Rotations

Parkland Memorial Hospital

Pulmonary Consult

The Pulmonary Consult Service consists of the fellow and a faculty attending. In addition, there is usually an internal medicine resident (program year two or three), along with a radiology resident on the team. The Pulmonary Consult Service responds to inpatient consultation requests. including all non-MICU intensive care units with teaching rounds held daily. The fellow also performs both inpatient and outpatient bronchoscopy and other pulmonary disease related procedures such as chest tube insertion and management. Along with his or her continuity clinic, the fellow participates in Chest Malignancy Clinic.

Parkland MICU

The MICU/Pulmonary Inpatient Service at Parkland Memorial Hospital consists of the fellow, a faculty attending, and four internal medicine intern/resident teams. There are 20 designated MICU beds. The MICU/Pulmonary Inpatient Service has direct management responsibility for all patients requiring admission or transfer to the MICU (a “closed” unit). The fellow has significant responsibility in the direct management of these patients, performs and supervises ICU procedures, helps supervise the internal medicine residents, and assists with triage decisions. Patients in the MICU have a wide variety of critical care problems and generally have a very high level of severity of illness.

Dallas Veterans Affairs Medical Center

Pulmonary Consult

The Pulmonary Consult Service at the VA Medical Center consists of the fellow and a faculty attending. The Pulmonary Consult Service responds to inpatient consultation requests, including all non-MICU intensive care units. The fellow again performs all inpatient and outpatient bronchoscopies. Teaching rounds, procedural responsibilities, clinic, and conference participation are analogous to the Parkland consult service. In addition, fellows attend VA Chest Clinic.

MICU

The MICU/Pulmonary service at the VA Medical Center consists of the fellow, a faculty attending, and four internal medicine intern/resident teams. The functioning of this Service is similar to the Parkland MICU rotation. The fellow participates in Parkland Continuity Clinic and the VA Pulmonary Disease Clinic.

St. Paul University Hospital Pulmonary Specialties

St. Paul University Hospital is the principal University Hospital for the Internal Medicine and Cardiothoracic Surgery sServices, as well as several other surgical teams.

Pulmonary Service

The team consists of a fellow, an attending, and four intern/resident teams. All non-cardiac medical admissions to the ICU become the primary responsibility of the Pulmonary Service. In addition, primary lung-related diseases admitted to the general wards also are cared for by the Pulmonary Service. Thus, this team acts as a traditional “chest service.”

Pulmonary Consultation/Procedure Service

The fellow and attending on the Pulmonary Consultation/Procedure Service see all pulmonary inpatient consults, including thoracic surgery patients in the ICU. In addition, the fellow performs conventional bronchoscopies and also regularly assists with interventional pulmonary techniques, including endobronchial ultrasound, airway stent placement, APC electrocautery, rigid bronchoscopy, and pleuroscopy.

Sleep and Neuromuscular Pulmonary Hypertension/Sleep Center

The fellow attends clinic in the University Hospital Sleep & Breathing Disorders Clinic and sees patients with a variety of respiratory control and circadian rhythm disturbances. The fellow also will see patients with chronic respiratory failure due to neuromuscular disease and be familiarized with a variety of noninvasive ventilator techniques. The fellow will also spend one week learning cardiopulmonary exercise interpretation at Presbyterian Medical Center with one of our research faculty members.

Lung Transplant/Cystic Fibrosis

The fellow and transplant attending care for both inpatients and outpatients for post-transplant care and pre-transplant evaluation. The fellow learns management of immunosuppressive therapy and sees a variety of post-transplant complications, including opportunistic infections and airway diseases. In addition, the fellow will also see inpatients with cystic fibrosis with a dedicated attending. The fellow will attend Parkland Continuity Clinic during this rotation.

Pulmonary Hypertension

The fellow will participate in inpatient rounds with a Pulmonary Hypertension attending caring for both ICU and non-ICU patients. The fellow will participate in right heart catheterizations and attend Pulmonary Hypertension Clinic. These patients provide a large spectrum of disease including rheumatologic, thromboembolic, and vascular conditions.

Elective

This rotation allows the fellow to participate in CT chest, PET, and V/Q scan interpretation with Radiology faculty. In addition, the fellow learns PFT interpretation with pulmonary faculty and attends clinic at the ILD referral center. Participation for first- and second-year fellows is encouraged.

Zale Lipshy University Hospital

The rotation at Zale Lipshy University Hospital provides exposure to both pulmonary disease and critical care in roughly equal proportion, with an emphasis on neurocritical care. The service consists of a fellow and a faculty member. All patients are seen on a consultative basis to the medical, surgical, and neurocritical care services, although the typical ICU consult requires very active participation in patient care matters with liberal writing of orders. Teaching rounds are held daily with other ad hoc rounds as well. The fellow performs bronchoscopy, other pulmonary related procedures, and all relevant intensive care unit procedures under appropriate supervision.

Ambulatory Care

The fellowship emphasizes ambulatory care as well as inpatient medicine. The first- and second-year fellows will maintain a weekly continuity clinic at Parkland Memorial Hospital in the Chest Medicine and Sarcoid clinics. The third-year fellows will have their continuity clinic at the private Aston Pulmonary clinics. Both clinics serve as a point of referral for a variety of chest diseases. In addition, fellows will also see outpatients in the VA Chest Clinic, University Hospital Sleep & Breathing Disorders Clinic, Parkland Chest Malignancy Clinic, University Hospital Heart & Lung Clinic, and the Pulmonary Specialty Clinic, during respective rotations.

Conferences

The following conferences are held recurrently:

  • Weekly Clinical Seminar presented by Division members and invited speakers
  • Case presentation conferences
  • Research conferences
  • Journal club
  • Weekly multidisciplinary Thoracic Surgery Conferences at Parkland and VA Medical Center
  • Weekly radiology and chest CT workshops with radiology faculty
  • Didactic Pulmonary Functions and Physiology conferences
  • Weekly inter-institutional transplant conference

In addition, a large number of conferences on topics of interest to the trainees are held by the Department of Internal Medicine and other departments.

Professional Meetings

The Division sponsors fellow attendance at both regional and national professional meetings throughout the three years of fellowship, including meetings of the ATS and the ACCP.