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.

Anesthesia

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.

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 Emanuel Hospital

Legacy Emanuel Hospital (EM) 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  unit houses 28 beds with an average occupancy of about 20.

Fellows have the opportunity to rotate through this busy community-teaching hospital during their training. The experience provides Fellows with the opportunity to 1) work in an "open," multi-disciplinary ICU; 2) provide consultative services to a variety of surgical specialties and subspecialties; 3) care for patients with disorders commonly found in community settings and 4) gain exposure to coding and billing practices of private practitioners. In addition, Fellows gain exposure to a private practice model of health care delivery.

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.

Trauma Intensive Care Unit

Training in Trauma Intensive Care is intended to provide Fellows with an understanding on applying the appropriate diagnosis and management of uni- or multi-system trauma in the ICU setting. As part of the Trauma Intensive Care Team, Fellows are provided with the opportunity to oversee the day-to-day care of trauma patients in the TICU by responding to trauma alerts, writing orders, placing lines, and resuscitating the patient.

Physiology / Cardiopulmonary Lab

During this month long rotation, Pulmonary Critical Care fellows will gain knowledge on respiratory care units, specifically, pulmonary function laboratories, and the importance of quality control, quality assurance, and proficiency standards. Fellows will also acquire knowledge of respiratory care and services, pulmonary physiology and pathophysiology in systemic diseases. Fellows will also gain the skills required to organize, administer and direct a respiratory therapy section and be able to work effectively as a member of a multidisciplinary team.

Cardiovascular ICU

The CVICU service is designed to provide peri-operative support to Cardiovascular & Cardiothoracic Services along with a variety of other surgical subspecialties. Working closely with the Primary Surgical Service and under the direct supervision of Anesthesia and Medical Intensivist, fellows gain experience in management of a variety of peri-operative problems including post-operative mechanical ventilation, hemodynamic instability, surgical bleeding, wound management, and graft complications. In addition, fellows have the opportunity to provide care under different patient care models including primary care, co-management and direct consultation.