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.
Two groups of fellows alternate on a bi-weekly basis in this clinic where they see new consultations and build their continuity clinics. Fellows are supervised by two attendings, and they present their patients to one of the attending physicians 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 chest roentgenograms, CT scans, pulmonary function tests of the patients are reviewed in detail with the attending physicians.
Mix of Diseases, Patient Characteristics, and Types of Clinical Services
All diseases required by the curriculum are encountered in this clinic.
A large patient population with bronchial asthma is also followed in this clinic, where an individual action plan for each patient’s management is developed.
Fellow Evaluation Method
Fellows are evaluated by the supervising attending physicians 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.