Jesse Brown VA Medical Center Outpatient Services

Educational Purpose

To gain experience with diagnosis and management of patients with pulmonary disease in the setting of an out-patient continuity clinic. This involves:

  • Development of therapeutic longitudinal relationships with patients
  • Development of a body of knowledge concerning the ambulatory care of adults
  • Developing efficiency and facility in handling acute, urgent and chronic problems in the care of ambulatory patients
  • Developing an appreciation of cost-effective, evidence-based care as well as exposure to principles of total quality management and managed care.

Teaching Methods

One of the fellow groups that attend the University of Illinois Pulmonary Continuity Clinic attends the VA Pulmonary Clinic on a bi-weekly. The fellows see new consultations and build their continuity clinics. Fellows are supervised by two attendings, to whom they present their patients after completing their initial evaluation. They discuss their plans for differential diagnosis and treatment with the attending physicians. The degree of the attending supervision evolves as the fellows gain experience in the out-patient pulmonary clinic.

In clinic pharmacy consultations are provided by a PharmD who participates in patient education as well.

The fellows review in detail the pulmonary function tests, chest roentgenograms and CT scans of their patients with one of the attending physicians.

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

Patients with chronic obstructive lung disease, asthma and lung cancer predominate this clinic. The fellows also gain experience with the diagnosis and management of a wide variety of patients with interstitial lung disease.

Fellow Evaluation Method

Fellows are evaluated by the attending physicians who supervise them twice a year. Verbal feedback is given is given on an ongoing basis. An ABIM-format evaluation is completed by all attendings 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 as soon as possible.

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.