Curriculum Template
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Family Medicine Residency Pulmonology Rotation Kevin Wheatley, M.D. Rotation Goal Family Medicine residents receive instruction in pulmonary diseases incorporated within their Family Medicine rotations, and especially as a part of the onemonth required rotation in critical care. Please see the ICU curriculum for pulmonary concepts and procedures covered during the critical care rotation. Lectures on common pulmonary problems are also incorporated into the noon conference and mini-seminar schedule. The residents gain experience with pulmonary diseases through their outpatient experiences in the Family Practice Center Clinic and with the Jackson Clinic Pulmonologists. If residents desire additional experience in pulmonology, they may choose to do an elective in pulmonology during their third year in residency as well. During this elective, residents will interact with physicians subspecializing in pulmonology to familiarize themselves with the impact of pulmonary illness and dysfunction in both inpatient and outpatient settings. Supervision Direct observation is provided by supervising physicians. Supervising physicians include Robert Gilroy, MD, William Mariencheck, MD, and Jeff McCartney, MD. Rotation Objectives By the end of the Pulmonology rotation, PGY II & III residents are expected to expand and cultivate skills and knowledge learned during previous training and to achieve the following objectives based on the six general competencies. The resident should exhibit an increasing level of responsibility and independency as he or she progresses throughout the year. Competency Required Skill(s) Teaching Method(s) Formative Evaluation Frequency of Method(s) Evaluation Patient Care SPECIALTY SPECIFIC OBJECTIVES Develop skills that allow for compassionate, appropriate Conferences/Didactics Direct Feedback Daily and effective care of patients with pulmonary disease while Daily Rounds Global Evaluation Monthly integrating evidence-based medicine and local standards of Self Directed Learning 360 Degree Evaluation Monthly care. Obtain complete medical history and perform a Conferences/Didactics Direct Feedback Daily comprehensive physical examination in patients with Daily Rounds Global Evaluation Monthly pulmonary complaints Self Directed Learning 360 Degree Evaluation Monthly Use the clinical exam to generate the differential diagnosis Conferences/Didactics Direct Feedback Daily and management plan Daily Rounds Global Evaluation Monthly Self Directed Learning 360 Degree Evaluation Monthly 1 Formulate a rational plan of investigation and management, including assessment of severity and need for immediate expert assistance Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Evaluate the circulatory system including volume status, stigmata of DVT, and cardiac evaluation Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Conferences/Didactics Daily Rounds Direct Feedback Global Evaluation Daily Monthly Evaluate laboratory testing results pertinent to various pulmonary disorders Evaluate findings of radiographic studies pertinent to pulmonary evaluation Interpret pulmonary function testing (PFTs) Institute and adjust mechanical ventilation Analyze arterial blood gases and apply to the clinical context Demonstrate competence in ordering and administering non-invasive ventilation Under direct supervision, perform specific procedures and interpretation of results a. Assist preceptor with bronchoscopy and biopsies b. Thoracocentesis c. Endotracheal intubation d. Thoracostomy Formulate a plan of management, investigation and need for expert advice with an awareness of the risks and costs of the investigation and the value of the information that will be obtained Manage and recognize the prevalent and treatable diseases listed under "Medical Knowledge" with consultation as 2 appropriate Proper use of diagnostic tests and pulmonary medications Medical Knowledge SPECIALTY SPECIFIC OBJECTIVES Develop an understanding of the following: Normal anatomy, physiology and anatomic principles of the respiratory tract Physiologic basis of dypsnea, hypoxia, and hypercapnea Develop adequate knowledge of common disorders of the pulmonary system as managed by board certified subspecialists in pulmonology Develop a basic knowledge of the pathophysiology, diagnosis, and management of abnormalities of the pulmonary system including: 1. COPD 2. Asthma 3. Pulmonary Fibrosis 4. Sleep Apnea Syndromes 5. DVT/PTE 6. Occupational 7. Sarcoidiosis 8. Lung cancer 9. Plural Effusion 10. Pneumonia a. Community Acquired b. Hospital Acquired c. Ventilator Associated 11. Tuberculosis 12. Histoplasmosis Compare and contrast the common modalities of mechanical ventilation Investigate “shared symptoms”: symptoms that may arise from more than one organ system (ie., dypsnea, cough, Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation Daily Monthly Monthly Daily Monthly 3 Practice Based Learning and Improvement Interpersonal and Communication Skills Professionalism chest pain) Develop understanding of the common modalities of pharmacologic respiratory therapy and their modes of administration (i.e., bronchodilators, steroids, anticoagulants, antibiotics, oxygen, etc.) and Pulmonary rehabilitation Develop and apply knowledge of the following aspects relevant to the care of patients with pulmonary disease: Principles of history taking and physical examination pertinent to the pulmonary system Indications for and limitations of each type of diagnostic testing of the pulmonary system SPECIALTY SPECIFIC OBJECTIVES See General Family Medicine Objectives for a comprehensive list. Develop tools to help meet the needs of patients Recognize own level of competence in handling pulmonary problems and the need for further consultation as appropriate. Facilitate learning of medical students, residents and other health care professionals to encourage quality improvement in patient care SPECIALTY SPECIFIC OBJECTIVES See General Family Medicine Objectives for a comprehensive list. Communicate effectively with patients and their families while in the presence of their daily preceptor. Convey information in a clear and concise manner to patients, families, and other health professionals (i.e., use appropriate vocabulary choice, realistic outcomes, and working with difficult patients and family) SPECIALTY SPECIFIC OBJECTIVES See General Family Medicine Objectives for a Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly 4 Systems-Based Practice comprehensive list. Provide compassionate and high quality care to all patients regardless of gender, age, culture, race, religion, disabilities, sexual orientation or socioeconomic class Behave in a professional manner when interacting with patients or other health care providers (i.e., integrity, respect, accountability, punctual) SPECIALTY SPECIFIC OBJECTIVES See General Family Medicine Objectives for a comprehensive list. Incorporate considerations of cost awareness and riskbenefit analysis in patient care Advocate for quality patient care and optimal patient care systems Develop an understanding of the appropriate role of subspecialty medicine in evaluation and treatment of pulmonary disorders and when a pulmonology consult is warranted Develop an understanding of coding and billing relevant to pulmonology. Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Daily Monthly Monthly Daily Monthly Monthly Conferences/Didactics Daily Rounds Self Directed Learning Direct Feedback Global Evaluation 360 Degree Evaluation Daily Monthly Monthly Educational Resources 1. Various pulmonary articles in the ICU rotation packet 2. www.uptodate.com (available free through www.utdol.com in Jackson General Hospital based computers) 3. The Washington Manual of Medical Therapeutics, 2nd edition Practical Guide to The Care of the Medical Patient, Fred Ferri 6th edition 4. www.epocrates.com 5. www.emedicine.com 6. Tarascon Internal Medicine 7. Additional information provided specifically by preceptor prior to beginning rotation. 5
