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


Critical Care Medicine


 


ROTATIONS

REQUIREMENTS, CONTENT, AND DISTRIBUTION

The residency and fellowship programs at Pitt County Memorial Hospital all operate on a schedule of 13 four week long blocks per year for a total of 39 blocks in the three year pulmonary disease and critical care medicine fellowship. Listed below in table format are the overall rotation requirements and the year by year breakdown. There are 26 blocks of required clinical rotations and 13 blocks for research and electives. Each fellow will design their own program as long as a minimum of 4 blocks are dedicated to research alone. Rotation descriptions are provided below.
 
 
 
REQUIRED ROTATIONS
Click on rotation name for link to syllabus/curricula
 
 
ROTATION
 
FIRST
YEAR
SECOND
YEAR
THIRD
YEAR

TOTALS

4

3

2

9

1
1
1
3
4
3
2
9
-
1
2
3
1
2
3
6
1
-
-
1
1
-
-
1
-
1
-
1
1
-
-
1
-
-
1
1
-
-
1
1
 
ELECTIVE
 

-

2

1

3

 
TOTALS
 

13

13

13

39

 
 

ELECTIVE ROTATIONS

ROTATION
FIRST
YEAR
SECOND
YEAR
THIRD
YEAR

TOTALS

THORACIC
SURGERY
-
1
1
INTERVENTIONAL
PULMONOLOGY
-
1
1
SLEEP
MEDICINE
-
1
1
OUTPATIENT
PULMONARY MEDICINE
-
1
1
THORACIC
RADIOLOGY
-
1
1
PULMONARY
HYPERTENSION
-
1
1
SARCOIDOSIS
-
1
1
ANESTHESIOLOGY
-
1
1
CYSTIC FIBROSIS
SICKLE CELL ANEMIA
-
1
1
LUNG
TRANSPLANTATION
-
1
1
ALLERGY
IMMUNOLOGY

-

1

1

 
ROTATION DESCRIPTIONS

INPATIENT PULMONARY CONSULTATION ROTATION

The fellows assigned to the pulmonary consultation service are responsible for all inpatient pulmonary and critical care medicine consultations and related procedures. Patient care on the pulmonary consultation service is provided by one attending, three fellows, and a variable number of internal medicine residents. The service receives between 100 and 150 new consultation requests per 4 week rotation. 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 faculty member. 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 ROTATION

The Medical Intensive Care Unit is a closed, 24 bed unit that serves the local population as well as being a referral center for hospitals in Eastern North Carolina. It is managed by two attending physicians, two fellows, three senior residents and 6 junior residents or interns. 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 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. The MICU fellow takes an active role in airway management and chest tube placement. The MICU fellow also provides evaluations for patients who may require admission to the MICU and manages patient flow in and out of the unit.

TRAUMA/SURGICAL CRITICAL CARE ROTATION

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. Fellows should document all procedures performed in the SICU.

PULMONARY FUNCTION AND RESPIRATORY CARE ROTATION

Fellows are required to do a one-month pulmonary function testing and respiratory care rotation during their first year. During this rotation, fellows learn to perform and interpret pulmonary function tests including, spirometry, lung volume measurement (helium dilution and body plethysmography), diffusing capacity measurement, methacholine challenge testing, altitude studies, exercise oximetry and cardiopulmonary exercise testing (CPET). The fellow is responsible for interpreting all pulmonary function tests done in the lab each day and reviewing them with the attending assigned to pulmonary function testing each week. Early in the rotation, fellow will review most of the studies with the attending, but as the fellow becomes more knowledgeable the team will only review the more complicated studies. Attendings are required to review all the studies and sign them once they are transcribed. The fellow and attending will meet on a daily basis, for formal PFT rounds. In addition to reading all the pulmonary function tests for the month, fellows will spend time in the PFT lab learning the about the supervision and administration of the pulmonary function lab, quality control, and calibration and maintenance of the testing equipment. Similarly the fellows will learn about the set up and maintenance of the mechanical ventilators and the operation, care and cleaning of the bronchoscopes and the bronchoscopy equipment. Finally, the fellows will shadow the respiratory therapists in both the ward and ICU settings to learn the technical aspects of NIV, oxygen therapy, chest physiotherapy, and other relevant respiratory care practices and procedures.

SLEEP MEDICINE ROTATION

The objectives of this rotation are to:

a) Learn physiology of sleep and pathophysiology of abnormal sleep,
b) Learn techniques of assessing sleep and proper interpretation of sleep studies
c) Learn proper management of sleep disorders.

During this period, fellows will:
a) Review literature on sleep disorders
b) Evaluate patients presenting to the sleep clinic.
b) Attend 2-3 nights of sleep studies.
c) Interpret sleep studies with attending.
d) Prescribe therapies and provide follow-up for patients with sleep disorders.

The fellows will be supervised and evaluated by the attending on service.

AMBULATORY PULMONARY MEDICINE ROTATION

During this block the fellow evaluates all emergent outpatient pulmonary consultations, and rotates through the subspecialty clinics including the Multi-disciplinary Thoracic Oncology Clinic, Sleep Clinic, Sarcoidosis Clinic, and Pulmonary Hypertension Clinic. Outpatient right heart catheterizations are performed by the Pulmonary Fellow in the Cardiac Catheterization Lab with the Pulmonary Hypertension Faculty.

RESEARCH ROTATIONS

In addition to the Clinical training, fellows are required to participate in the research program and complete a minimum of 6 blocks of research time. There are a wide variety of potential projects ranging from basic science in the Lung Cell Biology Laboratory to clinical studies to epidemiological studies. During the first year the fellow will choose a mentor and begin working on a research program. In addition to longitudinal big picture projects there are a number of different smaller projects that can be accomplished during the time the fellow is on the clinical services. As a minimum, each fellow is expected to present their work in progress at the monthly research meeting and to prepare and present at least one abstract at a national meeting as well as yearly presentations at the Internal Medicine Research Day. The fellow will be expected to make a presentation at the end of each research block.

CARDIOVASCULAR CRITICAL CARE ROTATION

Fellows spend one 4 week rotation block on the Cardiology Service learning about cardiovascular critical care. The fellow participates in the evaluation and management of patients with acute cardiac disease including acute myocardial ischemia and infarction, malignant arrhythmias, acute cardiogenic pulmonary edema, decompensated chronic heart failure, and aortic dissection.  The fellow will gain experience in the management of patients undergoing evaluation for various angioplasty procedures, for cardiac valve replacement, and for coronary bypass surgery. PCMH has a very active robotic cardiac surgery program.

CRITICAL CARE NEPHROLOGY ROTATION

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.

ELECTIVE ROTATIONS

Fellows may choose their own electives. There are a number of elective rotations available locally including Thoracic Surgery, Anesthesiology, Thoracic Radiology, Toxicology, Rheumatology and Allergy/Immunology. Fellows can also elect rotations with the faculty from Physicians East. Away rotations for Cystic Fibrosis, Lung Transplantation, or other areas can be arranged but 6 months notice is required in order to get these approved so planning ahead is a necessity.