UIH Pulmonary Consultation Orientation
Fellows
Welcome to the Pulmonary Consult Service!
DESCRIPTION
The Pulmonary Consultation Service rotation is designed to provide fellows with instruction and experience in
the diagnosis and management of common inpatient consultations, reading and administration of pulmonary
function tests, advanced bronchoscopic techniques and management of an interdisciplinary health care team,
including residents, students, pulmonary function technicians and nurses.
Pulmonary infections, including pulmonary tuberculosis, obstructive lung diseases, interstitial lung disease,
pulmonary embolism and hypertension, respiratory failure and pulmonary malignancy are commonly
encountered and emphasized.
EDUCATIONAL OBJECTIVES
Patient Care
Fellows are expected to provide patient care to patients with pulmonary diseases that is effective, appropriate,
and compassionate for the promotion of health, prevention of illness, treatment of disease and at the end of
life.
Medical Knowledge
Fellows are expected to demonstrate knowledge of established and evolving biomedical, clinical and social
sciences as it relates to pulmonary diseases, and demonstrate the application of their knowledge to patient
care and the education of others.
Practice-Based Learning and Improvement
Fellows are expected to be able to use scientific evidence and methods to investigate, evaluate and improve
patient care practices, particularly as it relates to pulmonary diseases.
Interpersonal and Communication Skills
Fellows are expected to demonstrate interpersonal and communication skills that enable them to establish
and maintain professional relationships with patients, families, and other members of health care teams.
Professionalism
Fellows are expected to demonstrate behaviors that reflect a commitment to continuous professional
development, ethical practice, and understanding and sensitivity to diversity and a responsible attitude toward
their patients, their profession and society.
Systems-Based Practice
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Fellows are expected to demonstrate both an understanding of the contexts and systems in which health care
is provided, particularly as it relates to patients with pulmonary diseases, and demonstrate the ability to apply
this knowledge to improve and optimize health care.
PRINCIPAL TEACHING METHODS
The principal teaching methods are daily bedside clinical teaching rounds, topic reviews and literature
discussion. This experience provides an in-depth exposure to complicated hospitalized patients with
pulmonary diseases in a setting characterized by close faculty supervision. Fellows learn that the "customer" of
a consultation is the referring physician and must ensure that this individual is assisted in the care of patients.
Importantly, fellows should ensure that the residents and students on the Pulmonary Consultation Service
should attend the Pulmonary Clinics at the VA on Wednesday afternoon.
Self-instruction is emphasized, and fellows are expected to read the chapters on pulmonary diseases in
medical textbooks (such as Murray and Nadel) or online. A selection of articles on the diagnosis and treatment
of common pulmonary diseases and pulmonary function testing is available online at
http://www.thoracic.org/go/atsreadinglist/.
FELLOW RESPONSIBILITIES (General)
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All days off (personal reasons, interviews, etc…) need to be discussed with and approved by the attending
and chief fellow.
The home base for pulmonary fellows on the consult team is the second floor room near the GI lab.
Residents and students should evaluate all new consults and discuss them with the fellow before
presenting to the attending during rounds.
A member of the team (fellow, resident or student) should write a detailed note regarding new patients
and forward that note to the attending.
Follow-up notes are needed if there are new results of tests recommended by the pulmonary service or if
there are new recommendations or change in patient status.
The fellow should personally examine and audit the chart of every patient on the consult service on a daily
basis.
Pulmonary function tests should first be read by the residents and students, then the fellow and attending.
These must be completed and entered into the computer within 24 hours. There is a computerized
template to assist with this process. These should be entered under “Pulmonary Laboratory Procedures” in
the computer.
Patients that need follow-up over the weekend should be signed out to the MICU fellow on call on Friday
night. That fellow will then follow those patients over the weekend.
Cardiopulmonary exercise tests are placed in a basket above the main computer bank in the fellows’ room.
These should be read initially by the consult fellow and then with Dr. Schraufnagel within 2 days of the
study. No exercise tests should be left in the basket at the end of the month. All cardiopulmonary exercise
tests should be logged in the procedure book.
The fellow on consults is responsible for bringing a case to the weekly case conference.
All right heart catheterizations on pulmonary patients should be performed by pulmonary fellows. When a
fellow receives a request for a right-heart catheterization, the fellow should schedule it with Peter Kondos,
the cardiac cath laboratory chief technologist. The cardiology attending will be the attending of record.
Pulmonary fellows will do pre-cath evaluation and notes. Enter these and all procedures in the fellows log
book. Ask the Cardiology attending to sign it.
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FELLOW RESPONSIBILITIES (Bronchoscopy)
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Fellows on the consult service will receive requests on clinic and hospitalized patients for bronchoscopy.
These should be scheduled promptly. Promptly informing the endoscopy nurses and the pulmonary
laboratory staff is integral to smooth bronchoscopy scheduling. There is a book in the GI lab on which
scheduled bronchoscopies should be noted. These should be coordinated with attending availability.
Pulmonary fellows may do bronchoscopies on their own patients or refer to the consult service fellow. If
they do their own, they must take care of scheduling.
The fellow should give the Bronchoscopy Evaluation sheet to the attending, who should fill it out and
discuss the evaluation of the bronchoscopy performance.
All results must be followed-up after a bronchoscopy is performed. These include histology, cytology and
bacterial, fungal and mycobacterial cultures. It is important for the fellow to view their own pathological
specimens.
EVALUATION
Fellows are evaluated by the attending who supervises them over the duration of the rotation. Verbal
feedback is given as needed on an ongoing basis. The attending must complete an ABIM Competency-Based
Evaluation Form and discuss the evaluation at the completion of the rotation. If an attending judges that a
fellow is performing poorly in any area, the attending should provide constructive feedback as soon as the
deficiency is apparent.
Fellows, in turn, evaluate attending physicians and program performance using a standard departmental form
that provides for comments.
EDUCATIONAL MATERIALS
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This orientation document should be given to each fellow at the beginning of each month at a brief
orientation meeting.
The principal teaching methods are daily patient-oriented, clinical teaching rounds, topic reviews literature
discussion, pulmonary function and other tests, and conferences.
Self-instruction is emphasized. Fellows are expected to read the chapters or reviews in standard textbooks.
Pertinent articles may be distributed and discussed during the rotation.
A list of essential reading is available online through the American Thoracic Society at
http://www.thoracic.org/go/atsreadinglist/.
Essential on-line resources include the American Thoracic Society’s statements, MDConsult, Ovid, and the
National Library of Medicine service (PubMed).
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