Clinical Training

Fellows in our program are exposed to the full spectrum of diseases in our specialty including allergy and asthma, COPD, lung cancer, sarcoidosis, interstitial lung disease, bronchiectasis, pulmonary hypertension, critical care, lung transplantation, and sleep disorders. The Fellow learns to diagnose and treat these conditions in their own outpatient clinics under the supervision of the training faculty, and in a number of sub-specialty clinics devoted solely to specific diseases (e.g. lung cancer in the Multi-disciplinary Thoracic Oncology Clinic, bronchiectasis in the cystic fibrosis clinic). Skills in critical care medicine are acquired through work in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Units.

The first year of the Fellowship is designed to emerge the Fellow intensely into the practice of pulmonary and critical care medicine. This is accomplished through one month rotations on the Pulmonary Consultation Service, MICU, and Ambulatory Pulmonary Block (four 1 month blocks of each). In the second and third years, Fellows spend 3/12 months either in the MICU as the Senior Fellow, or on the Lung Transplant Service. The Fellow is expected to maintain an active research program during the latter years of training, in addition to their ongoing clinical training.

Pulmonary Consultation Service

It is on this service that the Fellow acquires skills in fiberoptic bronchosocopy, pulmonary function testing, and inpatient pulmonary consultation. The Fellow becomes skilled in airway inspection, bronchoalveolar lavage, endobronchial biopsy, and transthoracic needle biopsy using endobronchial ultrasound (EBUS). The conduction of Pulmonary function testing (PFT) and the operation of a PFT lab is observed in both our inpatient and outpatient PFT labs, and the Fellow becomes highly skilled in interpretation of spirometry, lung volumes, diffusion, and exercise testing by interpreting, with the help of the attending, all PFTs conducted at UNC Hospitals.

Medical Intensive Care Unit

During the first year, Fellows participate in the primary care of all patients in our 18 bed MICU, and provide consultative care to patients in the surgical ICUs. The first year fellow performs all bronchoscopies in ICU patients, begins to learn airway management/intubation and pulmonary artery catheterization, and assists the housestaff with the placement of central lines, arterial lines and thoracenteses. Management of respiratory failure and the mechanical ventilator is a primary focus of this rotation. Skills in bedside ultrasound imaging of central veins, the pleural space, the heart and the abdomen are acquired. Finally, the Fellow learns how to diagnose and manage a wide spectrum of diseases including hemorrhagic shock from gastrointestinal bleeding, septic shock, cardiogenic shock from massive pulmonary emboli, respiratory failure, liver failure, renal failure, metabolic emergencies, and drug overdose. Second and third year Fellows act as the Attending for ½ of the MICU beds, running rounds with the housestaff and supervising patient care. Skills in chest tube placement are obtained during rotations on the surgical service, and through opportunities to participate in thoracic surgery cases in the OR.

Ambulatory Pulmonary Block

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

Lung Transplant Service

Fellows participate in the evaluation of patients referred for consideration of lung transplantation, and the pre-, peri-, and post-operative care of patients undergoing lung transplantation. Considerable experience with transbronchial biopsy and management of immunosuppressive therapy is obtained on this rotation.

Conferences

To complement the hands-on training, a number of didactic and interactive conferences are available.  Conferences are attended by fellows during their research and clinical years.  Core conferences held are:

• Clinical Case Conference - held on a weekly basis
• Didactic conference - held on a weekly basis
• Pulmonary Research Conference - held bi-weekly
• Journal Club - held bi-weekly
• Pulmonary Morning Reports - held monthly
• ICU Case Conference - held monthly
• Pulmonary Physiology - held monthly

Other conferences include a Multidisciplinary Thoracic Oncology Program conference, epithelia biology program project conference, Cilia meeting and Center for Environmental Medicine, Asthma and Lung Biology conference.