Goals and Objectives for the Pulmonary Fellowship Program

Ann Arbor VA Pulmonary Rotation

 

Medical Intensive Care Unit

Goal I: Patient Care

Fellows must demonstrate the ability to provide patient-centered care that is appropriate, compassionate, and effective for treatment of health problems and the promotion of health.

Objectives:  In the intensive care unit (ICU) setting:

    1. Fellows will gather essential and accurate information by performing complete and clinically-relevant history and physical exam.
    2. Fellows will understand how to order and interpret appropriate diagnostic tests.
    3. Fellows will make informed diagnostic and treatment decisions by analyzing and synthesizing information.
    4. Fellows will understand the limits of their knowledge and expertise.
    5. Fellows will develop and carry out care plans.
    6. Residents will maintain comprehensive, timely, effective, and legible medical records.
    7. Fellows will effectively counsel patients and families.
    8. Fellows will use consultants and referrals appropriately.

Goal II: Medical Knowledge

Fellows will know, critically evaluate and use current medical information and scientific evidence for patient care.

Objectives: In the ICU setting:

    1. Fellows will be able to access information and evaluate the medical literature.
    2. Fellows must demonstrate habits consistent with life-long learning.
    3. Fellows will demonstrate mastery of the basic and clinical science elements for pulmonary disorders, interventions and techniques including:

                  a.  ARDS

                  b.  Sepsis

                  c.  Pneumonia

                  d.  Multiple organ dysfunction syndrome

                  e.  Gastrointestinal hemorrhage

                  f.  Hepatic failure

                  g.  Noninvasive mechanical ventilation

                  h.  Airway management

                  i.  Invasive Mechanical Ventilation

                  j.  Weaning from mechanical ventilation

                  k  Endotracheal intubation

                  l.  Arterial line placement

                  m. Hemodynamic monitoring

                  n.  Central venous line placement

                  o.  Fiberoptic bronchoscopy

                  p. Tube thoracostomy

 

 

Goal III: Interpersonal Communication Skills

Fellows must demonstrate interpersonal and communication skills that result in effective information exchange, and collaboration with patients, families, and health professionals.

Objectives: In the ICU setting:

    1. Fellows will demonstrate the ability to develop highly effective therapeutic relationships with patients and families.
    2. Fellows will exhibit communication that is characterized by socio-cultural effectiveness.
    3. Fellows will communicate respectfully and effectively with other health professionals.
    4. Fellows will be able to act in a consultative role to other physicians and health professionals.

Goal IV: Professionalism

Fellows will demonstrate a commitment to professionalism, ethical behavior, and a commitment to the development of cultural humility.

Objectives: In the ICU setting:

    1. Fellows will demonstrate integrity, honesty, and compassion, empathy, and altruism.
    2. Fellows will acknowledge errors and limitations.
    3. Fellows will demonstrate responsibility, accountability, dependability, commitment, and encourage continuity of care.
    4. Fellows will respect patient and family privacy and autonomy.
    5. Fellows will exhibit a commitment to the development of cultural humility.

Goal V: Practice-Based Learning and Improvement

Fellows will investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and use these processes to improve patient care.

Objectives : In the ICU setting:

    1. Fellows will exhibit evidence of self-evaluation.
    2. Fellows will demonstrate ongoing self-education and habits of life-long learning.
    3. Fellows will accept and incorporate feedback to improve practice.
    4. Fellows will apply these processes to improve patient care.

Goal VI: Systems-Based Practice

Fellows will practice quality health care that is cost-effective and advocate for patients within the health system.  In addition, the fellow will understand the quality improvement process and how to partner with health care managers and providers toward this goal.

Objectives: In the ICU setting:

    1. Fellows demonstrate care coordination and knowledge of medical practice and delivery systems.
    2. Fellows advocate for patients and for populations of patients.
    3. Fellows understand and practice cost-effective health care that does not compromise quality of care.

 

 

Fellowship Learning Objectives for VA Consults

 

Goal I: Patient Care

 

Fellows must demonstrate the ability to provide patient-centered care that is appropriate, compassionate, and effective for treatment of health problems and the promotion of health.

