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HENNEPIN COUNTY MEDICAL CENTER

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					PEDIATRIC PULMONOGY
HENNEPIN COUNTY MEDICAL CENTER

DESCRIPTION OF ROTATION OR EDUCATIONAL EXPERIENCE
During this rotation the Pulmonology fellow will manage pediatric inpatients with primarily pulmonary
problems, provide a pulmonary consultation service for other pediatricians under the direction of the staff
pulmonologist. After performing a complete history and physical exam, they will present the patient to the
attending physician for discussion, interpretation of pertinent data, and formulation of differential diagnosis and
management plans, which then will be communicated to the other members of the care team. Fellows will also
assist with and perform bronchoscopies, and gain experience in the utilization and interpretation of pulmonary
function tests. This site is a Level 1 Trauma Center. The Regional Pediatric Sleep Center is located here as is
an active tuberculosis clinic. It serves immigrant and inner city populations.

ROTATION GOALS
The overall goal of this rotation is to provide educational and clinical opportunities to acquire the knowledge,
clinical skills and professional attitudes required to recognize and manage patients with pulmonary disorders.

PATIENT CARE
Goals
Pulmonology fellow must be able to provide patient care that is compassionate, appropriate, and effective for
the treatment of pulmonary health problems and the promotion of pulmonary health.

Objectives
Pulmonology fellow will arrive at an appropriate hour, pre-round on previous consultations and begin intakes of
new consultations. They will coordinate residents on the service to perform these chores and teach residents
patients’ problems. They will perform initial assessments as appropriate with residents. Consultations may be
requested from any inpatient hospital service and the emergency department.
     1. Develop practical skills pertaining to patient care including:
                 Performing appropriately focused history and physical exam.
                 Synthesis of differential diagnoses and plans for patient management.
                 Ability to coordinate diagnoses and plans for patient management.
                 Understanding the role of consulting physician
                 Treating the various conditions listed below in “Medical Knowledge.”
     2. Foster the involvement of sound clinical judgment and efficient clinical practical skills through:
                 Performing a complete history and physical examination on all pulmonary patients seen to
                  further develop history and physical exam skills.
                 Faculty review of the resident’s evaluation and management skill with appropriate guidance
                  and instruction.
     3. Develop diagnostic and therapeutic procedural skills that will be developed with one-on-one faculty
         supervision include:
                  Arterial Blood Gas Interpretation.
                  Pulmonary Function Test Interpretation.
                  Thorax and Chest Examination Interpretation.
                  Chest CT or MRI Scan Interpretation.
                  Radionuclide Scan Interpretation
                  Pulmonary Arteriogram/ Other Cardiopulmonary Catheterization Interpretation.
                  Ventilatory support, weaning and respiratory care techniques.
                  Hemodynamic Monitoring Techniques.
                  Thoracentesis Results Interpretation.
                  Diagnostic Fiberoptic Bronchoscopy Performance and Results Interpretation.

MEDICAL KNOWLEDGE
Goals
Pulmonology fellow must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.



Pediatric Pulmonology HCMC                          Page 1                                  Goals and Objectives
Objectives
Pulmonology fellow will demonstrate an investigatory and analytical thinking approach to clinical situations,
know and apply the basic and clinically supportive sciences which are appropriate to Pulmonary Medicine as
can be found in the literature resources cited below. Exposure to and discussions pertaining to individual
patients should subsequently enable to fellows to:
    1. To be able to make a diagnosis of Adult Respiratory Distress Syndrome (ARDS) and to understand
         techniques for providing adequate ventilation for these patients.
    2. To be able to diagnose and manage congenital anatomic respiratory disorders:
                 Pulmonary hypoplasia.
                 Congential diaphragmatic hernia.
                 Laryngeal and vocal cord abnormalities, including malacia, webs, stenoses, paralyses.
                 Bronchial abnormalities, including bronchus suis, malacia, external obstruction.
                 Congenital malformations, including cystic and lymphatic abnormalities.
    3. To be able to make a diagnosis of newborn Respiratory Distress Syndrome and to understand
         techniques for providing adequate acute respiratory support and subsequent chronic medical
         management of Chronic Lung Disease of Prematurity.
    4. To be able to diagnose and treat acute and chronic respiratory failure in obstructive lung disease and
         neuromuscular disease.
    5. To be able to diagnose and treat patients with airway diseases and respiratory compromise/failure,
         including:
                 Asthma/Status Asthmaticus.
                 Bronchitis.
                 Upper Airway Obstruction.
                 Bronchiectasis.
    6. To be able to diagnose and treat patients with Aspiration Pneumonia.
    7. To understand the differential diagnosis, apply appropriate diagnostic techniques, and manage patients
         with severe hemoptysis.
    8. To understand the differential diagnosis, apply appropriate diagnostic techniques, and manage patients
         with alveolar hemorrhage.
    9. To be able to diagnose and treat patients with massive pulmonary embolism.
    10. To be able to diagnose and treat patients with respiratory failure secondary to cardiac disease.
    11. To understand inheritance patterns, prognostic factors, diagnosis and treatment of congenital lung
         diseases including:
                  Cystic fibrosis.
                  Common variable immunodeficiency.
                  Alpha1-antitrypsin deficiency.
                  Dysmotile cilia syndrome.
    12. To be able to determine which diagnostic techniques and treatment options are effective in the
         treatment of community-acquired pneumonia, hospital-acquired pneumonia, pneumonia in
         immunosuppressed patients; as well as empyema, lung abscess, pulmonary mycoses, tuberculosis, and
         atypical mycobacteria.
    13. To understand x-ray presentations of, diagnosis of, and treatment options for interstitial lung diseases
         including those associated with drugs, hypersensitivity reactions, idiopathic pulmonary fibrosis and
         collagen vascular disease.
    14. To understand the differential diagnosis of pleural diseases, as well as the interpretation of diagnostic
         studies and management options, as related to pleural effusions and pneumothoraces.
    15. To understand the significance of prevention in pulmonary disease including the avoidance of
         respiratory irritants, allergens and carcinogens, immunization, and smoking cessation.
    16. To understand the concepts behind the diagnosis and management of sleep- disordered breathing.
    17. To be able to diagnose and treat patients with pulmonary vascular disease including pulmonary
         hypertension, cor pulmonale, pulmonary thromboembolic disease, and pulmonary vasculitis.




