Rotation: Shands Pulmonary Consultation
Updated: November 2012
Approved by Fellowship Program Education Committee
Fellow Level: F1 , F2, F3
Duration: 1 month blocks
Location: Shands Inpatient Hospital Wards
Evaluation: Done by supervising faculty in both written and verbal form
General Description:
The inpatient pulmonary Shands consult rotation includes the workup, evaluation, and management of patients with pulmonary disorders while hospitalized. Patients seen during this rotation have a wide variety of common and uncommon pulmonary diseases. Fellows are the first contact for inpatient consultation requests from any number of providers in the health care system. 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, thoracenteses, and chest tube thoracostomies 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.
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.
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
4. Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals.
5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
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.
Goals and Objectives
1. Patient Care
To recognize the following:
- The principles and practice of evaluation and management of pulmonary diseases
- Experience and expertise in the performance of procedures necessary to practice pulmonary medicine
- The principles of interpretation of pulmonary function tests, sleep studies, cardiopulmonary exercise tests, and methacholine bronchoprovocation challenge
- The principles of being an effective pulmonary consultant
2. Medical Knowledge
To understand the following:
- Obstructive lung diseases
- Pathophysiology, natural history, treatment, and management of obstructive lung disease
- Asthma-diagnosis and management
- Chronic bronchitis-diagnosis and management
- Emphysema-diagnosis and management
- Bronchiectasis
- Bronchoscopy diagnostic-indications, contraindications, techniques, management of complications
- Bronchoscopy interventional-indications, contraindications, techniques, management of complications
- Cystic fibrosis-diagnosis, management, genetics, family counseling
- Chronic cough and Dyspnea
- Cardiopulmonary exercise testing
- Methacholine challenge testing and exercise bronchoprovocation testing
- Disability evaluation
- Eosinophilic lung disease
- HIV: infectious and non-infectious pulmonary complications
- Inherited lung disease including alpha-1 antitrypsin deficiency-diagnosis and management
- Lung Transplantation
- indications and evaluation for transplant
- pharmacology of transplantation and post-transplant management
- Preoperative assessment of the surgical patient with lung disease.
- Pregnancy
- effect on pulmonary conditions such as asthma
- management of pulmonary problems during pregnancy
- Pulmonary malignancy, primary
- Diagnosis, staging, and management of lung cancer, including multimodality therapy
- Screening methods for lung cancer
- Basic understanding of histopathology
- Pulmonary malignancy, metastatic
- Pulmonary infections
- bacterial, fungal and viral
- Mycobacterium tuberculosis
- atypical mycobacterial
- atypical
- in the immunocompromised host
- Diffuse interstitial lung disease
- Pulmonary vasculitis/pulmonary hemorrhage syndromes
- Pulmonary hypertension
- idiopathic: diagnosis and management
- secondary: diagnosis and management
- Occupational and environmental lung disease
- Drug-induced lung disease
- Transfusion related lung injury
- Acute lung injury due to radiation, inhalation, or trauma
- Pulmonary manifestations of systemic disease, including the collagen vascular diseases
- Sarcoidosis
- Solid organ transplantation: pulmonary and non-pulmonary complications
- Thromboembolic disease, including pulmonary embolism
- Clinical presentation, diagnosis, and acute management of pulmonary embolism
- Interpretation of diagnostic studies including CT angiography
- Disorders
- pleura
- mediastinum
- Genetic and developmental
- Sleep disorders, including diagnosis and management of obstructive and central sleep apnea
3. Practice-Based Learning and Improvement
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
To recognize the following:
- The role of a consultant in assisting a primary team with the care of a patient.
- 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
To recognize the following:
- The skills needed to interact with patients and their families in a manner that demonstrates compassion, competence and professionalism.
- The role of consultant for other services always keeping the patient’s best interest as the primary goal, and performing these duties in a professional and courteous manner.
- Communication skills with patients and their families with attention not just to the medical aspects of patient care, but also to the psychological, social and spiritual dimensions as well.
- High standards of ethical / moral behavior
- Need for Reliability / Responsibility
- Commitment to on-going professional development and lifelong learning
- Attention to documentation in the medical record and communication with other treating physicians
6. Systems-Based Practice
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:
- Provides appropriate documentation of effort for reimbursement
- 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
- Begins to develop proficiency in selection, implementation, and application of diagnostic testing pertinent to pulmonary and critical care medicine
- Proficiency in the synthesis of clinical information
- Proficient in the ability to develop a patient care plan
- Competency in performing the following procedures necessary to practice Pulmonary and Critical Care Medicine
- Thoracentesis
- Chest tube placement and management
- Continues to develop proficiency in performing the following procedures necessary to practice Pulmonary and Critical Care Medicine and demonstrates greater independence in performing this procedures
- Bronchoscopy
- Transbronchial biopsy, endobronchial biopsy, transbronchial needle aspiration and biopsy
- Proficiency in the interpretation of pulmonary function tests, inhalation challenge tests, and cardiopulmonary exercise studies
- 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 pulmonary disease
- Continues to develop understanding of laboratory, imaging techniques, and invasive procedures required to make correct diagnoses in patients with pulmonary disease
- Continues to develop knowledge of pharmacologic and other management options for pulmonary diseases
- Greater understanding of surgical procedures relevant to pulmonary diseases
- Continuing 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 recordkeeping skills that:
- Provides appropriate documentation of effort for reimbursement
- 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 and demonstrates the ability to perform them in an independent fashion
- Bronchoscopy
- Transbronchial biopsy, endobronchial biopsy, transbronchial needle aspiration and biopsy
- Thoracentesis
- Chest tube placement and management
- Competency in the interpretation of pulmonary function tests, inhalation challenge tests, and cardiopulmonary exercise studies
- 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
- Competency in the understanding of laboratory, imaging techniques, and invasive procedures required to make correct diagnoses in patients with pulmonary disease
- Continues to develop knowledge of pharmacologic and other management options for pulmonary diseases and disease requiring ICU care
- Develops greater understanding of surgical procedures relevant to pulmonary diseases
- 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
- 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
- Professional and appropriate relationships and communication skills with patients and their families on medical and surgical services
- 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
- Competency in adequate recordkeeping skills that:
- Provides appropriate documentation of effort for reimbursement
- Demonstrates knowledge of and behavior consistent with strict Medicare compliance