 

Objectives: In the inpatient consultative service setting:

 

  1. Fellows will be an effective consultant in pulmonary and critical care medicine
  2. Fellows will gather essential and accurate information by performing and complete a clinically-relevant history and physical examination.
  3. Fellows will understand how to order and interpret appropriate diagnostic tests.
  4. Fellows will make informed diagnostic and treatment decisions by analyzing and synthesizing information.
  5. Fellows will understand the limits of their knowledge and expertise.
  6. Fellows will develop a differential diagnosis and management plan.
  7. Fellows will maintain comprehensive, timely, effective and legible medical records.
  8. Fellows will effectively counsel patients and families
  9. Fellows will effectively communicate with the primary healthcare team and effectively address issues in question.

 

Goal II: Medical Knowledge

 

Fellows will know, critically evaluate and use correct medical information and scientific evidence for patient care.

 

Objectives: In the inpatient consultative service setting:

 

  1. Fellows will be able to access information and evaluate the medical literature
  2. Fellows must demonstrate habits consistent with life-long learning.
  3. Fellows will demonstrate mastery of the basic and clinical science elements for the following disorders:
  4. Fellows will develop competence in the identification and management of the following clinical situations and symptoms:
    1. Approach and evaluate  “dyspnea”
    2. Approach and evaluation of hemoptysis
    3. Evidence based preoperative pulmonary evaluation
    4. Identification and management of the acutely ill patient
    5. Management of the lung transplant recipient
    6. Indications for bronchoscopy
    7. Indications, performance and management of chest tubes.
  5. Fellows will demonstrate mastery of the basic and clinical science elements for the following disorders:
    1. Obstructive lung diseases

                                                               i.      Asthma exacerbation

                                                             ii.      COPD exacerbation

                                                            iii.      Bronchiectasis

1.      Cystic fibrosis

                                                           iv.      Obliterative bronchiolitis           

    1. Restrictive disorders

                                                               i.      Diffuse interstitial lung disease

1.      Idiopathic pulmonary fibrosis

2.      Pneumoconiosis

3.      Sarcoidosis

4.      Other

    1. Pulmonary vasculitis and pulmonary hemorrhage syndromes
    2. Pulmonary venous thromboembolic disease
    3. Occupational and environmental lung diseases
    4. Pneumothorax and pleural effusions
    5. Pulmonary infections

                                                               i.      Community acquired pneumonia

                                                             ii.      Healthcare associated pneumonia

                                                            iii.      Pneumonia in the immunocompromised host

                                                           iv.      Fungal infections

                                                             v.      Opportunistic infections

                                                           vi.      Empyema

                                                          vii.      Tuberculosis

                                                        viii.      Atypical mycobacterial infections

                                                           ix.      HIV associated infections

    1. Identification, diagnosis and staging of pulmonary malignancy

                                                               i.      Primary lung

                                                             ii.      Metastatic disease to the lung

    1. Respiratory failure

                                                               i.      Acute lung injury/Adult respiratory distress syndrome

                                                             ii.      Neuromuscular respiratory failure

 

Goal III: Interpersonal Communication Skills

 

Fellows must demonstrate interpersonal and communication skills that result in effective information exchange and collaboration with patients, families and health professionals.

 

Objectives: In the inpatient consultative service setting.

  1. Fellows will demonstrate appropriate communication and documentation skills as a pulmonary/CCM consultant
  2. Fellows will demonstrate the ability to develop effective relationships with patients and families.
  3. Fellows will exhibit communication that is characterized by socio-cultural effectiveness.
  4. Fellows will communicate respectfully and effectively with other members of the health care team.
  5. Fellows will be an administrative leader and teacher of house officers and medical students

 

Goal IV: Professionalism

 

Fellows will demonstrate a commitment to professionalism, ethical behavior, and a commitment to the development of cultural humility.

 

Objectives: In the inpatient consultative service setting

  1. Fellows will demonstrate integrity, honesty, compassion, empathy and altruism.
  2. Fellows will respond in a timely manner to requests for consultation.
  3. Fellows will acknowledge errors and limitations.
  4. Fellows will demonstrate responsibility, accountability, dependability, commitment, leadership and encourage continuity of care.
  5. Fellows will respect patient and family privacy and autonomy.
  6. Fellows will exhibit a commitment to the development of cultural humility.

 

Goal V: Practice-Based Learning and Improvement

 

Fellows will investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and use these processes to improve patient care.

 

Objectives: In the inpatient consultative service setting

  1. Fellows will exhibit evidence of self-evaluation
  2. Fellows will demonstrate ongoing self-education and habits of life-long learning.
  3. Fellows will discuss performance and incorporate feedback from colleagues, co-workers and supervising attending physicians.
  4. Fellows will apply these processes to improve patient care.

