Clinical Rotations
- Pulmonary training includes six months at MHMH. The first month of the fellowship is spent on the inpatient consult service. The goals and objectives for this rotation are listed below. The fellow will have ample time to focus on learning the systems of care at our main teaching site. One month of Cardiac Care Unit experience allows the PCC fellow to gain expertise in acute management of common cardiac problems. The PCC fellow also brings ventilation management skills to the CCU team.
- Six months of critical care medicine are scheduled as one month blocks in the MHMH combined medical-surgical ICU, spread over the three years of fellowship training. We try to schedule the first ICU month well into the first year, to allow the fellow time to have developed some expertise in pulmonary diseases and procedural skills before assuming the increased responsibilities of supervising housestaff in a multi-disciplinary medical-surgical Intensive Care Unit.
- Six months of inpatient and outpatient combined pulmonary consultation take place at the Veterans Administration Hospital in White River Junction, Vt. The VA also affords fellows the opportunity to supervise housestaff in a 7-bed combined medical-surgical ICU.
- A two-week rotation at the Hospital for Special Care in New Britain, CT, will take place during a fellow's third year. During this rotation, fellows will be directly involved in the management of patients with chronic ventilator dependency.
These 19.5 months of clinical activity are distributed over the three-year fellowship. The program aims for flexibility in scheduling, but typically tries to front-load clinical work. Most fellows will have 9 months, 7 months and 3.5 months of clinical time in their first, second and third years, respectively. See a typical training schedule.
In addition to inpatient responsibilities, each fellow participates in two half-day outpatient continuity clinics each week throughout the three year fellowship. One outpatient clinic is at DHMC, and the other is at the Veterans Administration Hospital in White River Junction, VT. These two sites are nine miles and approximately 12-15 minutes driving time from one another. Fellows present all initial pulmonary outpatient evaluations to a faculty member for discussion and review. Thereafter, the fellow assumes primary responsibility for the patient. This supervised and graded responsibility is closely monitored by attending faculty. A faculty member is always available for discussions and back-up assistance.
During the 12 months of inpatient pulmonary consultation time at MHMH and the VA Hospital, fellows participate in approximately 100 bronchoscopies and ten thoracenteses, and will interpret hundreds of pulmonary function tests involving measurement of flow rates, lung volumes, and diffusing capacity, in addition to methacholine bronchoprovocation challenge testing. Clinical time in the ICU provides opportunities for acquiring and honing skills at placement of central venous catheters, including pulmonary arterial catheters, arterial lines, airway management (including endotracheal intubation), and placement of chest tubes.
In addition to the inpatient and outpatient responsibilities above, there are two mandatory rotations. All fellows are required to spend a minimum two-week block in the MHMH Pulmonary Function Laboratory, working with the director to understand indications for pulmonary function testing, the methodology and mechanics of both static and dynamic (exercise) testing, and to learn to interpret the results. Fellows also spend a minimum of one month in the Sleep Disorders Center, learning the basics of sleep physiology and pathophysiology, the technique of polysomnography and the interpretation of sleep studies.
