Clinical training occurs at the North Carolina Baptist Hospital complex with 804 hospital beds distributed within interconnecting buildings. Within the main hospital are the general medicine units, 33 intermediate care and 75 medical-surgical intensive care beds. The fellows rotate through three inpatient venues: the Medical Intensive Care Unit, the Critical Care Consultation service and the General Pulmonary Medicine Consultation service. These are busy rotations with the Section averaging more than 800 inpatient consults and an estimated 1700 admissions to the MICU every year. Within each venue, fellows are paired 1:1 with attending faculty for the rotation. The first-year fellow will be exposed to the entire spectrum of pulmonary and critical care diseases by spending time both in the MICU and on busy consultative services. The fellows also rotate through off-service surgical intensive care units to broaden their critical care training. (Sample Rotation)
In the outpatient venue, approximately 7,000 outpatients are seen in the Pulmonary Clinic annually. During the first year, each fellow has:
Two, half-day clinics;
Half-day for six-month blocks with an assigned faculty member (total three to four blocks throughout fellowship) and
Half-day of three-year continuity clinic.
Upper level fellows continue in continuity clinic, but experience other subspecialty clinics, such as Cystic Fibrosis Clinic of Pulmonary or Asthma Hypertension. The clinic environment assures the fellow of a broad knowledge base encompassing a wide spectrum of pulmonary diseases and provides the opportunity to manage both acute and chronically-ill patients on an outpatient basis.
From a procedural aspect, the Pulmonary Section performs more than 600 bronchoscopies (fiberoptic and rigid) per year. The fellow will be trained in all aspects of bronchoscopy including bronchoalveolar lavage, endobronchial and transbronchial biopsies, transbronchial needle aspiration and interventional bronchoscopy. Fellows will acquire competence in thoracentesis, closed pleural biopsy, and thoracostomy tube insertion and drainage. Furthermore, the fellow will spend time learning clinical pulmonary physiology by interpreting pulmonary function tests, exercise tests, inhalation challenge studies and sleep studies. During the ICU rotations, the fellow will develop expertise in hemodynamic and noninvasive monitoring procedures. The trainee will acquire not only technical proficiency necessary for these procedures but also the judgmental skills essential to their appropriate use.
The remaining clinical elective time during the second and third years of fellowship are designed to be flexible and individualized. The fellows may elect for additional inpatient critical care experiences involving rotations in other intensive care units, such as trauma, burn, neurosurgery, coronary care, and/or cardiothoracic surgery. The clinical pulmonary exposure also involves sub-specialty consultations in the transplantation programs (including bone marrow, cardiac and kidney transplants). Outpatient electives in allergy and immunology and sleep medicine are available to fellows, as well as, time spent with subspecialty services such as thoracic oncology or radiology. After successful completion of the three-year program, the fellow will meet all requirements for the ABIM Subspecialty Board Examinations for Pulmonary Medicine and Critical Care Medicine. All fellows who have graduated from the program are dual certified at this time.
Additionally, the fellows spend two 2- week blocks at the Salisbury Veterans Medical Center for more additional exposure to sleep medicine. Here they will see and evaluate patients in the sleep clinic and also spend time with the faculty reviewing and scoring sleep studies.