 

Goal VI: Systems-Based Practice

 

Fellows will practice quality health care that is cost-effective and advocate for patients within the health system.  In addition, the fellow will understand the quality improvement process and how to partner with health care managers and providers toward this goal.

 

Objectives: In the inpatient consultative service setting

  1. Fellows will demonstrate care coordination and knowledge of medical practice and delivery systems at the Ann Arbor VA Medical System.
  2. Fellows will utilize evidence based practice guidelines to optimize patient care.
  3. Fellows will advocate for patients and for populations of patients.
  4. Fellows will understand and practice cost-effective health care that does not compromise quality of care.

 

 

Ann Arbor VA Medical System Procedures and Pulmonary Function Test Interpretation

 

Learning Objectives

 

Goals

 

  1. To improve knowledge of pulmonary physiology and apply that knowledge to the interpretation of pulmonary function tests.
  2. To provide understanding of how pulmonary function testing is performed and to supervise pulmonary function testing.
  3. To gain proficiency in the use and performance of bronchoscopy and thoracentesis as diagnostic and therapeutic tools.

 

Objectives

 

I. Medical Knowledge

 

  1. Gain knowledge in pulmonary physiology and the methods used to assess physiology in the following areas:
    1. Flow volume loops and spirometry
    2. Lung volumes
    3. Specific airway resistance and conductance
    4. Gas exchange and diffusion capacity
    5. Respiratory muscle testing
    6. Arterial blood gas analysis
  2. Gain knowledge in lung and chest cavity anatomy in both normal and diseased states.
  3. Identify the indications, complications and likelihood of successful outcome in performing bronchoscopy and thoracentesis.
  4. Gain knowledge in the pharmacology of analgesics, topical anesthetics, sedatives and anticholinergics.

 

II. Patient Care

 

  1. Interpret the outpatient and inpatient pulmonary function tests done at the Ann Arbor VA Hospital.
  2. Recognize the appropriate clinical context for pulmonary function testing interpretation.
  3. Supervise pulmonary function testing.
  4. Become familiar with the operation of a fiberoptic bronchoscope, supporting equipment and fluoroscope.
  5. Become proficient in the following bronchoscopic procedures:
    1. Endotracheal intubation
    2. Airway examination
    3. Bronchoalveolar Lavage
    4. Bronchial brushing and washing
    5. Endobronchial forceps biopsy
    6. Transbronchial forceps biopsy
    7. Transbronchial needle aspiration and core biopsies (Wang needle aspiration)
    8. Foreign body removal
  6. Become proficient at performing diagnostic and therapeutic thoracentesis.
  7. Learn to manage complications of bronchoscopy and thoracentesis including bleeding, pneumothorax and respiratory failure to optimize patient safety.
  8. Become proficient in the proper use of analgesics, sedatives and anticholinergics, and in managing the complications of conscious sedation.
  9. Become proficient at appropriately selecting the sampling methods and diagnostic tests to optimize yield.

 

III. Practice-Based Learning and Improvement

 

1.      Evaluate and improve pulmonary function test interpretation through self-evaluation and feedback from attending staff.

2.      Improve procedural practices by following up on test results in order to identify methods of optimizing yield and to identify special circumstances that alter yield and risks.

3.      Improve patient care practices through education of patients and families on the indications, usual risks and complications and meaning of results when procedures are performed.

4.      Improve teaching skills by educating and supervising housestaff on the performance and interpretation of pulmonary function testing and procedures.

 

IV. Systems-based Practice

 

1.      Become proficient at patient scheduling to maximize unit throughput.

2.      Become proficient in managing a procedural unit.  This includes managing nurses and technicians, patient flow and specimen collection, handling and transport.

3.      Understand how test results influence patient care.

4.      Communicate with referring physicians in a timely way where appropriate.

 

V. Professionalism

 

  1. Demonstrate effective communication skills in interactions with procedure unit staff, nurses, and respiratory therapists.
  2. Achieve dependability in the appropriate follow through of test results.
  3. Demonstrate effective communication with patients in delivering healthcare, and planning appropriate follow-up after procedures.
  4. Demonstrate respect for patient privacy, autonomy and awareness during conscious sedation.
  5. Acknowledgement of errors and limitations

 

VI. Interpersonal Communication Skills

 

  1. Communicate respectfully and effectively with staff, nurses and technicians in procedural units.
  2. Maintain comprehensive, timely, and effective procedure reports and interpretations.
  3. Act in a consultative role to other physicians and effectively communicate procedure results to the appropriate care-takers.