Course/Rotation Title: RESPIRATORY CARE UNIT (RCU)
Date of Last Review/Update:
3/07
Course/Rotation Director: Jack Ringler, MD
Location of Clinical Encounters
Inpatient % time = 97%
(Check all that apply)
[ ]
Wards
[ ]
ICU
[X]
ED
[X]
Other: Chronic Respiratory Care Unit
Outpatient % time = 3%
Course/Rotation description with educational purpose/value
The Respiratory Care Unit is a subspecialty block inpatient rotation required yearly for
all residents at Berkshire Medical Center. The Respiratory Care Unit has been designed
to optimize multidisciplinary care for patients with acute non-critical respiratory issues
(both ventilated and non-ventilated) which require subspecialty pulmonary / nursing / and
respiratory therapy input on at least a daily basis.
The goal of this rotation is to prepare future general internists with the skills and
knowledge to appropriately evaluate, treat, and refer in a timely fashion patients with
systemic illnesses with a respiratory component as well as acute and chronic respiratory
illnesses.
During this rotation the Trainee will round daily at the bedside with a Pulmonologist,
respiratory therapist and nurse as part of a multidisciplinary team.
Residents should review all appropriate policies within the curriculum which may apply
to this rotation.
There is no overnight call during this rotation. The long day/short day schedule will be
the same as the Ward Medicine rotation with the exception that if it is a two intern team
the long day will occur every third rather than every second.
On the intern long day they will be supervised by the ICU resident after the RCU senior
has gone home.
Types of Clinical Encounters: Patients are seen primarily in the hospital and ED
settings. Clinical encounters include admissions, transfers, procedures, discharges, endof life discussions, family meetings, multidisciplinary team meetings, etc.
Types of Patients: (PLEASE SPECIFY)
[X]
[X]
[X]
[X]
Adults of all ages
Male
Female
Other: Primarily respiratory illnesses as described above
Mix of Diseases: (PLEASE SPECIFY ANY ADDITIONAL DISEASES
See above under rotation description
Types of Procedures: (PLEASE SPECIFY):
 Endotracheal intubation
 Airway management
 Diagnostic and therapeutic thoracentesis
 Tracheostomy tube care and changes
 Arterial blood gas sampling
 Nasogastric tube insertion.
 PFT interpretation
 Central venous catheter placement
Describe the level of supervision by faculty:
[X]
[X]
[X]
[X]
Attending staff will supervise and precept all patient care activity directly or
indirectly.
Attending staff will provide mid rotation feedback
Attending staff will provide end-of-rotation feedback
Other: Teaching Rounds: A Pulmonologist is responsible for Teaching Rounds.
Teaching Rounds occur at a minimum of 3 days per week and total at least 4.5 hours per
week. Format is generally bedside teaching involving a multidisciplinary team and
fulfills the RRCIM Program Requirements V.E.1. “Teaching, or attending, rounds must
be patient-based sessions in which current cases are presented as a basis for discussion of
such points as interpretation of clinical data, pathophysiology, differential diagnosis,
specific management of the patient, the appropriate use of technology, the incorporation
of evidence and patient values in clinical decision-making, and disease prevention."
"Teaching rounds must include direct resident and attending interaction with the patient,
and must include bedside teaching and the demonstration of interview and physical
examination techniques.”
Graded expectations:
Please see Roman numeral III.
Please see General Medicine Ward Rotation
Team Census
Please see Team Census Regulations (RCU)
Other:
All rules and regulations applicable to Ward Medicine months apply to this rotation
please review Ward Medicine Curriculum you will be accountable to these regulations.
Competency Based Objectives/Expectations. Please see Roman Numeral II with
additional items specific to this rotation as below:
Patient Care:
 Work up admissions and care for patients with acute and chronic respiratory
problems
 Perform Procedures as outline above
 Present patients on rounds to multidisciplinary team caring for patient
 Participate in family meetings discussing end of life care
 Gains ability to integrate history, physical, data into a cohesive assessment and
care plan
Medical Knowledge:
 Approach to the evaluation and management of acute respiratory disorders
including hypoxic and hypoventilatory respiratory failure, chronic obstructive
pulmonary disease, asthma, bronchiectasis, respiratory infections including
pneumonia, & empyema, pulmonary embolism, obstructive sleep apnea, acute
respiratory distress syndrome, and lung cancer and its complications.
 Interpretation of data from arterial blood gases and pulmonary function testing in
a critical care setting
 Develops medical knowledge and clinical skills to be able to discern between
chronic disease states and acute exacerbations and their interrelationships
Practice-Based Learning:


