Core Curriculum for the Pulmonary and Critical Care Fellowship

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Objectives

All fellows are expected to maintain certification in basic and advanced cardiopulmonary resuscitation. Arrangements are made every 2-3 years for group BCLS/ACLS refresher training.

Pulmonary Diseases

After completing training, fellows are expected to:

  • Diagnose and manage
    • obstructive lung disease
    • pulmonary malignancies, including primary and metastatic cancers
    • pulmonary infections due to all causes
    • pulmonary infections that occur in the immunocompromised host
    • diffuse interstitial diseases
    • pulmonary vascular diseases such as pulmonary vasculitis, pulmonary hemorrhage, pulmonary embolism, and pulmonary hypertension
    • occupational disorders
    • diseases due to drugs and radiation therapy
    • pulmonary diseases associated with connective tissue disorders
    • pleural space problems due to infection, neoplasms, and pneumothorax
    • inherited pulmonary diseases such as a1 antitrypsin deficiency and cystic fibrosis.
  • Know the indications for and management of lung transplantation.
  • Interpret chest x-rays, chest computed tomography, ventilation perfusion scans, and pulmonary angiograms.
  • Assess pre-operative risk.
  • Assess disability related to pulmonary diseases.
  • Understand the pharmacology of drugs commonly used in patients with pulmonary diseases.
  • Manage chest wall deformities.
  • Manage neurological and muscular disorders affecting ventilation.

Critical Care Medicine

After completing training, fellows are expected to:

  • Diagnose and manage acute respiratory failure due to all causes.
  • Manage ventilators and know the proper use of different ventilator modalities.
  • Know the indication for and proper use of non-invasive ventilator modalities.
  • Wean patients from mechanical ventilation.
  • Diagnose and manage sepsis.
  • Know the proper management of airway in intubated and non-intubated patients.
  • Intubate with a laryngoscope and with a bronchoscope.
  • Manage enteral and parenteral nutrition.
  • Measure and interpret arterial blood gases and central venous pressures.
  • Measure and interpret hemodynamics studies.
  • Know the proper sedation of awake and intubated patients.
  • Know the proper use of paralytic agents.
  • Measure and interpret outcomes in the medical intensive care unit.
  • Manage renal and electrolyte problems in critically ill patients.
  • Know the proper management of blood transfusions and transfusion reactions.
  • Know the proper management of hemostatic disorders.
  • Manage anaphylaxis and acute allergic reactions.
  • Manage postoperative patients and complications.
  • Diagnose and manage nosocomial pneumonia.
  • Assess and manage psychosocial and emotional issues of critically ill individuals and their families.
  • Understand clinical, economic and legal aspects of the care of critically ill patients.
  • Understand obstetric and gynecologic disorders.
  • Understand the pharmacology of drugs commonly used in critically ill patients.
  • Manage chest trauma.
  • Manage drug overdose.
  • Diagnose and manage gastrointestinal hemorrhage.
  • Diagnose and manage acute and life-threatening endocrine and metabolic derangements.

Sleep Disease

After completing training, fellows are expected to:

  • Diagnose and manage sleep disorders, particularly obstructive sleep apnea.
  • Preliminary interpretation and polysomnographic and nap studies.
  • Diagnose and manage problems related to CPAP and BiPAP therapy.
  • Diagnose and manage sleep diseases other than obstructive sleep apnea.

Procedures

After completing training, fellows are expected to:

  • Perform bronchoscopy with endobronchial biopsy, transbronchial biopsy, bronchoalveolar lavage, bronchial washing, and transbronchial needle aspiration.
  • Intubate with a laryngoscope and with a bronchoscope.
  • Ventilate patients with a bag or mask.
  • Know the proper administration of oxygen.
  • Be capable of performing pericardiocentesis.
  • Be capable of performing and interpreting pleural fluid drainage and pleural biopsy.
  • Insert chest tubes and perform pleurodesis of the pleural space.
  • Insert Swan-Ganz catheters, central venous catheters, and arterial catheters and know how to properly calibrate hemodynamic monitoring equipment.
  • Insert transvenous pacemakers.
  • Be capable of performing arterial puncture and interpreting blood sampling.
  • Be capable of performing cardioversion.
  • Be capable of performing emergent tracheostomy.
  • Understand the indications for hemodialysis and peritoneal dialysis.
  • Understand the indications for peritoneal lavage.

Pulmonary Physiology and Immunology

After completing training, fellows are expected to:

  • Interpret spirometry, bronchodilator studies, diffusing capacity, lung volumes, flow volume loops, and bronchial provocation tests.
  • Perform and interpret exercise studies.
  • Interpret bronchoalveolar lavage studies.
  • Know the indications for immunization against pulmonary diseases.
  • Calculate and interpret oxygen content, delivery, and consumption.
  • Have knowledge of pulmonary pathology and interpretation of lung and pleural biopsy material.

Basic Science and Clinical Research

After completing training, fellows are expected to:

  • Identify a clinical or a basic science research problem.
  • Develop experimental methods.
  • Understand simple concepts of protein analysis and purification.
  • Understand simple molecular biological principles and techniques.
  • Design clinical or basic science research studies.
  • Interpret data and statistical problems related to research studies.
  • Prepare and submit grants to seek funding.
  • Prepare manuscripts for publication.