Pulmonary and Critical Care Fellowship Information

FELLOWSHIP INFORMATION

Fellowship Director: Heath Latham, M.D.

The three-year fellowship in Pulmonary and Critical Care Medicine allows for the opportunity to complete the requirements for certification in both pulmonary medicine and critical care medicine. The program can be customized to emphasize either clinical training or research. Clinical conferences, core lectures, small discussion groups, journal clubs, and an advanced research conference are all integral parts of the program, along with the opportunity for 12 months of research.

FACILITIES

The University of Kansas Medical Center is comprised of the School of Medicine, Nursing and Health Professions.

Mission Statement
With a dedication to excellence, it is the mission of the University of Kansas Hospital along with its partner physicians to maintain and enhance the health of all people living within the communities that we serve and to facilitate and support education, research and public service activities of the University of Kansas Medical Center.

The medical center's mission is to improve the health of Kansas through premier educational programs, innovative research, the highest quality patient care and outreach to underserved populations.

Clinical facilities are the University of Kansas Hospital and the Kansas City, Missouri Veterans Administration Hospital.

CLINICAL TRAINING & ROTATIONS

Pulmonary Consult Service
There is a pulmonary consult service at the University Hospital and Kansas City Veterans Hospital. Both services consist of the pulmonary fellow and the pulmonary attending. They receive an average o 2-4 consults per day and generally follow 6-12 patients at any one time. The pulmonary consult service also follows patients in the Surgery ICU and Bone Marrow Unit who are on mechanical ventilators. The fellow can expect to perform 10-15 bronchoscopies per month while other procedures such as chest tube placement and pleural biopsies are dependent on case ICU.

Medical Intensive Care Unit (MICU)-University Hospital
The MICU Team consists of 2-3 students, 3-4 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 the 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 is a closed ICU with the exception of the Coronary Care Unit (CCU) patients and the renal transplantation patients.

Medical Intensive Care Unit(MICU)-Kansas City Veterans Hospital
The MICU at the VA Hospital is a closed ICU. The MICU team is composed of a PCCM attending physician, medical student and 3 Internal Medicine residents. The Fellow does not supervise the MICU at the VA.

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 consultation 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.

Ambulatory Experience
The ambulatory experience is similar throughout the three years of PCCM training. 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 two half-day ambulatory experiences per week. One is the Fellows Continuity Clinic and one is an individual Pulmonary Staff Clinic. The first and second year fellows average 8-9 months/year in the Fellows Continuity Clinic. The only time they are excused is when they have simultaneous PCCM continuity clinic responsibilities at the KC VA Hospital. In this instance when their VA responsibilities do not allow their returning to the KU Hospital for Fellows Continuity Clinic. However, when at the VA Hospital, they are involved twice weekly in the VA Pulmonary Continuity Clinic.

The Fellow Continuity Clinic is organized about a team approach. Each of the fellows is assigned to on of two teams. Each team has first, second and third year fellow on the team. Each patient is assigned to one doctor on the team and to one team. This ensures that if the doctor assigned to the patient is not available, at least one doctor from that team will be able to see the patient. Fellows are encouraged to discuss their patients with other members of the team so as to provide collective team knowledge of each patient. Each patient remains the fellows' patient for the entire PCCM residency. One faculty is always present for Continuity Clinic.

Six individual Pulmonary Staff Clinics exist, each for one half-day per week. Each fellow is assigned to one Staff Clinic a month and that assignment is changed monthly. The fellows are responsible for evaluating both new and return patients to the Staff Clinic. As different staff has different clinical emphasis, a variety of pulmonary ambulatory experiences are available for the fellows.

