CLINICAL ROTATIONS

inpatient service

Year 1

reading objectives

1. Understand basic respiratory pathophysiology at least at the level of detail described in West, J.B. Respiratory Physiology – the essentials. 3rd ed. Williams & Wilkins, 1985; and West, J.B. Pulmonary Pathophysiology – the essentials. 3rd ed. Williams & Wilkins, 1987. Goal should be to cover the entire book each in the first year and answer all end of chapter questions.

2. 2007 NIH guidelines on Asthma management. Particular focus should be paid to inpatient management of asthma exacerbation.

 

3. Essentials of mechanical ventilation by Hess and Macnarek, 2007.

 

PBLI= Practice Based Learning and Improvement

ICS= Interpersonal and Communication Skills

P= Professional

MK= Medical Knowledge

PC= Patient Care

SBP= System Based Practice

1. Develop and demonstrate competent skills in obtaining an inpatient history and performing a physical examination focused on the respiratory system, including but not limited to evaluation of breath sounds, work of breathing, lung consolidation and pleural effusion. MK PBLI, P

2. Develop and demonstrate an orderly approach to the inpatient evaluation of pediatric patients with respiratory symptoms including apnea/ALTE, atelectasis, chest pain, chronic cough, chronic respiratory insufficiency, hemoptysis, obstructive sleep apnea syndrome, recurrent pneumonia, stridor, tachypnea, and wheezing. PBLI, MK

3. Develop and demonstrate the ability to manage mechanical ventilator units in the PICU, NICU and on the inpatient floor. MK

4. Develop and demonstrate ability to interpret respiratory imaging studies including primarily chest radiographs. MK

5. Develop and demonstrate ability to interpret pneumogram and nocturnal desaturation studies.

6. Understand the indications for, limitations of, and risks of other specialized diagnostic techniques in children, including flexible bronchoscopy, rigid bronchoscopy, mediastinoscopy, and thoracoscopy. SBP, PC, ICS, MK

7. Develop and demonstrate the ability to interpret respiratory tract cultures in the context of the overall pulmonary evaluation. MK

8. Develop and demonstrate the ability to interpret laboratory studies of pleural fluid. MK

9. Understand the indications for, current techniques for, and potential complications of lung biopsy in children. MK

10. Develop a functional understanding and clinical application of the PBLI, MK ARDS protocol from        ARDS-net.systems and the benefits of each device.

inpatient service

Year 1

Competency Based Objective

&

ACGME Competency Goal

11. Understand the appropriate inpatient use, risks and benefits of commonly used therapeutic modalities such as supplemental oxygen, airway clearance techniques, bronchodilators, diuretics, systemic and inhaled corticosteroids, leukotriene inhibitors, inhaled DNAase, and antibiotics. MK

12. Understand the use and utilization of airway clearance measures including the thairapy VEST and IPPV devices. MK

13. Demonstrate an understanding of inpatient neonatal pulmonary disease including pulmonary interstitial emphysema, bronchopleural fistula, bronchopulmonary dysplasia, etc. MK

14. Demonstrate an understanding of the inpatient management of apnea of prematurity. MK

15. Demonstrate clinical competency of the diagnosis, management and treatment of hospital acquired and community acquired pneumonia. MK

16. Understand the use and utilization of various nebulization delivery systems and the benefits of each device. MK

17. Demonstrate clinical competency in the inpatient treatment of cystic fibrosis pulmonary exacerbations. MK

18. Demonstrate clinical competency in the inpatient management of bronchiectasis. MK

19. Demonstrate communication skills appropriate for end of life discussions with patient and families. ICS, P

outpatient service

Year 1

reading objectives

1. Understand basic respiratory pathophysiology at least at the level of detail described in West, J.B. Respiratory Physiology- the essentials. 3rd ed. Williams & Wilkins, 1985; and West,

J.B. Pulmonary Pathophysiology- the essentials. 3rd ed. Williams & Wilkins, 1987.  Goal should be to cover the entire book each in the first year and answer all end of chapter questions.

2. 2007 NIH guidelines on Asthma management.

