Clinical Training Overview
Clinical Rotations
Educational Activities
Procedures and Areas of Training

Clinical Training Overview

linical training comprises the entire first year and parts of the second and third years of the fellowship.

Year one is divided into 8 six-week rotations. These consist of rotations at University of Washington Medical Center (UWMC), Harborview Medical Center (HMC), the Veterans Affairs Medical Center/Puget Sound Health Care System-Seattle (VAMC), and the Fred Hutchinson Cancer Research Center (FHCRC). There is also a combined rotation in sleep medicine and cardiopulmonary exercise testing.

In the second and third years, there are clinical rotations at Madigan Army Medical Center (MAMC), Virginia Mason Medical Center, and in outpatient pulmonary clinics at the UWMC.


Clinical Rotations

LINICAL ROTATIONS: FIRST YEAR
The fellow's clinical responsibilities vary depending on service and hospital. At each location, the fellow works under the direct supervision of a designated attending physician. The on-call schedule varies between rotations, but there is no in-house call during the fellowship.

University of Washington Medical Center
Pulmonary Consultation and Transplant: The fellow supervises a team consisting of a medical resident and medical student(s) in performing in-patient and occasional emergent out-patient pulmonary consultations. The fellow also supervises a primary, in-patient floor service of post-operative lung transplant patients. Also attends one half-day general pulmonary clinic. Patient population is largely tertiary care.

Medical/Transplant Intensive Care Unit: The fellow supervises four medical interns in providing intensive care to patients in the MICU (closed unit) as well as to post- operative liver, lung and kidney-pancreas transplant recipients. MICU patients are often transferred in from community hospitals.

Rounding in the UW MICU

Sleep/Exercise: Training in sleep medicine involves interpreting polysomnograms and attending two half-day sleep clinics per week. During this rotation, the fellow also performs and interprets cardiopulmonary exercise tests.


Harborview Medical Center
Consult: The fellow, along with medical and anesthesia residents, provides pulmonary consultation to all ventilated patients (including trauma, burn and neurosurgical patients) and other select patients at a busy public teaching hospital. Also attends one half-day out-patient clinic.
Neurologic Critical Care Service: The fellow supervises residents in providing care to critically ill patients with neurologic injuries, working closely with the neurosurgical service.
Medical Intensive Care Unit: The fellow supervises four residents and four interns in the care of critically ill medical patients in this large public hospital setting.


Veterans Affairs Medical Center
This rotation involves the fellow in critical care consultation (open unit) as well as general pulmonary consultation for in-patients. The population of the VA provides ample exposure to chronic lung disease and lung neoplasms. Attends one half-day general pulmonary clinic.


Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
The fellow provides pulmonary consultation and primary critical care services to a population of oncology patients, including bone marrow/stem cell recipients. Out-patient consultations are provided upon request.


CLINICAL ROTATIONS: SECOND AND THIRD YEARS

University of Washington Medical Center
Subspecialty Clinics: This rotation involves the fellows in the half-day subspecialty clinics at UWMC (adult cystic fibrosis, pulmonary vascular disease, interstitial lung disease and neuromuscular disease) and HMC (tuberculosis).

Madigan Army Medical Center
One month will be spent during the second year at MAMC. The fellow will be involved primarily in out-patient clinics providing primary and consultative pulmonary care to a large population of both active duty and retired military personnel and their families.

Continuity Clinic
All second and third year fellows will attend one half-day pulmonary clinic per week at one of the primary clinical sites (UWMC, HMC, or VAMC).


Educational Activities

everal scheduled weekly conferences and seminars supplement the fellow's clinical training. These include curricula in clinical pulmonary medicine and critical care (presented by faculty and fellows) to prepare for the board exams in both areas.

Fellows present cases in rotation at the weekly Seattle Area Chest Grand Rounds. When on service at those sites they also participate in the additional chest conferences at VAMC, MAMC and UWMC.

Other regular division teaching activities include weekly post-clinic conferences, a weekly pulmonary research seminar, a monthly journal club, and weekly or biweekly meetings of research interest groups in cell biology, gas exchange, pulmonary circulation, exercise physiology, and clinical research.

During the second and/or third year of fellowship training, fellows will participate as small group instructors in Human Biology 541 for second-year medical students. The Division encourages and supports the fellows attendance and participation at regional and national scientific meetings.

	Fellows on break from the VanSeaPort Conference

Procedures and Areas of Training

nder supervision and instruction by the faculty, fellows gain mastery in all of the procedures related to the practice of pulmonary and critical care medicine, including fiberoptic bronchoscopy and related procedures, polysomnography, and exercise testing.

Procedures such as establishing central venous access, passage of pulmonary arterial balloon flotation catheters, and radial arterial catheterization are generally learned during residency training in internal medicine, completion of which is a requirement for entrance to the program. However, supplementary training in these procedures as well as in airway management, is provided under the supervision of division faculty as required.

During their clinical training, fellows acquire a basic knowledge of all relevant areas of pathogenesis, pathophysiology, manifestations, clinical assessment, and management of pulmonary disease. In addition, they acquire in-depth knowledge in the most common and otherwise most important diseases and conditions, including chronic obstructive pulmonary disease, asthma, tuberculosis, pulmonary aspects of HIV infection, and the different forms of acute respiratory failure.

Education and training of all fellows in the areas of occupational safety and health care regulations, critical assessment and decision analysis, continuous quality improvement, psychosocial, economic, and ethical issues, teaching skills, research methodology, and professionalism, are also provided by the training program.

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Comments to Donna Schier, dschier@u.washington.edu
Last reviewed: February 22, 2005 - Last updated: February 22, 2005