Pediatric Pulmonology HCMC                         Page 2                                  Goals and Objectives
Pediatric Sleep Laboratory
         To diagnose and mange sleep disorders in children.

Tuberculosis Clinic
        To diagnose and manage patients with tuberculosis.

PRACTICE-BASED LEARNING AND IMPROVEMENT
   1. To acquire skills to enable investigation and evaluation of patient care practices, appraisal and
       assimilation of scientific evidence and improvement of patient care practices.
   2. To analyze one’s practice experience, recognizing strengths, deficiencies, and knowledge limits;
       perform practice-based improvement activities using a systematic methodology.
   3. To consider and utilize performance evaluations from peers, attendings, patients, parents, nurses,
       respiratory therapists, and other ancillary health care providers for clinical performance improvement
       in the care of critically ill children.
   4. To Utilize information technology to access and manage medical information.

SYSTEMS BASED PRACTICE
   1. To achieve cognizant responsiveness to the larger context of the health care system and the effective
      employment of system resources to provide care that is of optimal value.
   2. To understand the effect of patient management decisions and professional practices upon other health
      care professionals, the health care organization, and the larger society.
   3. To appreciate the differences in medical practice and health care delivery systems, and their effect
      upon medical management.
   4. To practice cost-effective health care and resource allocation while maintaining an uncompromised
      quality of care.
   5. To advocate for quality patient care and assist patients in dealing with system complexities.
   6. To partner with health care managers and health care providers to assess, coordinate, and improve
      health care and system performance.
   7. To acknowledge medical errors and assist in developing or improving systems for their prevention.

PROFESSIONALISM
   1. To commit to executing professional responsibilities, adherence to ethical principles, and sensitivity to
       diverse populations.
   2. To demonstrate respect, compassion, integrity, honesty, compassion, and empathy.
   3. To respond to the needs of patients and society in a benevolent manner that supercedes self-interest.
   4. To demonstrate accountability to patients, society, and the profession.
   5. To commit to consistently performing professional responsibilities, including complete medical
       records.
   6. To demonstrate HIPPA compliance.
   7. To participate in program requirements in clinical, research and educational curricula.
   8. To commit to excellence and continuing professional development.
   9. To commit to ethical principles pertaining to provision, withholding, or withdrawal of clinical care,
       patient confidentiality, informed consent, and clinical practices.
   10. To demonstrate sensitivity and responsiveness to patients’ and colleagues’ culture, age, gender, beliefs,
       and disabilities.
   11. To present oneself in professional manner, both in behavior and dress.
   12. To submit fellowship paperwork in a timely fashion.

INTERPERSONAL AND COMMUNICATION SKILLS
   1. To develop interpersonal and communication skills resulting in effective information exchange and
       collaboration with patients, families, and health care professionals.
   2. To develop and maintain a therapeutic and ethically appropriate relationship with patients and their
       families.
   3. To listen effectively.
   4. To elicit and provide information using effective nonverbal, informative, interrogative, and writing
       skills.



Pediatric Pulmonology HCMC                         Page 3                                 Goals and Objectives
    5.   To communicate and work effectively with other fellows, residents, attendings, consultants, nurses and
         ancillary health care providers as a member of the critical care medicine team.
    6.   To communicate effectively with surgeons and other subspecialists.
    7.   To assume responsibility for frequent and effective communication with referring and primary care
         physicians.
    8.   To consistently maintain accurate, timely, and legally appropriate medical records.

ASSESSMENT METHOD OF FELLOW PERFORMANCE
   1. By Pediatric Pulmonology Faculty Evaluation, including the Fellow’s Research Oversight Committee.
   2. By Other Specialty Faculty Evaluation where appropriate to the Rotation.
   3. By Unit Staff 360 Evaluations.
   4. By Parent 360 Evaluation.
   5. By Professionalism Evaluation Form.
   6. By Successful completion of HIPPA training through Human Subjects Committee.
   7. By Timely submission of fellowship duty hours, evaluations and procedure logs.
   8. By the American Board of Pediatrics Pulmonology In-Training Examination.

ASSESSMENT METHOD OF ROTATIONS BY FELLOWS
The fellows provide an anonymous review of the rotation, including comments on patient volume, quality of
supervision and overall value of rotation.
The fellows provide an anonymous overall program review biannually and participate in Divisional discussion
of the reviews and remediation planning.

LEVEL OF SUPERVISION
The fellow is directly supervised by pediatric pulmonology faculty, more senior fellows or other faculty as
appropriate to the rotation.

EDUCATIONAL RESOURCES
Faculty
University of Minnesota Biomedical Library
Web-based educational sites such as Up To Date

LABORATORY , BIOSTATISTICAL AND EPIDEMIOLOGIC RESEARCH RESOURCES
In conjunction with the Fellow’s Research Mentor.




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