Clinical Training and Rotations

Pulmonary Consult Service

There is a pulmonary consult service at both the University of Kansas Hospital and Kansas City Veterans Hospital. Both services consist of the pulmonary fellow and the pulmonary attending. They receive an average of 2-4 consults per day and generally follow 8-15 patients at any one time. The pulmonary consult service also may follow patients in other intensive care units who are on the ventilator.

Procedure Service-University Hospital

There is a separate procedural service consisting of the pulmonary fellow and a pulmonary attending. The fellow is expected to perform procedural consults and procedures, and follow up on procedural results. This is an ever-growing service, and the fellow can expect to perform bronchoscopy, EBUS, chest tubes, Pleur-x catheters, among other procedural duties.

Medical Intensive Care Unit (MICU)-University Hospital

The MICU Team consists of 2-3 students, 2-3 residents, the fellow and the attending physician. The fellow is expected to lead the team and to ensure the flow of daily duties. The fellow should expect to assume more responsibility for running of the service as greater abilities for leadership are demonstrated to the attending. The census of patients followed by the team averages 8-12 patients. The MICU experience covers a broad range of patients across three intensive care units. There is extensive experience in caring for immunocompromised patients and those with acute and chronic liver disease. Occasionally, the fellow will also assist in the care of critical post-operative patients from other surgical services.

Pulmonary Function/Exercise

There is a pulmonary function laboratory at both the University Hospital and the Kansas City Veterans Hospital. Progressive exercise study, exercise oximetry and overnight polysomnography are performed at the University Hospital. The fellow assigned to this service is expected to read all PFT's each weekday and review them with the attending on the service. The fellow will perform all exercise studies with the assistance of the Pulmonary Function Lab personnel. These will also be interpreted with the assistance of the attending. Fellows will also rotate with the pulmonary hypertension and cystic fibrosis services on this rotation to gain experience on the care of these subspecialty pulmonary patients in the inpatient and outpatient setting.

Ambulatory Experience

Ambulatory facilities are located at the University of Kansas Hospital and the Kansas City Veterans Administration Hospital. At the University Hospital each fellow is scheduled in one half-day continuity clinic per week. The first and second year fellows average 8 months/year in the Fellows Continuity Clinic. The only time they are excused is when they have simultaneous MICU responsibilities at the University Hospital. During the third year, the fellows participate in continuity clinic for one half-day at the Veteran's Hospital and one half-day in a subspecialty clinic at the University Hospital. When at the VA Hospital, fellows are involved twice weekly in the VA pulmonary clinic.
The Pulmonary clinics are a regional referral center for the entire state of Kansas and regionally from the surrounding States. The ambulatory clinics are also referred patients from the inpatient Consult service for problems requiring on-going pulmonary care. Over 2,000 visits are scheduled per year. Each patient is discussed and evaluated separately by the supervising attending.

Additional Rotations

• Radiology - The fellows may take a rotation in Radiology, gaining experience reading chest films, V/Q scans, and CT's. There is a large teaching file available for review. Fellows work directly with a pulmonary radiologist.
• Sleep Laboratory - The fellows may take a rotation in the Sleep Lab, providing ample experience in reading polysomnography and in the operation of a well-run laboratory. The fellow will also participate in the monthly multidisciplinary Sleep Conference.
• Cardiothoracic Surgery - A one-month cardiothoracic surgery rotation is required during the second year. Fellows evaluate thoracic surgical patients with the attending thoracic surgeon. Fellows are present for the intra-operative and post-operative care.
• Neurological ICU - A one-month rotation in the Neurological ICU is required during the third year. Fellows will round with the Neuro ICU team and participate in discussions and day-to-day care of the critical neurologic patient.
• Cardiology - The elective cardiology experience consists of one month of Coronary Care Unit(CCU) and one month of the Cardiology catheterization unit. The fellow works with the attending Cardiologist, as well as the Cardiology fellow and residents.