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Division of Pulmonary, Critical Care and Sleep Medicine
Pulmonary Disease & Critical Care Medicine Fellowship




 


CURRICULUM AND RELATED RESOURCES
ROTATION SYLLABI
 
CURRICULUM MODULES
 
CURRICULUM COMPONENTS
PulmCurricTable1A
PulmCurricTable1B
COMPONENTS

The Educational Program has several basic components:

1.     Inpatient Clinical Rotations

2.     Outpatient Clinics

3.     Conferences

4.     Research

5.     Elective Rotations

6.  Courses

7.  Core Curriculum

       -Modules

       -Core Conferences 

CURRICULUM MODULES

The core curriculum is divided into 13 separate modules, one for each block of the academic year. Each module has both pulmonary and critical care elements with goals, objectives, and assignments for each year of the fellowship. The fellows all work on the same module at the same time and the core conferences and journal clubs are integrated into each module. In addition to stepwise progression within each module, many themes such as respiratory physiology and mechanical ventilation are presented progressively throughout the year with the content of each module building a foundation for the next module.

SERVICES
INPATIENT PULMONARY CONSULTATION SERVICE
The fellows assigned to the pulmonary consultation service are responsible for all inpatient pulmonary and critical care medicine consultations and related procedures at Pitt County Memorial Hospital and East Carolina Heart Institute. Patient care on the pulmonary consultation service is provided by two attendings, two fellows, and a variable number of internal medicine residents. The service receives between 120 and 180 new consultation requests per 4 week rotation or an average of 4 to 6 each day. The diverse patient population is drawn from a catchment area of 1.3 million people, in addition, the hospital serves as a tertiary referral center for the rest of Eastern North Carolina. The fellows will interview, examine, and evaluate all new patients, review and interpret all relevant tests, formulate an assessment and plan, and present the cases to the attending during teaching rounds. The fellows also teach and supervise the residents who rotate on the service. The fellow is responsible for interpreting all pulmonary function tests under the guidance of the consult attending. The fellow will perform all inpatient bronchoscopy with the direct supervision of a attending. Procedures such as Thoracentesis and tube thoracostomy are the responsibility of the fellow who will perform the procedure or supervise and/or teach a resident to perform the procedure. With the exception of bronchoscopy, the fellows may perform procedures independently once they have demonstrated competency to perform and teach the procedure. The attending assigned to the service has no other responsibilities and is always available to assist with, supervise and teach procedures. The fellow will learn to use ultrasound guidance for thoracentesis as well as other pleural procedures including chest tubes, tunneled catheters, pigtail catheters, and central venous catheter placement.

MEDICAL CRITICAL CARE SERVICE

The Critical Care Service covers a closed, 24 bed Medical Intensive Care Unit that serves the local population as well as being a referral center for all hospitals in Eastern North Carolina. It is managed by two attending physicians, two fellows, three senior residents, 6 junior residents/interns, and a variable number of third and fourth year medical students. The fellows and the MICU attendings lead daily teaching rounds and provide education on relevant aspects of critical care medicine for the residents. The fellows interact closely with the residents providing supervision and guidance for patient care as well as teaching them to perform and supervising them performing procedures. Between 3 and 5 bedside bronchoscopies are performed each week in the MICU and a variable number of percutaneous tracheostomies. Bedside ultrasonography and echocardiography are available and the fellows are taught to use these devices. The MICU fellow takes an active role in airway management and chest tube placement and provides evaluations for patients in regular ward beds who may require admission to the MICU. As the physician responsible for patient flow in and out of the unit,  the MICU fellow fields requests for transfers from outlying hospitals and learns how to triage these patients including decisions about air transport for patients accepted for transfer.

TRAUMA/SURGICAL CRITICAL CARE SERVICE

The hospital is a level I trauma center and has a very busy trauma service. The goal of this rotation is to acquire the knowledge and skills necessary to manage patients with problems unique to the surgical intensive care setting and to appreciate the differences in management strategies between the surgical and medical intensive care units. The fellow will accomplish this by caring for SICU patients as a member of the Surgical Critical Care/Trauma Team. Fellows will rotate on the service in all three years of training. Bedside teaching and procedure training will occur as part of the daily work rounds. The fellow will assist the trauma team with any respiratory problems they face including ventilator management, bronchoscopy, and airway management.

