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Clinical Training

 Pulmonary Hospital

The great majority of our clinical training is offered at the Wake Forest Baptist Health Medical Center Campus, which operates 1,004 acute care, rehabilitation and psychiatric care beds. Within the main hospital are general medicine nursing units, 33 intermediate care and 85 medical-surgical intensive care beds. The fellows care for patients in three inpatient venues: Medical and Surgical Intensive Care Units, the Pulmonary Intermediate Care service and the Pulmonary Medicine Consultation service. These are busy rotations with the Section averaging more than 800 inpatient consults and nearly 3500 admissions to the MICU every year. Within each venue, fellows are paired 1:1 with attending faculty for the rotation. During the first year each fellow will be exposed to the entire spectrum of pulmonary and critical care diseases by spending time both in the ICU and on busy consultative services. See our page “Three Year Experience” for a schematic overview of the schedule structure. 

In the outpatient venue, approximately 7,000 outpatients are seen in the Pulmonary Clinic annually. All fellows experience a longitudinal continuity care clinic where they care for patients with the full spectrum of pulmonary diseases as their primary pulmonary specialty physician. These clinics occur one half-day every week except when the fellow is rotating on an inpatient service. Additionally, all fellows spend two months each year on an outpatient pulmonary medicine rotation. During this rotation, the fellow does not have inpatient duties, and rotates through faculty general pulmonary clinics and subspecialty clinics in severe asthma, pulmonary hypertension, cystic fibrosis, and thoracic oncology/interventional pulmonary.

Additional experience (4-6 weeks per year) is gained at the William “Bill” Hefner Veterans Administration Medical Center in Salisbury, North Carolina. During the past three years we have developed new clinical experiences in the comprehensive assessment and management of patients with sleep disorders. A team of faculty based primarily at the VA hospital, complemented by our sleep-certified pulmonary critical care faculty from Wake Forest, has led to a superb experience in clinical sleep medicine. Additionally, our faculty have established a general pulmonary clinic designed to provide for veterans with lung cancer. This provides fellows with additional experience in diagnostic and interventional bronchoscopy, including sample acquisition for appropriate molecular and genetic analysis. Lastly, our fellows have gained access to a high-fidelity bronchoscopy simulator through the VA which affords additional guided bronchoscopy training in a simulated patient environment. The training curriculum for this simulator has been adapted by our own faculty for use in fellowship training.

From a procedural aspect, the Pulmonary Section performs more than 1800 bronchoscopies (fiberoptic and rigid) per year. The fellow will develop competence in all aspects of bronchoscopy including bronchoalveolar lavage, endobronchial and transbronchial biopsies, transbronchial needle aspiration (conventional and ultrasound-guided [convex and radial EBUS]), and navigational bronchoscopy. Additional experience in interventional bronchoscopy techniques is gained by working alongside our fourth-year Interventional Pulmonology fellow and IP faculty. Fellows will also acquire competence in pleural procedures such as thoracentesis and thoracostomy tube insertion (tunneled and non-tunneled) and drainage.

Pulmonary diagnostic testing experience includes 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 invasive and noninvasive hemodynamic 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 time during the second and third years of fellowship is designed to be flexible and individualized. The fellow may elect for additional inpatient critical care experiences involving rotations in other intensive care units, such as our trauma, burn, neurosurgery, coronary care, and/or cardiothoracic surgery ICUs. The clinical pulmonary exposure also involves cross-specialty consultations in the transplantation programs (including bone marrow, heart, and kidney transplants), thoracic oncology, thoracic surgery, pulmonary pathology, or radiology. After successful completion of the three-year program, the fellow will meet all requirements for the ABIM Subspecialty Board Examinations for Pulmonary Disease and Critical Care Medicine. All fellows who have graduated from the program have successfully achieved dual certification.


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Last Updated: 07-14-2016
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.

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