Georgetown University - Department of Medicine

The educational curriculum includes both hands-on clinical training and didactic sessions at all of the participating institutions. This experience includes:

1. Daily Consultation Rounds: Rounds are led by a full-time faculty member on a monthly rotation basis. Pulmonary physiology, pathophysiology and clinical correlation are stressed. The fellows are trained in and develop expertise in the interpretation of chest roentgenograms, thoracic CT and MRI studies, lung scans and pulmonary arteriography. Fellows are trained in and perform all pulmonary diagnostic techniques including thoracentesis, bronchoscopy, transbronchial biopsy, closed thoracostomy and chest tube management. All procedures are performed with attending physician instruction and back up. All inpatients seen in consultation are discussed at Pulmonary Morning Report two mornings per week to give weekend and night covering staff familiarity with the cases in house. In addition, difficult diagnostic or management problems are discussed at a twice-weekly Case Conference.

2. Critical Care Rotations: The twelve months of critical care training required for board eligibility is integrated into the three-year Pulmonary and Critical Care Medicine Program. A total of 6 months of the experience are in the critical care units at GUH. The Medical Intensive Care Unit is an 19-bed unit with acutely ill patients, medical and cardiac, with multi system failure. The ICU attending and fellow direct the care of these patients, supervising a house staff team consisting of a medical resident, two medical interns and a medical student. Morning rounds, immediately followed by radiology rounds, and evening sign-out rounds are made daily by the ICU fellow and attending. Fellows are trained on ICU procedures including intubation, bronchoscopy, right heart catheterization, and chest tube placement.

In addition to this primary patient care responsibility in the MICU, the critical care team is responsible for critical care consultation for patients in the SICU and the Neurosurgical ICU.

Additionally, fellow will spend one month at the Washington Hospital Center in the Surgical Intensive Care Unit where they will experience level I trauma, burn and neurosurgical patients.

They spend one month in the 14-bed CCU at the WHC taking care of high acuity cardiology patients.

They spend one month in the cardiovascular surgical ICU at the WHC expanding their experience taking care of post-operative cardiac patients.

3. Outpatient Experience: Each fellow is assigned one half day per week to see outpatients with a full-time attending in an office setting. Fellows have the opportunity to see new outpatient consultations, follow up their own recent hospital discharges, and follow selected patients longitudinally over the three-year fellowship. Patients are seen in a physicians' office building with outpatient radiology and laboratory facilities. The Pulmonary Function Laboratory is located on the clinic floor in this building.

4. Pulmonary Function Training: Fellows interpret all PFTs with daily full-time faculty member supervision. In July of the first year fellows observe demonstrations of spirometry, flow volume loops, DLCO, body plethysmography for thoracic gas volume and lung compliance determinations, and arterial blood gas analysis in the Pulmonary Function Laboratory. Fellows also place indwelling arterial catheters for patients undergoing exercise testing, and interpret exercise studies.

5. Sleep Laboratory: Fellows have the opportunity to learn to read and interpret polysomnograms, MSLT's and home screening readings for sleep apnea with two board certified sleep specialists on our faculty. Additionally they will attend a weekly sleep conference as well as rotate through an out patient clinic for sleep disorders.