Advanced Lung Disease and Lung Transplantation Rotation

Duration: 1 month blocks

Location: Shands Hospital

Evaluation: Done by supervising faculty in both written and verbal form

Approved by Fellowship Program Education Committee, Updated: July 2019

Description:

The advanced lung disease and lung transplantation rotation includes the workup, evaluation, and management of patients who have advanced lung disease and who have undergone lung transplantation.  Patients seen during this rotation have a wide variety of common and uncommon pulmonary diseases. 

In the inpatient setting:
The fellow cares for patients who have received lung transplant and are hospitalized in the ICU and on the wards. 

In outpatient clinics:
The Fellow evaluates patients with advanced lung disease who are being considered for lung transplantation and evaluates patients who return for outpatient clinic follow-up after lung transplantation. 

Fellows will have extensive exposure to the use of immunosuppressive medications on this rotation.  Professionalism and helpfulness to the requesting providers are expected at all times.  The fellow is primarily responsible to evaluate patients, speak to families and co-ordinate the care with other health-care professionals.  An attending pulmonary and critical care medicine faculty member rounds with the fellow to provide data, guidance, and education.  The fellow will perform bronchoscopies while on this service.  Procedures will be supervised by a pulmonary and critical care medicine faculty member. Learning takes place during bedside rounds, didactic conferences, sit down teaching rounds related to the care of patients, and through self study.

Core Competencies:

1. Patient Care 

To recognize the Principles and Practice of :

  • evaluation and management of end-stage lung diseases
  • evaluation for lung transplantation
  • management of pre-lung transplant patients and post-lung transplant patients
  • evaluation and management of pulmonary hypertension
  • ethical considerations in end-of-life decision making

2. Medical Knowledge

To recognize and understand:

  • Pathophysiology of end-stage pulmonary disease
  • Prognostic factors for end-stage lung disease
  • Timing of referrals for lung transplantation
  • Indications and contraindications for lung transplantation
  • Characteristics of a suitable organ donor
  • Management of the post-operative lung transplant patient
  • Basic familiarity with immunosuppressive medications and immunosuppression regimens
  • Clinical, physiologic and pathologic characteristics of acute and chronic lung rejection
  • Diagnosis and treatment of opportunistic infections post transplantation

3. Practice-Based Learning and Improvement 

To recognize and understand:

  • The effective utilization of educational and evidence-based resources to seek answers to scientific and clinical questions.
  • Identification of perceived deficiencies in knowledge or experience and actively seek opportunities for correction.
  • Appropriate response to faculty direction and criticism and demonstrate learning from faculty/fellow interactions
  • Proficiency at using the electronic medical record and the use of electronic resources to look up medical information
  • Commitment to self-education by attending Divisional educational activities including conferences and journal clubs
  • Facilitate the learning of students, residents, and other healthcare professionals as well as colleagues

4. Interpersonal and Communication Skills 

To recognize and understand:

  • Skills needed to interact with patients and their families in a manner that demonstrates compassion, competence and professionalism.
  • Education to the residents and students working with their patients.
  • Appropriate relationships and communication skills with the Bronchoscopy and Pulmonary Diagnostics staff including nurses, respiratory therapists, cardiopulmonary technologists, and all other support personnel

5. Professionalism

To recognize and understand:

  • Effective communication with colleagues, medical consultants, and consultants from other specialties
  • Appropriate relationships with supervising faculty
  • Professional and appropriate relationships and communication skills with:
    • Patients and their families on the transplant service, in the ICU, and outpatient clinics Lung transplant coordinators and staff
    • Bronchoscopy and Pulmonary Diagnostics staff including nurses, respiratory therapists, cardiopulmonary technologists, and all other support personnel
    • ICU staff including nurses, pharmacists, respiratory therapists, social workers, and all other support personnel

6. Systems-Based Practice

6a. The 1st Year Fellow:

