Clinical Training

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 75 medical-surgical intensive care beds. The fellows rotate through three inpatient venues: Medical and Surgical Intensive Care Units, the Pulmonary Intermediate Care service and the General 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. The first-year 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. (Sample Rotation)

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 in addition to their continuity clinic rotates through faculty general pulmonary clinics and subspecialty clinics in severe asthma, pulmonary hypertension, and cystic fibrosis.

A major new development for our program has been the high-yield expanded training based at the William “Bill” Hefner Veterans Administration Medical Center in Salisbury, North Carolina. During the past two years we have developed new, robust 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.

From a procedural aspect, the Pulmonary Section performs more than 600 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 (traditional and ultrasound-guided [EBUS]), and interventional bronchoscopy techniques. Fellows will also acquire competence in thoracentesis and thoracostomy tube insertion (tunneled and non-tunneled) 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 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. Over the past year, our faculty have also initiated pulmonary thoracic oncology services at the VA, including basic and advanced bronchoscopy procedures and a thoracic oncology clinic based on-site in Salisbury. Lastly, our fellows have gained access to a high-resolution computerized 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.

The remaining clinical elective 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, 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.

Quick Reference

School of Medicine
Student Admissions

336-716-4264

medadmit@wakehealth.edu

Student Financial Planning

336-716-2889

finaid@wakehealth.edu

Student Services

336-716-4271

stuserv@wakehealth.edu

Location:
3rd Floor Watlington Hall
Wake Forest Baptist Medical Center
Medical Center Blvd.
Winston-Salem, NC 27157-1090
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Last Updated: 09-06-2013
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