Pulmonary Consultation Service
Fellows spend six to nine months on the consultation service. Patients from the medical, surgical, neurologic, and obstetric units are seen, including critically ill patients in the surgical and neurological ICUs and the cardiac care unit. A sleep disorders consultation service is also provided. The fellows perform bronchoscopies, thoracentesis, and chest tube insertions under supervision of the attending physician. Emphasis is placed on the fellow’s professional development into an expert in inpatient pulmonary consultation. The fellow consultant develops proficient skills in:
- Medical knowledge
- Patient communication
- Interprofessional communication (chest radiology and primary teams)
- Coordination of care
- Proper triage
Pulmonary Procedure Rotation
Fellows spend a month each year as a dedicated procedural fellow. In this capacity, they work closely with our procedurally based attendings performing, with appropriate use of ultrasound:
- Advanced bronchoscopic techniques including EBUS
- Navigational bronchoscopy
This rotation allows our fellows to obtain proficiency with advanced bronchoscopic techniques that are becoming the cornerstone of a pulmonary specialist who performs bronchoscopy as part of their practice.
Procedures are performed in the intensive care units, UVA operating room, and the multidisciplinary endoscopy unit.
Intensive Care Units
Fellows spend at least six months in the medical ICU where they evaluate and treat both common and unusual cases under the guidance of the critical care medicine board-certified attending faculty. As a part of the daily responsibilities, fellows are expected to:
- Organize and lead teaching/work rounds.
- Formulate care plans with attending supervision.
- Facilitate communication between the ICU team and surgical services, consultative services, and family members.
Extensive experience is gained in:
- Ventilator management
- Hemodynamic monitoring techniques, including balloon floatation Swan-Ganz and arterial catheter placement
- Ultrasound-guided central venous catheter insertion
- Chest tube thoracostomy
- Percutaneous thoracotomy
- Percutaneous tracheostomy
Emphasis is also placed on critical care ultrasound.
The critical care experience is broadened by rotations through non-medical intensive care units including time spent in:
- Thoracic and Cardiac Surgery Intensive Care Unit
- Neurologic Intensive Care Unit
- Coronary Care Unit
- Special Pathogens Unit (developed during COVID-19)
In these units, pulmonary fellows care for patients who presented with trauma, postoperative complications, strokes, spinal cord injury, cardiovascular diseases, or who are on ECMO.
Outpatient Pulmonary Clinic
Pulmonary fellows have one half-day continuity clinic per week, seeing 2 new patients and several returning patients. Fellows follow their patients throughout the three-year fellowship. The fellow’s clinics are staffed by one of the Pulmonary/Critical Care attendings available specifically for the fellow’s outpatient clinic.
Third year fellows also have the opportunity for further experience in ambulatory subspecialty clinics of their choice, which include:
- Cystic Fibrosis
- Interstitial Lung Disease (one of only 45 national Pulmonary Fibrosis Foundation Care Centers)
- Sleep Disorders
- Lung Transplant
- Pulmonary Hypertension
- Post-ICU COVID-19
The fellows spend nearly 3 months on lung transplant rotation, seeing patients in all stages of the lung transplant process. This includes those undergoing evaluation for transplant, listed and waiting for a transplant, as well as recent and long-term post-operative patients. In addition, the fellows will see adult cystic fibrosis patients both inpatient and in the clinic.
In the second year, the Pulmonary/Critical Care fellows have the opportunity to rotate on the Anesthesiology Service where they achieve proficiency in airway management and intubation.
Rotation includes activities at the Sleep Disorders Center, with its associated Sleep Lab, and the Pulmonary Function Laboratory. Although sleep apnea syndromes make up a large part of the caseload, all types of sleep disorders are seen during clinic in this rotation. Ongoing research, particularly in the treatment of obstructive sleep apnea, is discussed. Pulmonary fellows gain experience in patient evaluation and in the techniques and interpretation of nocturnal polysomnography. More recently the sleep rotation has been nested with the Physiology and PFT rotation.
Physiology and Pulmonary Function Laboratory
A clinical physiology rotation is a unique opportunity to learn the foundations of pulmonary function testing under expert supervision. Rotations such as these were once commonplace in pulmonary fellowships. However, increasing service needs and a general de-emphasis of physiology has led them to be dropped from programs. We would like to provide our fellows with this exposure because we believe a solid understanding of pulmonary physiology remains essential to understand the effects of disease, and that pathophysiology bridges cellular events and the patient’s experience.
This rotation requires extensive outside reading on the part of the fellow in addition to providing hands-on training in:
- Pulmonary function
- Exercise testing
- Laboratory management
- Quality control
The fellows will also meet individually with attendings who have a background in physiology and pulmonary function testing. These meetings will review the pulmonary function testing and will provide an opportunity to discuss a variety of physiology topics.