Pulmonary/Critical Care

Overview:

The Pulmonary Medicine/Critical Care rotation is a one-half or one block preceptorial rotation, depending on your curriculum. The rotation occurs at Memorial Hospital and in the pulmonologist’s office. The teaching of pulmonology and critical care in the program includes this rotation as well as experiences in the Family Medicine Center, the noon conference series and on other rotations (see other curricula).

Goals:

1. At the completion of this rotation, the resident will have an understanding of the practice of Pulmonary Medicine/Critical Care in a community setting which will facilitate appropriate referral practices in the future.
2. At the completion of this rotation, the resident will have knowledge and skills in the areas of Pulmonary Medicine/Critical Care pertinent to the practice of family medicine.

Objectives:

At the completion of this rotation, the resident will have demonstrated to the satisfaction of the Pulmonary Medicine/Critical Care preceptor:

• medical knowledge in Pulmonary Medicine/Critical Care pertinent to the practice of family medicine, including the appropriate evaluation and treatment of (MK): respiratory failure, shock, COPD, asthma, tobacco abuse, pulmonary emboli, interstitial lung disease, pneumonia and other lung infections, pulmonary nodules, primary and metastatic lung cancers, and sarcoidosis.
• the ability to perform an appropriate history and physical examination on pulmonary and critically ill patients and to present these findings to another physician in an appropriate manner (PC).
• the ability to interpret appropriate data related to the pulmonary and critically ill patients and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits and risks of diagnostic and therapeutic options, and co-managing patients appropriately with other specialists (PC).
• the ability to make appropriate decisions to assure high-quality care in a cost-effective manner ( SBP ).
• communication and interpersonal skills, which facilitate positive and therapeutic relationships (ICS).
• the ability to work cooperatively with other health professionals as part of a healthcare team (ICS).
• compassion, respect and integrity; responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; a commitment to excellence and on-going professional development (P).
• a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices (P).
• sensitivity and responsiveness to a patient’s culture, age, gender and disabilities (P).

There are no specific procedural requirements for this rotation. However, there are multiple opportunities for residents to participate and perform procedures. Procedures typically performed by residents with the pulmonologist on this rotation include (PC): ventilator management, endotracheal intubation, central line placement, arterial line placement, chest radiograph interpretation, pleural tube management and spirometry. During this rotation, residents will manage critically ill patients that will count towards their required management of at least 15 critically ill patients during their three year residency. This experience is documented through the usual residency procedural documentation system.

Implementation:

This is a preceptorial rotation, so the resident is assigned to a particular pulmonologist or Pulmonary Medicine/Critical Care group. The resident will accompany the pulmonologist during his/her professional activities in Memorial Hospital and in the pulmonologist’s office. In the course of seeing patients, the pulmonologist will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in Pulmonary Medicine/Critical Care.

The resident is responsible for contacting the pulmonologist prior to the start of the rotation to arrange a schedule for the rotation. The resident must continue to meet usual residency obligations to his/her Family Medicine Center population, including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital and rounding in the nursing home. The resident is expected to attend noon conferences and abide by duty-hour restrictions in keeping with usual program policies. Upon completion of the rotation, the resident must complete and return the evaluation form provided by the program.

Evaluation:

The Pulmonary Medicine/Critical Care preceptor will complete an evaluation form at the end of the rotation. Residents will specifically be evaluated on the following ACGME Milestones:

• PC-1: Cares for acutely ill or injured patient in urgent/emergent situations and in all settings.
• PC-2: Cares for patients with chronic conditions.
• MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
• PROF-2: Demonstrates professional conduct and accountability.
• C-2: Communicates effectively with patients, families, and the public.
• C-3: Develops relationships and effectively communicates with physicians, other health professionals, and health care teams.