Parkland Pulmonary Consult: 

The pulmonary consult service at Parkland Memorial Hospital (the county hospital) consists of the fellow and a faculty attending who is based at the institution.  In addition there is usually an internal medicine resident (PGY 2 or 3).  The service responds to inpatient consultation requests including all non-MICU intensive care units.  Teaching rounds are held daily.  The fellow also performs bronchoscopy and other pulmonary disease related procedures such as chest tube insertion and management with appropriate supervision.  The fellow participates in continuity clinic and the chest malignancy clinic.  The fellow attends all division conferences and Parkland's multidisciplinary chest conferences. 

VAMC Pulmonary Consult:

The pulmonary consult service at the Dallas VA Medical Center consists of the fellow and a faculty attending who is based at the institution. The service responds to inpatient consultation requests including all non-MICU intensive care units, and the fellow performs the majority of bronchoscopies. Teaching rounds, procedural responsibilities, clinic and conference participation are analogous to the Parkland consult service. In addition, fellows attend VA Chest clinic.

Parkland MICU:

The MICU/Pulmonary inpatient service at Parkland Memorial Hospital consists of the fellow, a faculty attending who is based at the institution and four internal medicine intern/resident teams.  There are 20 designated MICU beds.  The service has direct management responsibility for all patients requiring admission/transfer to the MICU (it is a “closed” unit).  The fellow has significant responsibility in the direct management of these patients, performs/supervises ICU procedures, helps supervise the internal medicine residents, assists with triage decisions, etc.   Patients in the MICU have a wide variety of critical care problems and generally have a very high level of severity of illness.  Teaching rounds are held daily.  The fellow will also attend half-day Parkland Chest Medicine clinic every week. 

VAMC MICU:

The MICU/Pulmonary service at the VA Medical Center consists of the fellow, a faculty attending who is based at the institution and four internal medicine intern/resident teams.   The functioning of this service is analogous to the Parkland MICU rotation.   The fellow participates in Parkland continuity clinic and the VA Pulmonary Disease Clinic.  The fellow attends all division conferences. 

Zale Lipshy Pulmonary/Critical Care:

The rotation at Zale Lipshy University Hospital provides exposure to both pulmonary disease and critical care in roughly equal proportion.  The service consists of a fellow and a faculty member.  All patients are seen on a consultative basis to the surgical services, although the typical ICU consult requires very active participation inpatient 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.  In all situations, the fellow has major patient care responsibilities.  The fellow attends all division conferences and Parkland continuity clinic. 

St. Paul Pulmonary Specialties:

The University Hospital at St. Paul is the principal University Hospital for the Internal Medicine and Cardiothoracic Surgery services, as well as several other surgical teams.  It is thus a high volume facility.  There are four rotations for the pulmonary fellows.

1.  Pulmonary Service.  The team consists of a fellow, an attending, and four intern/resident teams.  The ICU's are closed, so 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".

2.  Pulmonary Consultation/Procedure Service.  The fellow and attending on this 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.  The fellow will attend Parkland continuity clinic during this rotation.

3.  Pulmonary Hypertension/Sleep Center.  The fellow attends Pulmonary Hypertension clinic and assists with right heart catheterizations.  These patients have a variety of pulmonary hypertensive conditions.  The fellow also attends clinic in the Sleep Center and sees patients with a variety of disorders 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 ventilatory techniques.  The fellow will also spend one week learning cardiopulmonary exercise interpretation at Presbyterian Medical Center with one of our research faculty members.  The fellow will attend Parkland continuity clinic during this rotation.

4.  Lung Transplant/CF.  The fellow spends time with two lung transplant attendings seeing both inpatients and outpatients for both post-transplant and pre-transplant evaluations.  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.

Ambulatory Care:

The fellowship emphasizes ambulatory care as well as inpatient medicine.  The 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, fellow will also see outpatients in the VA Chest Clinic, the Sleep Center, the Parkland Chest malignancy clinic, the Lung Transplant clinic, and the CF 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 Dallas VAMC; weekly radiology and chest CT workshops with radiology faculty; didactic Pulmonary Functions and Physiology conferences, and weekly interinstitutional 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 medical school 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.