Rotation Goals and Objectives
OHSU Pulmonary Consult Service
Over the course of training, PCCM fellows will spend approximately half of their required pulmonary rotations within Oregon Health & Science University. This exposure is intended to provide fellows with the necessary cognitive, technical, and ethical/social skills to manage a host of complex pulmonary conditions including but not limited to 1) Pulmonary Hypertension; 2) Cystic Fibrosis; 3) Interstitial Lung Disease; 4) Opportunistic pulmonary Infections arising from immune suppression; 5) Asthma; 6) COPD including role of smoking cessation; 7) Pulmonary thromboembolism; 8) Lung cancer; 9) Sleep Disorders; 10) Pleural diseases and effusions; 11) Lung transplantation; 12) Neuromuscular diseases affecting respiratory muscles including role of non-invasive ventilation. Working closely with Pulmonary-Critical Care Attendings, Fellows gain familiarity with health care delivery within the context of the OHSU University Health care system.
OHSU Medical Intensive Care Unit
Training in Critical Care Medicine is intended to provide fellows with the necessary cognitive, technical, and ethical/social skills to manage the most complex of medical conditions. Under the direct supervision of Critical Care Specialists, fellows gain the opportunity to evaluate, manage, and coordinate the care of a diverse population of patients.
The Anesthesia rotation is one month in duration and is intended to provide the fellow with necessary cognitive and technical skills to manage patients in need of assisted ventilation and undergoing general anesthesia. In addition, fellows are expected to gain familiarity with issues of perioperative risk reduction and complications arising from use of anesthetic agents, paralytics, and airway devices.
VAMC Intensive Care Unit
The VAMC Intensive Care Unit Rotation was developed with the goal of providing senior PCCM and CCM Fellows experience in administration, management, and organization of Intensive Care Units. Fellows are expected to develop 1) leadership skills 2) an understanding of the role of regulatory agencies in shaping ICU care 3) a culture of safety and 4) skills necessary for technology assessment/guideline implementation. In addition, Fellows are encouraged to learn the fundamentals of disaster management and responses to threats from emerging infectious diseases and biological and chemical weapons.
VAMC Pulmonary Consult Service
Over the course of training, PCCM Fellows will spend approximately half of their required pulmonary rotations within the VA system. This exposure is intended to provide fellows with the necessary cognitive, technical, and ethical/social skills to manage a host complex of pulmonary conditions including but not limited to 1) chronic obstructive pulmonary disease 2) thoracic malignancies 3) occupational & environmental lung disease and 4) mycobacterial diseases. Working closely with Pulmonary-Critical Care Attendings, Fellows gain familiarity with health care delivery within the context the Veterans Administration system.
Sleep medicine is typically a one month ambulatory clinic rotation during the second year for pulmonary fellows in the OHSU Pulmonary and Critical Care Program. This rotation is designed for fellows to gain experience and a multidisciplinary exposure to the practice of sleep medicine. The fellow will participate in sleep clinics both at the Portland VA and OHSU and will work with sleep specialists with base discipline training in pulmonary medicine, neurology, pediatrics or psychiatry. During the sleep rotation, fellows will spend 1-2 hours a week interpreting sleep studies with Dr. O'Hearn or Dr. Boudreau. Fellows should also arrange to spend part of an evening with the sleep technicians observing sleep study preparation and performance. Participation in the weekly OHSU Wednesday sleep conference and the Friday Sleep medicine didactic conference held at the VAMC is expected.
During this rotation fellows are expected to develop: 1) communication skills that will facilitate clinical interaction with patients and their families and thus ensure the creation of a complete and accurate data base; 2) competency in the physical examination of patients with sleep-disorders; 3) competency in the provision of consultative services; and 4) ability to work as a member of, and when appropriate leader of, a multidisciplinary team. In addition, trainees will demonstrate beginning competency in the analysis and interpretation of comprehensive polysomnography, become proficient in understanding sleep study reports, be able to describe the positive pressure therapies for sleep disordered breathing, and become oriented with the science of evidence-based sleep medicine.
Neuroscience Intensive Care Unit
Training in Neurosciences Intensive Care is intended to provide fellows with the necessary cognitive, technical, and ethical/social skills to manage a variety of complex neurologic and neurosurgical conditions. As part of the Neurosciences Intensive Care Team, fellows are provided the opportunity to evaluate, manage, and coordinate the care of this unique population of patients. Specifically, the rotation offers training in CT/MRI interpretation, peri-operative management, traumatic brain and spinal cord injury along with education in acute seizure management, control of intracranial pressure, and acute stroke intervention. In addition, fellows will provide general management of the non-neurologic aspects of care such as mechanical ventilation, hemodynamic interpretation and support.
Legacy Good Samaritan Hospital
Legacy Good Samaritan Hospital (LGSH) is a major tertiary care center in Portland, OR, with an independent medical residency program, and active full service patient care activities, including a renal transplant and cardiac surgery program. The Kern Critical Care Unit (the Kern) is a state of the art medical-surgical intensive care unit, at Legacy Good Samaritan Hospital. It was the recipient of the 1996 Society of Critical Care Medicine Award for Best Designed ICU. The multidisciplinary unit houses 28 beds with an average occupancy of about 20.
Fellows have the opportunity to participate in direct patient care, along with co-management and consultative practice models. In this setting, fellows will be responsible for communication and interaction with private practice physicians and should learn the vital role of the intensivist in providing multidisciplinary care of patients in this setting. The service also has a large post-operative surgery population providing fellows the opportunity to gain experience in post-surgical pain, respiratory insufficiency, hemodynamic instability and peri-operative nutrition.
Kaiser Sunnyside Medical Center
The Kaiser rotation provides a critical care experience in a community hospital caring for patients with a broad range of medical, surgical, and neurological illnesses. Fellows provide comprehensive critical care physician services; including admitting critically ill patients from the Emergency Department, responding to codes and airway emergencies, and providing daily ICU care. This is done in the context of a highly integrated group practice, which requires standardized care and effective transitions of care. There is an emphasis in the rotation on developing the leadership and communication skills needed to effectively lead a multidisciplinary care team. Kaiser is a fully integrated health care system, offering opportunities for insight into systems of care.