Seeks out resources independently to gain increased knowledge and
understanding of disease states with which the trainee is unfamiliar
Demonstrates facility with hospital based online databases (OVID, Cochrane,
PubMed)
Interpersonal and Communication Skills:

Develops a therapeutic relationship with patients such that they look to the
resident as their primary physician contact
Professionalism


Develops a true sense of ownership and responsibility for all care their patients
receive
Shows respect to and is able to learn from Respiratory Therapy, Nursing and other
ancillary RCU staff
Systems Based Practice


Ability to work as part of a multidisciplinary team in caring for patients with
respiratory illness
Understanding the principles of withholding/withdrawing life support and
advanced directives.
Check Any Methods Used For Teaching and Assessment:
[ ] Ambulatory Clinic (feedback written & verbal)
[ ] Annual In-service Exam (feedback written)
[X] Attending Rounds (feedback written & verbal)
[ ] Board Review (feedback written examination)
[ ] Cancer Conference
[X] Case Management Evaluation (360 degree written evaluation)
[X] Chart Stimulated Recall & Feedback (feedback verbal)
[X] Direct Observation and Feedback (feedback written & verbal)
[ ] GME Core Curriculum
[ ] Interns Report (feedback written & verbal)
[ ] Journal Club (feedback written & verbal)
[X] Medical Record Review (feedback written & verbal)
[ ] Mentor Feedback (feedback written & verbal)
[ ] Monthly End of Elective Exam (feedback written)
[X] Monthly Mini CEX (feedback written & verbal)
[X] Monthly Competency Based Written Evaluation
[X] Morning Report (feedback written & verbal)
[ ] Multidisciplinary Rounds Feedback (feedback verbal)
[X] Nursing Evaluation (360 degree written evaluation)
[X] Patient Evaluation (360 degree written evaluation)
[X] Patient Management Discussions (feedback written & verbal)
[X] Procedure Logs
[ ] Performance improvement Multidisciplinary Morbidity and Mortality (feedback
written & verbal)
[ ] Semi Annual Program Director Feedback (feedback written & verbal)
[ ] Student Evaluation (feedback written & verbal)
[ ] Supervised Sign-In Rounds (feedback written & verbal)
[ ] Supervised Sign-Out Rounds (feedback verbal)
[ ] Other _______________________________
[ ] Other _______________________________
[ ] Other _______________________________
[ ] Other _______________________________
Other Policies:
The Course Director recognizes that the trainee is accountable to all BMC Residency and
GME Personnel Policies and Procedures. The Course Director recognizes that the
residents are expected to attend all continuity clinics and mandatory educational
conferences unless excused by the Program Director or Chief Medical Resident with
advanced notice.
Check The Educational Materials Used (beyond direct patient care):
[X] Reading List (Please Specify):
Required
 Rotation Goals & Objectives
 Appendix to Curriculum: Communicating with Patients to Enhance the
Patient Experience and Coordination of Care
 Overview chapters on Respiratory Disease in UpToDate™
Resources
 ACCP and ATS guidelines
 Saunders: Weinberg.S. Pulmonary Medicine
[X] Review of Appropriate Radiology Images (Please Specify):
 Daily radiology rounds where all appropriate studies are reviewed either with the
Pulmonologist on service or with attending radiologist
[X] Review of Appropriate Pathology (Please Specify):
 Review with Pathologists any biopsy material obtained
 Review sputum Gram Stain C&S as appropriate
[X] Review of Appropriate Laboratory Data (Please Specify):
 Any ordered lab must be personally reviewed by the resident team with
appropriate differential diagnosis and action plan to address lab findings
documented in the medical record.
[ ] Articles from the Literature (Please Specify):
[ ] Case Studies
[ ] Other (Please Specify):