It is estimated that each trainee evaluates over 150 "new" pulmonary ambulatory patient per year and approximately 300 "return" patients. The PCCM clinics are a regional referral center for a 150-mile radius. About two-thirds of patient will remain on for "Principled" care with the pulmonary physician. The ambulatory clinics are also referred patient from the Pulmonary Consultative Service for primary problems requiring on-going pulmonary care. Over 2,000 visits are scheduled per year. Pulmonary trainees often continued pulmonary care for patients they have evaluated and care for while hospitalized. After the trainee, either in the Fellows Continuity Clinic or in the Pulmonary Staff Clinic evaluates each patient the patient is also evaluated by the faculty physician assigned. Any pulmonary procedure deemed necessary, the resident who had seen and evaluated the patient performs i.e. bronchoscopy or exercise testing.

The Pulmonary Ambulatory Clinic at the VA Hospital operates two half-days per week. A majority of patients are pulmonary continuity patients cared primarily for by the Pulmonary/Critical Care Medicine faculty. Referral patients from the Pulmonary Consultative Service at the VA are also evaluated. The same procedure for PCCM resident evaluate, follow-up and performance of procedures occurs as at the University Hospital.

ADDITIONAL ROTATIONS

Radiology
The fellows may take a rotation in Radiology, gaining experience reading chest films, V/Q scans, CT's and MRI's. There is a large teaching file available for review. Fellows work directly with a pulmonary radiologist.

Sleep Laboratory
The sleep lab is an active service, which provides the fellow with 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 two-month cardiothoracic surgery rotation is available during the second or third year. Fellows evaluate thoracic surgical patients with the attending thoracic surgeon. Fellows are present for the intra-operative and post-operative care.

Renal
A two-month renal medicine experience is available for all fellows in their second or third year. The fellow rounds with the attending nephrologist and will attend the Nephrology Case conference.

Cardiology
The 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.

CONFERENCES

  1. Selected Topic Conference
    Each PCCM resident will prepare and present at total of four "topic" conferences, either clinical or basic, to other PCCM residents and faculty. Topics are developed and assigned to the individual residents for presentation. All faculty and trainees are present. Once a month, selected journal articles are reviewed by the designated trainee for the other trainees and faculty. On average, research conferences by the PCCM resident are presented twice a year, generally just immediate to either the annual meeting of the American College of Chest Physicians or the American Thoracic Society.
  2. Pulmonary and Critical Care Case Conference
    The PCCM resident on the University Consultative Service coordinates and presents pulmonary and critical care cases from both the University and VA Hospital, which have timely educational value. Not only all faculty and trainees, but also other specialists and subspecialties including Cardiothoracic Surgery, Pulmonary Radiology, Pathology and Cardiology attend the conference. The PCCM resident coordinates the presentation of pertinent pathologic material by a full time pathologist who attends the conference.
  3. Veterans Hospital Surgical/Medical Chest Conference
    The PCCM resident coordinates with the Cardiothoracic Surgery resident and Oncology fellow to present various pulmonary cases of surgical interest, especially lung cancer.
  4. Internal Medicine Conference
    The PCCM resident is responsible for presenting at least one conference per year in the Internal Medicine conference series. These conferences are a general pulmonary topic. All medical students on the Internal Medicine rotation as well as other Internal Medicine residents attend the conference. The conference is telecasted simultaneously to the VA Hospital.

RESEARCH OPPORTUNITIES

The fellow will be expected to choose a faculty mentor early on in the fellowship. The mentor will help guide the fellow in choosing a topic for research and be responsible for providing the resources needed for the fellow to complete the project. The fellow, in consultation with the mentor, will be expected to develop and execute the research project. The majority of fellows present abstracts at national meetings. When an abstract is produced for presentation at a national meeting, the section will assist the fellow with expenses for attending that meeting.

Last modified: Jun 13, 2014
Contact Info

For detailed information on the Pulmonary and Critical Care Fellowship contact:

Heath Latham, M.D.
University of Kansas Medical Center
3901 Rainbow Blvd.
Kansas City, KS 66160-7381

Or contact the program coordinator: brobinson2@kumc.edu or fax: 913-588-4098

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