Revised February 17, 2008
PULMONARY MEDICINE
ACADEMIC CURRICULUM
2006-2008
Rotation Coordinator:
J. F. Turner, M.D.
Subspecialty Education Coordinator
University of Nevada School of Medicine
2040 W. Charleston Blvd., Suite 300
Las Vegas, Nevada 89102
(702) 671-2345 – Fax: (702) 671-2376
Overview
Educational Purpose
Pulmonary medicine is the diagnosis and management of disorders of the lungs, upper airways,
thoracic cavity, and chest wall. The pulmonary specialist has expertise in neoplastic, inflammatory,
and infectious disorders of the lung parenchyma, pleura, and airways; pulmonary vascular disease and
its effect on the cardiovascular system; and detection and prevention of occupational and
environmental causes of lung disease. Other specialized areas include respiratory failure and sleepdisordered breathing.
The general internist should be able to evaluate and manage couch, dyspnea, fever with infiltrates,
mass or nodule on the chest radiograph, pleurisy, and pleural effusion. He or she should also be able to
diagnose and manage patients with common respiratory infections; initiate the diagnostic evaluation of
respiratory neoplasm; and manage the initial approach to patients with respiratory failure, including
those in intensive care units.
The internist will usually be assisted by the pulmonary specialist for diagnostic procedures and
complicated conditions such as advanced respiratory failure. If such expertise is not available, the
internist, with additional training, may have to assume these roles.
Teaching Methods
The rotation will be under the supervision of the attending pulmonologist. The resident will see
consultations and patients as assigned by the attending pulmonologist. The resident will obtain the
initial data, write a consultation note, and present the patient to the attending physician. The attending
will confirm the findings, teach about the case, and with the resident, craft the final recommendations.
The resident will see the patient daily, write the follow up consult notes, and review them with the
attending pulmonologist.
Daily rounds will occur with the attending physician at which time instruction in the unique aspects of
the consultative process will be provided. Residents will be required to continue their regular morning
report and noon conference core curriculum. The resident and attending will review and discuss any
required reading.
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Mix of Diseases
A wide variety of pulmonary diseases are seen, including asthma, emphysema, chronic bronchitis,
usual interstitial pneumonitis, rheumatologic lung diseases, pneumonia, tuberculosis, obstructive sleep
apnea, obesity-hypoventilation syndrome, lung cancer, and cystic fibrosis.
Patient Characteristics
The patient population is diverse, male and female, of all ages from adolescent to geriatric,
representing most ethnic and racial backgrounds, from all social and economic strata. The hospital
serves primarily the indigent population of the city of Las Vegas.
Types of Clinical Encounters
All patient encounters are in the inpatient setting on a consultative basis from other clinical services or
from an ambulatory physician who has referred a patient for admission.
Close interaction with various other healthcare team members including care managers, discharge
planners, home health agencies, inpatient nurses, respiratory therapists, physical therapists, and patient
care technicians occurs daily.
Common Clinical Presentations
 Chest pain
 Cough
 Dyspnea
 Excessive daytime sleepiness
 Fever with pulmonary infiltrate
 Hemoptysis
 Nodule or mass on chest radiograph
 Pleural effusion, pleurisy
 Stridor, hoarseness
 Wheezing
Resident Supervision
Residents have constant on site supervision as well as daily personal supervision in their patient care.
Procedures
 Arterial blood gas sampling
 Endotracheal intubation
 Monitoring of oxygen saturation
 Skin test for tuberculosis
 Spirometry and peak flow assessment
 Thoracentesis
 Pleural biopsy (optional)
Primary Interpretation of Tests
 Complete pulmonary function tests (spirometry; measurement of lung volumes, diffusing
capacity, flow volume loop)
 Chest x-ray and chest CT interpretation
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Ordering and Understanding Tests
 Bronchoscopy, including lavage and biopsy
 Cardiopulmonary exercise test
 Computed tomography of thorax
 Cytology, pathology of lung and pleural biopsy speciments
 Diagnostic studies for venous thrombosis
 Mediastinoscopy, mediastinotomy
 Pleural fluid analysis
 Pulmonary angiography
 Sleep study
 Ventilation/perfusion lung scans
Didactic Teaching
Morning Report
Residents are required to maintain greater than 60 % attendance at morning report. Morning
Report begins at 8 a.m. on Monday through Thursday and at 8:30 a.m. on Friday.
