Educational Purpose

This rotation is designed to provide the fellows with exposure to and experience with the diagnosis and treatment of a wide range of pulmonary pathology that is characteristically encountered in a relatively older patient population than that encountered at the University of Illinois Hospital.

Teaching Methods

Attending Rounds include bedside teaching, review of diagnostic tests such as chest roentgenograms, computed axial tomograms, radionuclide scans, pulmonary angiograms (also discussed with the radiology attending physicians), and discussion and development of a meaningful, practical and cost-effective approach to diagnosis and treatment.

Interaction and communication with the primary care providers, health promotion, preventive medicine, and cultural, socioeconomic, ethical, occupational, environmental, and behavioral issues are emphasized.

Procedures are performed under the supervision of the attending physician whose role gradually evolves to that of a critical observer as the fellow gains experience with fiberoptic bronchoscopy, bronchoalveolar lavage, bronchial and transbronchial biopsies, transbronchial aspiration, and thoracentesis.

Pulmonary Function Laboratory: The fellows learn how to perform and interpret pulmonary function tests under the supervision of the attending physician and the chief technician to assess respiratory mechanics, gas exchange and respiratory drive, including spirometry, flow-volume studies, lung volumes, diffusion capacity, arterial blood gas analysis, exercise and inhalational challenge studies.

During this rotation, the fellows also develop competence in monitoring and supervising pulmonary function laboratories.

Pathology: The fellows are expected to review the results of diagnostic studies that include bronchoalveolar, pleural fluid and tissue, and lung tissue specimens, with their attending physician and the pathology attending.

Case Conference: Diagnostic and therapeutic approach to pulmonary and critical care patients are discussed in detail along with the relevant literature on a weekly basis.

Disease Oriented Clinical Conference: Pulmonary, Critical Care, and Sleep Medicine diseases are covered in this weekly conference.

Principles of Practical Pulmonary Conference: Topics not identifiable as belonging a disease are covered in these weekly sessions. Subject matter includes physiology, procedures, and interpretations of tests.

Medical-Surgical Case Conference: The fellows, the attending physician along with the physicians from medical Oncology and Thoracic Surgery attend this weekly conference.

Mix of Diseases, Patient Characteristics, and Types of Clinical Procedures and Services

The patients vary from primary care to referral patients and most of the diseases required by the curriculum are encountered at this site. The fellows gain proportionately more expertise in the diagnosis and treatment of patients with lung cancer and obstructive lung disease that is frequently encountered at this institution. Pulmonary diseases that are common in patients with drug abuse and HIV are frequently observed. Patients with tuberculosis and sleep-induced respiratory disorders are often managed by the fellows. Patients at this site are evaluated for lung transplantation and surgery. The fellows frequently evaluate post operative patients.

The fellows serve as consultants to the primary care teams and discuss the diagnostic and therapeutic approach to the patients’ problems along with the results of the diagnostic tests.

Fellow Evaluation Method

Fellows are evaluated by the attending physician who supervises them over the duration of the rotation. Verbal feedback is given is given on an ongoing basis. An ABIM-format evaluation is completed and reviewed with the fellow at the completion of the rotation. If an attending physician judges that a fellow is not performing adequately in any area of evaluation, he or she must explicitly provide constructive feedback sometime during the middle of the rotation.

Fellows in return, evaluate their attending physicians and the rotation in terms of patient mix, experience as well as the number of procedures by filling in an evaluation form at the end of the rotation.