
  • Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

The specific application of these General Competencies to Pulmonary and Critical Care Medicine will result in the following being evaluated in ALL rotations.


Patient Care Skills:

  • Medical interviewing
  • Physical examination
  • Diagnostic studies including selection, implementation, and application
  • Synthesis of clinical information
  • Development of patient care plan
  • Technical expertise in performing procedures necessary to practice Pulmonary and Critical Care Medicine
    • Bronchoscopy
    • Transbronchial biopsy, endobronchial biopsy, transbronchial needle aspiration and biopsy
    • Fiberoptic bronchoscopy in the ventilated patient
    • Endotracheal intubation
    • Management of the difficult airway
    • Initiation, maintenance, and discontinuation of mechanical ventilation
    • Initiation, maintenance, and discontinuation of noninvasive ventilation
    • Arterial cannulation
    • Central line placement
    • Swan-Ganz catheterization
    • Chest tube placement and management
    • Pleural biopsy
    • Interpretation of pulmonary function tests, inhalation challenge tests, and cardiopulmonary exercise studies
    • Interpretation of polysomnograms
    • Emergency pericardiocentesis
    • Placement of temporary transvenous pacemaker
    • Cardioversion
  • Counseling of patient and family
  • Respect for patient’s privacy
  • End-of-life decision making and ability to discuss these issues with patients and families

Medical Knowledge and Application of Knowledge:

  • The Pulmonary and Critical Care Medicine specialist must possess an appropriate fund of medical knowledge for level of training and experience and must be able to critically evaluate and use current medical information for competent patient care
  • The Pulmonary and Critical Care Specialist must demonstrate basic science knowledge (physiology, pharmacology, anatomy) as related to the patient’s pulmonary disease or disease process requiring ICU care
  • The Pulmonary and Critical Care Specialist must understand the pathophysiology of the patient’s pulmonary disease or disease process requiring ICU care
  • The Pulmonary and Critical Care Specialist must understand laboratory, imaging techniques, and invasive procedures required to make correct diagnoses in patients with pulmonary disease and disease processes requiring ICU care
  • The Pulmonary and Critical Care Specialist must demonstrate specific knowledge of pharmacologic and other management options appropriate to the individual patient.
  • The Pulmonary and Critical Care Specialist must understand surgical procedures relevant to pulmonary diseases and care of the ICU patient
  • The Pulmonary and Critical Care Specialist must understand how to organize a research project, analyze data, and write a scientific paper
  • The Pulmonary and Critical Care Specialist must have the ability to make slides, organize a clinical or research presentation, and give a satisfactory lecture to his/her peers

Practice-Based Learning and Improvement:

  • The Pulmonary and Critical Care fellow must respond appropriately to faculty direction and criticism and demonstrate learning from faculty/fellow interactions
  • The Pulmonary and Critical Care fellow must appropriately utilize general medical literature and pulmonary and critical care medicine literature to develop a management plan for their patients
  • The Pulmonary and Critical Care fellow must learn how to use evidence-based medicine to improve patient care
  • The Pulmonary and Critical Care fellow must become proficient at using the electronic medical record and the use of the Internet to look up medical information
  • The Pulmonary and Critical Care fellow must be committed to self-education by attending Divisional educational activities including conferences and journal clubs
  • The Pulmonary and Critical Care fellow must be able to use information technology to manage information, access online medical information, and support their own education
  • The Pulmonary and Critical Care fellow must facilitate the learning of students, residents, and other healthcare professionals as well as colleagues

Interpersonal and Communication Skills:

  • The Pulmonary and Critical Care Specialist must be able to communicate and work effectively with patients, their families and members of the health care team in relevant health care delivery settings and systems
  • The Pulmonary and Critical Care fellow must demonstrate effective communication with colleagues, medical consultants, and consultants from other specialties
  • The Pulmonary and Critical Care fellow must demonstrate appropriate relationships and communication skills with the ICU staff including nurses, pharmacists, respiratory therapists, social workers, and all other support personnel
  • The Pulmonary and Critical Care fellow must demonstrate appropriate relationships and communication skills with the Bronchoscopy and Pulmonary Diagnostics staff including nurses, respiratory therapists, cardiopulmonary technologists, and all other support personnel
  • The Pulmonary and Critical Care fellow must demonstrate appropriate relationships with supervising faculty
  • The Pulmonary and Critical Care fellow must demonstrate professional and appropriate relationships and communication skills with patients and their families in the ICU and outpatient clinics

Professionalism:

The Pulmonary and Critical Care Medicine Specialist must demonstrate the following essential professional attributes:

  • High standards of ethical / moral behavior
  • Honesty / integrity
  • Reliability / Responsibility
  • Learns well from experience
  • Reacts to stressful / emotional situations in an appropriate manner
  • No documented current substance abuse problem
  • No cognitive, physical, sensory, or motor impairment that precludes acquiring and processing information in an independent and timely manner or independent responsibility for any aspect of patient care
  • Respect for the dignity of patients and colleagues
  • Commitment to on-going professional development and lifelong learning
  • Attention to documentation in the medical record and communication with other treating physicians

Systems-Based Practice:

  • The Pulmonary and Critical Care fellow must practice cost-effective health care that does not compromise patient care
  • The Pulmonary and Critical Care fellow must appropriately utilize consultants and diagnostic testing information to provide effective patient care
  • The Pulmonary and Critical Care fellow must develop an awareness of community resources available for patient care
  • The Pulmonary and Critical Care fellow must develop knowledge about home care nursing services, home care respiratory services, and patient support services and how to refer patients to these programs
  • The Pulmonary and Critical Care fellow must develop an awareness of hospice and end-of-life resources available for patients and families
  • The Pulmonary and Critical Care fellow must possess adequate recordkeeping skills that:
    • Provides appropriate documentation of effort for reimbursement
    • Demonstrates knowledge of and behavior consistent with strict Medicare compliance