In addition to inpatient responsibilities, each fellow participates in outpatient continuity clinics. Outpatient pulmonary consultation (continuity clinic) gives fellows experience with the broad spectrum of pulmonary problems seen in a tertiary care, outpatient pulmonary referral practice.
The primary goal of the outpatient rotation is the development of skills necessary for the diagnostic assessment and medical management of complex pulmonary problems outside the hospital. Although the practice is fundamentally a referral practice, the nature of the clinical problems often requires involvement of the fellow over multiple visits, sometimes extending over years.
Fellows do not have clinic responsibilities during their critical care rotations, but otherwise generally have a weekly outpatient clinic at Mary Hitchcock Memorial Hospital (MHMH) and the Veterans Administration Hospital (VA). A typical clinic session consists of 1 to 2 new patient evaluations, and 2 to 4 follow-up visits. Fellows are expected to present all 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.
In addition to their longitudinal clinic, fellows also have a required outpatient rotation in sleep medicine as well as a required outpatient subspecialty clinic rotation. During this rotation fellows will have an opportunity to rotate in faculty clinics in cystic fibrosis, interstitial lung disease and pulmonary hypertension. They will also have an opportunity to perform right heart catheterizations in the cardiac catheterization lab.