 

 

PBLI= Practice Based Learning and Improvement

ICS= Interpersonal and Communication Skills

P= Professional

MK= Medical Knowledge

PC= Patient Care

SBP= System Based Practice

1. Develop and demonstrate competent skills in obtaining a history and performing a physical examination focused on the respiratory  system, including but not limited to evaluation of breath sounds, work of breathing, lung consolidation and pleural effusion.MK

2. Develop and demonstrate an orderly approach to the evaluation of pediatric patients with respiratory symptoms including apnea/ALTE, atelectasis, chest pain, chronic cough, chronic respiratory insufficiency, hemoptysis, obstructive sleep apnea syndrome, recurrent pneumonia, stridor, tachypnea, and wheezing. PBLI, MK

3. Develop and demonstrate ability to interpret respiratory imaging studies including primarily Chest radiographs.MK

4. Develop and demonstrate ability to interpret pulmonary function tests primarily focused on flow volume loop evaluation. Evaluation of arterial and venous blood gases are incorporated as well. PBLI, MK

5. Understand the indications for, limitations of, and risks of other specialized diagnostic techniques in children, including rigid bronchoscopy, mediastinoscopy, and thoracoscopy. PBLI, MK

6. Develop and demonstrate the ability to interpret respiratory tract cultures in the context of the overall pulmonary evaluation. MK

7. Develop and demonstrate the ability to interpret laboratory studies of pleural fluid. MK, PBLI,

8. Understand the indications for, current techniques for, and potential complications of lung biopsy in children. MK

9. Understand the appropriate use, risks and benefits of commonly used therapeutic modalities such as supplemental oxygen, airway clearance

techniques, bronchodilators, diuretics, systemic and inhaled corticosteroids, leukotriene inhibitors, inhaled DNAase, and antibiotics. MK

outpatient service

Year 1

Competency Based Objective

&

ACGME Competency Goal

10. Understand the use and utilization of various nebulization delivery systems and the benefits of each device. PC, MK

11. Understand the proper sterilization techniques utilized in home respiratory equipment. MK

12.  Understand the appropriate use; risks and benefits of more specialized therapeutic modalities such as tracheostomy, chronic mechanical ventilation (positive and negative pressure), CPAP and BiPAP. MK, PC

13.  Understand the indications and proper prescription of home apnea monitoring. MK

14.  Complete clinical understanding and application of the NIH 2007 Guidelines on Asthma Management. MK

15.  Demonstrate an understanding of the outpatient management of pediatric cystic fibrosis pulmonary and non-pulmonary care. MK, PBLI

16.  Demonstrate an understanding of the outpatient management of neonatal onset bronchopulmonary dysphasia and chronic lung disease. MK

17. Understand and demonstrate knowledge base of vaccine development and delivery along with patient conceptions of danger. MK, P, SBP

Pulmonary

and

Sleep Diagnostics

Here at Miller’s, our center offers an accredited sleep center with two board certified sleep specialists.  Our sleep center caters to a complex patient population. Many of our patients have special healthcare needs and are supported by technology including positive airway pressure, ventilators, or oxygen therapy.

An important part of the Pediatric Pulmonology Fellowship training is an understanding of respiratory physiology and the use of the physiology laboratory in the diagnosis and management of patients. In the outpatient rotation, 6-7 hours per per week is set aside for this activity.

 

The Fellow participates in the performance of specialized tests, such as graded exercise stress tests and infant pulmonary mechanics, so that he or she will be able to perform them after fellowship. Thus, fellowship training provides extensive exposure to the performance and interpretation of routine pulmonary function tests, sleep studies, exercise stress tests, and tests of ventilatory muscle strength.

 

Flexible Fiberoptic Bronchscopy

Fellows will be able to master multiple procedures including flexible fiberoptic bronchoscopy.  Throughout training, difficult airway sessions are offered to learn how to maneuver the bronchoscope on an airway model.

Even during first year, Fellows immediately learn bronchoscopy and its associated aspects including aspiration, lavage, foreign body removal and biopsy.  Our fellowship program sees our graduates completing on average 200 bronchoscopies prior

to graduation. 

 

NightCall

The Miller’s Pediatric Pulmonology Fellowship program requires NO in house call.  Night call is by an electronic paging system, arranged by the fellows and generally shared equally.  The inpatient fellows receives the calls during the week of inpatient call.  One day in seven, the phone call is shifted to an outpatient fellow per ACGME requirements.