Noon Conference
Residents are required to maintain greater than 60 % attendance at noon conference. Noon
conference occurs daily, Monday through Friday. These sessions cover the basic core
curriculum, and other curriculum topics such as ethical issues, geriatrics, computer systems and
informatics, health care systems, occupational and environmental health issues, and other topics
of concern. A pulmonary disease topic is presented at least once during each month.
Attending Rounds
Didactic discussions will be held regarding all primary inpatients and consultative activities
occurring during the month. Each resident and medical student will be required prepare and
discuss during teaching rounds one article or pulmonary disease topic each week. Teaching
rounds by the attending physician will occur every day for 45 - 60 minutes after regular
management rounds. Each resident is required to review common infectious disease topics.
Lectures
1.
Pulmonary exam; lung function testing; and ABG’s
2.
Asthma
3.
COPD
4.
Pneumonia; community and hospital acquired
5.
Radiologic interpretation of chest (x-ray/CT/Nuclear)
6.
Chronic diffuse infiltrative lung disease
7.
Sleep apnea and other ventilation dysfunction
8.
Pulmonary nodules/lung mass management
3
9.
Disorders chest wall, pleura, hilia, mediastinum
10.
Pulmonary hypertension, corpulmonale, pulmonary vascular
11.
Nicotine dependency treatment
Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper DL, ed. McGraw Hill
Fishman's Pulmonary Diseases and Disorders, 4th ed., Fishman AP, ed. McGraw Hill.
The Washington Manual Pulmonary Medicine Subspecialty Consult, Shifren A, ed. Lippincott
Williams & Wilkins
The Washington Manual of Medical Therapeutics, 32nd ed.
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology, Endocrinology, Infectious
Diseases, Rheumatology as well as General Medical References (Harrison’s Principles of
Internal Medicine, Cecil’s Textbook of Medicine) are available 24 hours a day, seven days a
week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of the
University of Nevada - Reno) via their computer in the resident room, Suite 300 of the 2040 W.
Charleston Building. Access to this room is available 24 hours a day, seven days a week.
Full text is available for many peer-review journals including, but no limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and Grateful Med Databases
Pathological Material and Other Educational Resources
Residents are encouraged to review the pathological reports on patients for whom they have consulted
and to follow the hospital care of those patients. If a patient with whom the resident has consulted
should die and have an autopsy, the resident is encouraged to attend the post-mortem session.
Training Sites
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University Medical Center
All of the inpatient endocrine consultation experience occurs at University Medical Center
(UMC) under the supervision of one of the full-time endocrine faculty. The resident will also
participate in the UMC outpatient endocrinology clinic on the second and fourth Thursday of
each month.
UNSOM Faculty clinics, Patient Care Clinic, Special Care Clinic
The resident will participate in this endocrine outpatient clinic under the supervision of the fulltime endocrine faculty.
