The Purpose of this rotation is to have the fellows gain experience with the diagnosis and management of medical and surgical patients who are critically ill in the setting of a Αclosed unit≅, to benefit from multi-disciplinary faculty, to gain experience with monitoring and supervision of such a unit.
Attending Rounds: Bedside teaching; review of mechanical ventilation and weaning techniques, theoretical and practical experience with hemodynamic monitoring, review of diagnostic tests such as chest roentgenograms, computed axial tomograms, radionuclide scans, pulmonary angiograms; discussion and development of a meaningful, practical and cost-effective approach to diagnosis and treatment; interaction and communication with the primary care providers.
Special emphasis is placed on cultural, socioeconomic, ethical, occupational, environmental, as well as behavioral issues by the attending physicians.
The attending physicians rotate on a weekly basis in this unit. Pulmonary, Anesthesiology, and Critical Care attendings alternate providing the residents with different perspectives in the management of patients with critical illnesses.
Procedures: Performed under the supervision of the attending physician whose role gradually evolves to that of a critical observer as the fellow gains experience with establishment of and maintenance of open airway, intubation, invasive and non-invasive mechanical ventilation, liberating the patient from mechanical ventilation; calibration and operation of hemodynamic recording systems; maintenance of circulation; pharmacokinetics and dynamics, use of paralytic agents; insertion of central venous, arterial and pulmonary artery flotation catheters; basic and advanced cardiopulmonary resuscitation; parenteral nutrition.
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. Fellows are expected to review all deaths in detail. This includes obtaining and participating in the autopsy and questioning all aspects of the management of the case.
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.
Mix of Diseases, Patient Characteristics, and Types of Clinical Services
The patient population in this unit provides ICU experience for fellows who serve as junior attendings to the house-staff. Patients with a range of critical illnesses as would be seen in a large community hospital.
Fellow Evaluation Method
Fellows are evaluated by the attending physicians who supervise them over the duration of the rotation. 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 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.