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Educational Purpose

This rotation is designed to provide the fellows with exposure to and experience with the diagnosis and treatment of a range of pulmonary pathology that is encountered in a large community hospital.

Teaching Methods

Attending Rounds: These include bedside teaching, review of diagnostic tests such as chest radiographs, 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 as a consultant, special emphasis on health promotion, preventive medicine, and cultural, socioeconomic, ethical, occupational, environmental, as well as behavioral issues by the attending physicians.

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 fiberoptic bronchoscopy, bronchoalveolar lavage, bronchial and transbronchial biopsies, and transbronchial aspiration, 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, and blood gas analysis. During this rotation, the fellows also develop competence in monitoring and supervising pulmonary function laboratories.

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 Procedures and Services

Most diseases required by the curriculum are seen at this site. These include those patients typically seen at a large urban community hospital.

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.