Competency-based Goals and Objectives
Pulmonary Elective Rotation
(Only a single level of competency is described, as this is a resident-level elective
undertaken once during residency)
Learning Venues
Evaluation Methods
1. Direct Patient Care/Consultation
2. Attending Rounds
3. Residency Core Lecture Series
4. Self Study
A. Attending Evaluation
B. Direct Observation
C. Nurse Evaluation
D. Written Examination
E. Self-evaluation
Competency: Patient Care
Learning Venues
Evaluation Methods
Obtain an accurate patient
history regarding regarding
pulmonary symptoms
Perform a thorough physical
examination on patients with
pulmonary disease
1,2
A,B,C
1,2
A,B,C
Generate differential diagnosis,
diagnostic strategy, and define
appropriate therapeutic plan and
modifications to therapy in
patients with newly diagnosed
pulmonary problem
1,2,3,4
A,B,C,D, E
Recognize side effects and
toxicities of common
pulmonary medicines, including
bronchodilators, corticosteroids,
antibiotics, and anti-tuberculous
1,2,3,4
A,B,C,D, E
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drugs
Generate differential diagnosis,
diagnostic strategy, and define
appropriate therapeutic plan and
modifications to ongoing
therapy in patients with
pulmonary disease
1,2,3,4
A,B,C, D, E
Recognize and provide
appropriate treatment for
respiratory emergencies,
including respiratory failure,
barotraumas, and massive
hemoptysis
1,2,3,4
A,B,C,D
1,2,4
A,B,C,D
Learning Venues
Evaluation Methods
1,2,3,4
A,B, D, E
1,2,3,4
A,B,D
1,2,3,4
A,B,D
1,2,3,4
A,B,D
1,2,3,4,5
A,B,C,D
Monitor a patient’s progress and
respond to a change in the
patient’s condition during
treatment
Competency: Medical
Knowledge
Know appropriate precautions
and treatment regimens for
common problems, including
COPD, asthma, sleep apnea,
pneumonia, tuberculosis, and
lung cancer
Understand the diagnosis and
staging of lung cancer
Identify indications for
bronchoscopy, thoracentesis,
pleurodesis, chest tube
placement, and pleural biopsy
Understand and interpret
common pulmonary function
test abnormalities
Articulate the genetic
predisposition to, and the
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pathophysiology, evaluation,
and management of asthma,
emphysema, cystic fibrosis, and
ciliary dysfunction
Competency: Interpersonal
and Communication Skills
Learning Venues
Evaluation Methods
Interact in an effective way with
physicians and nurses
participating in the care of
patients with pulmonary
diseases (including physicians
requesting consultation, fellows,
attendings, medical students,
and infusion unit personnel)
1,2
A,B,C, E
Show understanding of
differing patient preferences in
diagnostic evaluation and
management of pulmonary
diseases
Maintain accurate medical
records
Serve as a patient advocate
Ensure adequate transfer of
information when transferring
patient care to another physician
1,2
A,B,C, E
1,2
A,B,C
1,2
A,B,C, E
1,2
A,B,C, E
1,2
A,B,C, E
Competency: Professionalism
Learning Venues
Evaluation Methods
Treat team members, primary
care-givers, and patients with
respect and empathy
Understand, practice and adhere
to a code of medical ethics
1,2
A,B,C, E
1,2
A,B,C, E
Participate actively in
1,2
A,B,C
Communicate efficiently and
effectively with referring
physician, regarding diagnoses,
treatment and follow-up
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consultations and on rounds
Attend and participate in all
scheduled conferences
3
attendance, A
Incorporate case studies with
relevant research outcomes and
report those findings during
clinical rounds
1,2,4
A, E
Review the outcomes of patient
care in order to reflect on the
approach taken in the delivery
of care
1,2,4
A, E
Utilize established practice
guidelines for individual
diseases to devise care
strategies
1,2,4
A, E
Identify limitations of one’s
medical knowledge in
evaluation and management of
patients with oncologic
disorders and use medical
literature (primary and
reference) to address these gaps
in medical knowledge
1,2,4
A, E
Competency: Systems-Based
Practice
Learning Venues
Evaluation Methods
Understand need for effective
communication between
multiple caregivers and sites
(eg, thoracic surgeons,
oncologists, primary care
physicians, general surgeons,
radiation oncologists, nurses,
social workers, rehabilitations
units, LTAC’s and hospitals) in
delivering optimal care to
pulmonary patients
Understand clinical trial design
and the statistical methods for
evaluating scientific studies, in
cooperation with attendings and
1,2,3,4
A, E
1,2
A,B,C, E
Competency: Practice-Based
Learning
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research nurses/personnel
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the standard
ABIM resident evaluation form. All clinical faculty are encouraged to provide face-to-face
feedback with the residents. The night-float resident is evaluated by one of the three service
attendings. In addition, residents may receive interim feedback utilizing the ABIM’s Praise
and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty member, at the
completion of the rotation. This evaluation form is included at the end of this document.
These evaluations are then converted to type and shared anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure rotation quality
and satisfaction.
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Pulmonary Rotation Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty member and
resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising faculty
member.
5. Demonstrated understanding of the basic principals of pulmonary medicine.
6. Receive verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising attending__________________________
Date___________________
All items must be completed for rotation credit and checklist returned to the Department of
Medicine by the rotation’s end.
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