RESPIRATORY CARE SERVICE

The Respiratory Care Department at PCMH includes Respiratory Therapy, the bronchoscopy suite, and the pulmonary function laboratory. This department is an integrated part of the fellowship. The respiratory therapists play a big role in fellows’ education about mechanical ventilation and pulmonary function testing. The respiratory therapists assist in education about bronchoscopy including use of the simulator, and they participate in conferences and journal clubs. The fellows all spend at least one block rotating on this service performing a required pulmonary function testing and respiratory care rotation during their first year.

PULMONARY MEDICINE CLINIC

The Pulmonary outpatient facility contains the general pulmonary medicine clinic, the subspecialty clinics, the sleep laboratory and clinic, the research and outpatient bronchoscopy suite and the outpatient pulmonary function laboratory. The fellows’ have their continuity clinic and the ambulatory pulmonary medicine rotation in this facility which is located on the first floor of the Moye Medical Building across the street from the main medical school building on Moye Boulevard. The subspecialty clinics include Pulmonary Hypertension, Sarcoidosis, Sleep Medicine, and Research.

SLEEP MEDICINE CLINIC

The ECU Sleep Disorders Center is a state-of-the-art facility providing comprehensive diagnosis and management for sleep and sleep related disorders for the Eastern North Carolina community. The Center began operating in December 2008 and  has been given a five year period of accreditation by the American Academy of Sleep Medicine. The Center has four beds and is in the process of expanding to six beds. It is located on the first floor of the Moye Medical Building in the Pulmonary Medicine Clinic. In addition to studies perform in the sleep laboratory proper, the Center is equipped for home or in hospital monitoring for screening and follow up purposes. The Center uses a multidisciplinary team of specialists experienced in the various aspects of sleep disorders that include otolaryngologists, neurologists, psychiatrists, respiratory therapists, and pulmonologists. The Sleep Center serves as the sleep medicine training site for the fellows and medicine residents. Plans are currently being made for a formal sleep fellowship.

CARDIOLOGY SERVICE

The Department of Cardiovascular Sciences is composed of the combine the cardiology and cardiovascular surgery services. They occupy a new state of the art six-story 375,000 square foot 120 bed inpatient facility that includes 13 interventional rooms and its own operating suite and an equally new and  impressive four-story 206,000 square foot outpatient treatment and educational facility that includes room for the human performance laboratory and the cardiology fellowship program. In addition to its inpatient service and cardiac intensive care unit, the Cardiology Division provides consultative services to the main hospital. Fellows spend one 4 week rotation block on the Cardiology Service learning primarily about cardiovascular critical care. The cardiology service also hosts the pulmonary hypertension service for right heart catheterizations in their interventional facility. The fellows are encouraged to collaborate with the cardiology fellows and assist each other in their research.

NEPHROLOGY SERVICE

Fellows spend one block on the Nephrology Service learning and acquiring the knowledge, clinical skills, and professional attitudes required for the management of patients with a variety of acute and chronic renal diseases. This includes but is not limited to becoming informed about renal replacement therapy in the intensive care unit. Although the primary focus will be on critically ill patients with renal disease located in the various ICUs at PCMH, the fellows will also see patients on the entire Nephrology consultation service.The fellow will be assigned patients per the Nephrology section’s policies and standard procedures. They will see patients, perform the necessary history and physical exams, review the pertinent lab and/or imaging studies, and present the patient on rounds.  Formal teaching, instruction, and feedback will be given.

INFECTIOUS DISEASE SERVICE

The Division of Infectious Disease has an accredited two year fellowship program that takes two fellows per year. Pulmonary fellows spend one four week rotation with the Infectious Disease Service. They will participate in the Tuberculosis Clinic, the HIV Clinic, and the Travel Clinic. They will see inpatient pulmonary cases with the ID consult team, attend the ID Division Conferences, and make a presentation to be given at the end of the rotation.