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ADVANCED LUNG DISEASE AND LUNG TRANSPLANTION

Rotation: ADVANCED LUNG DISEASE AND LUNG TRANSPLANTATION

Updated: November 2012

Approved by Fellowship Program Education Committee

Fellow Level: F1        Duration: 1 month blocks

Location: Shands Hospital

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

General 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.  Fellows also participate in outpatient clinics and evaluate patients with advanced lung disease who are being considered for lung transplantation and evaluate 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.  This 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 that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

To recognize the following:

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

2. 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.

To understand the following:

  • 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 that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care 

To recognize the following:

  • 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 that result in effective information exchange and teaming with patients, their families, and other health professionals.

To recognize the following:

  • The 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, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

To recognize the following:

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

6. 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.

To recognize the following:

  • Coordination the care of patients moving from the inpatient to the outpatient setting and thus learn the complexities of our health-care delivery system.
  • Importance of leadership within a healthcare team.
  • 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:
  1. Provides appropriate documentation of effort for reimbursement
  2. Demonstrates knowledge of and behavior consistent with strict Medicare compliance

 

Rotation: ADVANCED LUNG DISEASE AND LUNG TRANSPLANTATION

Updated: November 2012

Approved by Fellowship Program Education Committee

Fellow Level: F2       Duration: 1 month blocks

Location: Shands Hospital

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

General 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.  Fellows also participate in outpatient clinics and evaluate patients with advanced lung disease who are being considered for lung transplantation and evaluate 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.  This 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 that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

To recognize the following:

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

2. 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.

To understand the following:

  • 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 that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

To recognize the following:

  • 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 that result in effective information exchange and teaming with patients, their families, and other health professionals.

To recognize the following:

  • The 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, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

To recognize the following:

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

6. 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.

To recognize the following:

  • Coordination the care of patients moving from the inpatient to the outpatient setting and thus learn the complexities of our health-care delivery system.
  • Importance of leadership within a healthcare team.
  • 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:
  1. Provides appropriate documentation of effort for reimbursement
  2. Demonstrates knowledge of and behavior consistent with strict Medicare compliance

The second year fellow will demonstrate the following:

  • Competency in medical interviewing
  • Competency in physical examination
  • Develop proficiency in selection, implementation, and application of diagnostic testing pertinent to pulmonary and critical care medicine
  • Becomes proficient in the synthesis of clinical information
  • Becomes proficient in the ability to develop a patient care plan
  • Continues to develop proficiency in performing the following procedures necessary to practice Pulmonary and Critical Care Medicine and demonstrates greater independence in performing these procedures:
    • Bronchoscopy
    • Transbronchial biopsy
    • Flexible bronchoscopy in the ventilated patient
    • Chest tube placement and management
    • Becomes proficient in the interpretation of pulmonary function tests
    • Proficiency in counseling of patient and family
    • Continues to develop basic science knowledge (physiology, pharmacology, anatomy) and understanding of pathophysiology as related to the patient’s lung transplantation
    • Continues to develop understanding of laboratory, imaging techniques, and invasive procedures required to make correct diagnoses in lung transplant patients
    • Continues to develop knowledge of pharmacologic and other management options for lung transplant patients
    • The fellow develops greater understanding of surgical procedures relevant to lung transplantation
    • Continues to learn how to use evidence-based medicine to improve patient care
    • Proficiency in using medical databases and the use of Internet resources to improve their knowledge base, improve patient care, and conduct research
    • Ability to teach students, residents, and other healthcare professionals as well as colleagues
    • Proficiency in communicating and working effectively with patients, their families and members of the health care team in relevant health care delivery settings and systems
    • Effective communication with colleagues, medical consultants, and consultants from other specialties
    • Commitment to on-going professional development and lifelong learning
    • Attention to documentation in the medical record and communication with other treating physicians
    • 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 an awareness of community resources available for patient care
    • Continues to develops knowledge about home care nursing services, home care respiratory services, and patient support services and how to refer patients to these programs
    • Continues to develop an awareness of hospice and end-of-life resources available for patients and families
    • Continues to develop adequate record keeping skills that:
      • Provides appropriate documentation of effort for reimbursement
      • Demonstrates knowledge of and behavior consistent with strict Medicare compliance

 

Rotation: ADVANCED LUNG DISEASE AND LUNG TRANSPLANTATION

Updated: November 2012

Approved by Fellowship Program Education Committee

Fellow Level: F3   Duration: 1 month blocks

Location: Shands Hospital

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

General 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.  Fellows also participate in outpatient clinics and evaluate patients with advanced lung disease who are being considered for lung transplantation and evaluate 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.  This 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 that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

To recognize the following:

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

2. Medical Knowledge about established and evolving bio-medical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

To understand the following:

  • 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 that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

To recognize the following:

  • 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 that result in effective information exchange and teaming with patients, their families, and other health professionals.

To recognize the following:

  • The 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, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

To recognize the following:

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

6. 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.

To recognize the following:

  • Coordination the care of patients moving from the inpatient to the outpatient setting and thus learn the complexities of our health-care delivery system.
  • Importance of leadership within a healthcare team.
  • 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:
  1. Provides appropriate documentation of effort for reimbursement
  2. Demonstrates knowledge of and behavior consistent with strict Medicare compliance

The third year fellow will demonstrate the following:

  • 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 performing the following procedures necessary to practice Pulmonary and Critical Care Medicine
    • Bronchoscopy
    • Transbronchial biopsy
    • Flexible bronchoscopy in the ventilated patient
    • Chest tube placement and management
    • Competency in the interpretation of pulmonary function tests
    • Competency in counseling of patient and family
    • Continues to develop basic science knowledge (physiology, pharmacology, anatomy) and understanding of pathophysiology as related to the patient’s pulmonary disease or disease process requiring ICU care
    • Understanding of laboratory, imaging techniques, and invasive procedures required to make correct diagnoses in patients before and after lung transplantation
    • Continues to develop knowledge of pharmacologic and other management options for lung transplant patients
    • Greater understanding of surgical procedures relevant to the lung transplant patient
    • Proficiency in using information technology to manage information, access online medical information, and support their own education
    • Ability to teach students, residents, and other healthcare professionals as well as colleagues
    • 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
    • Competency in effective communication with colleagues, medical consultants, and consultants from other specialties
    • Commitment to on-going professional development and lifelong learning
    • Attention to documentation in the medical record and communication with other treating physicians
    • 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 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
    • The  fellow demonstrates competency in adequate record keeping skills that:
      • Provides appropriate documentation of effort for reimbursement
      • Demonstrates knowledge of and behavior consistent with strict Medicare compliance