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Outpatient Consultation

Outpatient pulmonary consultation (continuity clinic) gives fellows experience with the broad spectrum of pulmonary and other medical problems seen in a tertiary care, outpatient pulmonary referral practice.

The primary goal of the outpatient consultation 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 and, occasionally, several years. This longitudinal experience is a reminder of the fellow's original internal medicine training and of the privilege of caring for patients over time.

Primary education venues

Fellows see outpatients in the faculty practice at DHMC and at the pulmonary subspecialty clinic at the White River Junction, VT, VA hospital.

New patient evaluations

Fellows present all new patient pulmonary outpatient evaluations to a faculty member for discussion and review at the time of the initial visit. This interaction offers:

  • Discussion and review of patient history.
  • Exploration of pathophysiology, epidemiology and diagnostic testing strategies.
  • Review of physical examination and pertinent physical findings.
  • Staff review of fellow documentation.


Follow-up patient evaluations

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:

  • Clinical updates, re-evaluation, and review of test results on continuing consults.
  • In-depth research of chronic pulmonary issues.
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