  • Importance of leadership within a healthcare team.
  • Coordination in the care of patients moving from the inpatient to the outpatient setting and thus learn the complexities of our health-care delivery system.
  • Practice of cost-effective health care that does not compromise patient care
  • Appropriate utilization of consultants and diagnostic testing information to provide effective patient care
  • Awareness of community resources available for patient care
  • Knowledge about home care nursing services, home care respiratory services, and patient support services and how to refer patients to these programs
  • Awareness of hospice and end-of-life resources available for patients and families
  • Adequate record keeping skills that:
    • Provide appropriate documentation of effort for reimbursement
    • Demonstrate knowledge of and behavior consistent with strict Medicare compliance

6b. The 2nd Year Fellow:

  • Continues to develop the ability to deliver cost-effective health care that does not compromise patient care
  • Continues to develop the ability to appropriately utilize consultants and diagnostic testing information to provide effective patient care
  • Continues to develop knowledge and awareness of home care nursing services, home care respiratory services, and patient support services and how to refer patients to these programs
  • Continues to develop awareness of hospice and end-of-life resources available for patients and families
  • Continues to develop knowledge of basic science (physiology, pharmacology, anatomy) and understanding of pathophysiology as related to the patient’s pulmonary disease or disease process requiring ICU care
  • Continues to develop knowledge of pharmacologic and other management options for lung transplant patients
  • Continues to develop adequate record keeping skills that:
    • provide appropriate documentation of effort for reimbursement
    • demonstrate knowledge of and behavior consistent with strict Medicare compliance
  • Continues to develop proficiency and demonstrates greater independence in performing the following procedures:
    • Bronchoscopy
    • Transbronchial biopsy
    • Flexible bronchoscopy in the ventilated patient
    • Chest tube placement and management
    • Interpretation of pulmonary function tests
  • Demonstrates Competency in Medical interviewing
  • Demonstrates Competency in Physical examination
  • Demonstrates Proficiency in the selection, implementation, and application of diagnostic testing pertinent to pulmonary and critical care medicine
  • Demonstrates Proficiency in the synthesis of clinical information
  • Demonstrates Proficiency in the ability to develop a patient care plan
  • Demonstrates Proficiency in counseling of patient and family
  • Demonstrates Proficiency in using medical databases and the use of Internet resources to improve their knowledge base, improve patient care, and conduct research
  • Demonstrates Proficiency in Communicating and working effectively with
    • patients, their families and members of the health care team in relevant health care delivery settings
    • systems colleagues, medical consultants, and consultants from other specialties

6c. The 3rd Year Fellow Demonstrates:

  • Competency in delivering cost-effective health care that does not compromise patient care
  • Competency in the ability to appropriately utilize consultants and diagnostic testing information to provide effective patient care
  • Awareness of community resources available for patient care
  • Knowledge of home care nursing services, home care respiratory services, and patient support services and how to refer patients to these programs
  • Awareness of hospice and end-of-life resources available for patients and families
  • Continued development in knowledge of basic science (physiology, pharmacology, anatomy) and understanding of pathophysiology as related to the patient’s pulmonary disease or disease process requiring ICU care
  • Knowledge of pharmacologic and other management options for lung transplant patients
  • Competency in adequate record keeping skills that:
    • provide appropriate documentation of effort for reimbursement
    • demonstrate knowledge of and behavior consistent with strict Medicare compliance
  • Competency in performing the following procedures:
    • Bronchoscopy
    • Transbronchial biopsy
    • Flexible bronchoscopy in the ventilated patient
    • Chest tube placement and management
    • Interpretation of pulmonary function tests
  • Competency in Medical interviewing
  • Competency in Physical examination
  • Competency in the selection, implementation, and application of diagnostic testing pertinent to pulmonary and critical care medicine
  • Competency in the synthesis of clinical information
  • Competency in the ability to develop a patient care plan
  • Competency in counseling of patient and family
  • Proficiency in using information technology to manage information, access online medical information medical information and the support their own education
  • Competency in Communicating and working effectively with
    • patients, their families and members of the health care team in relevant health care delivery settings and systems
    • colleagues, medical consultants, and consultants from other specialties