Research: We offer research experiences in both clinical and basic science. The fellows’ time in research is sufficiently protected to allow for success. In addition, the ability to participate in the Human Investigator Program (HIP), which offers formal training in clinical study design, biostatistics, etc. and adds to the robust nature of this experience. Our program has an established track record of allowing fellows to participate in research in any suitable environment within OHSU and the Portland VA. This greatly expands the number of opportunities available and ties back to our multidisciplinary approach to Pulmonary & Critical Care Medicine. More information on current research can be found on our PCCM Research website and our PCCM Labs website.
MultiDisciplinary: Our Critical Care Conference series is organized in conjunction with the surgical critical care and anesthesia critical care fellowships. It provides our fellows with a valuable multidisciplinary critical care experience. This interdisciplinary didactic experience is complemented by a very robust interdisciplinary clinical experience. Our fellows spend time both on the Cardiovascular ICU (CVICU) with direct hands-on exposure to care of complicated cardiac surgical cases including LVAD and heart transplant. The CVICU service also cares for all OB/GYN and ENT ICU related cases. Our fellows also rotate in the Neurosurgical ICU. This service provides a robust experience in both surgical and non-surgical neurocritical care related issues.
Simulation Training: We use simulation training for Cardiac Arrest (weekly simulations in the OHSU MICU), bronchoscopy, central line simulation, ultrasound, code simulation and effective use of the electronic health record. OHSU has two dedicated simulation centers. VirtuOHSU is located on Marquam hill, is 7,500 square feet and is home to our Bronchoscopy simulator. After a quick tutorial fellows have 24hour access to the Bronch sim for additional practice whenever time allows. Our second, and largest simulation center is the Mark Richardson Interprofessional Simulation Center located on the South Waterfront, just a short Tram ride down the hill. This simulation center is 20,000 square feet, covers two floors with multi-purpose classrooms, debriefing rooms, an eight-bedskills training lab, and eight state-of the-art simulation suites.
Clinical Diversity: Our fellows are required to work in a quaternary care medical center (OHSU), a VA, a community hospital (Legacy health system) and an HMO based system (Kaiser). In addition, all of these systems have different call rotations, accurately reproducing the different types of clinical systems they will be working in upon completion of their training and thus allowing them to make better and more informed career choices.
Quality Improvement: All fellows, as part of their curriculum in the VA ICU, must perform a Quality Improvement Project under the guidance of the VA MICU director, Stephen Smith. This experience provides them with real time experience in how to design and perform QI and will place them in an excellent position to enter into leadership/management roles upon completion of their training.
Diverse outpatient clinics: Our fellows rotate in 2 separate ambulatory pulmonary clinics. Between these, they cover the full array of pulmonary disorders from Lung Cancer to Asthma to COPD to Interstitial Lung disease. This combined experience prepares them extremely well for general pulmonary practice. In addition, all second and 3rd year fellows rotate in our sub-sub specialty clinics including Sleep, multidisciplinary lung cancer clinic, Pulmonary Hypertension, Lung Transplant and Cystic Fibrosis. This gives our fellows additional exposure to niche diseases within Pulmonary medicine.
Pulmonology at the VA Portland Health Care System
Pulmonary medicine at the VAPORHCS can be divided into two categories: General Pulmonology and Interventional Pulmonology. The General Pulmonology team provides consultative services for a variety of pulmonary problems such as obstructive airways disease, lung cancer, interstitial lung disease, pleural effusions and pulmonary infections in the inpatient and outpatient setting. Regular inpatient and outpatient services are supplemented by several specialized services. A complex diagnostic unit allows the service to quickly provide care to ambulatory veterans from all over the VISN-20 by expediting access to care and minimally invasive procedures. The Telemedicine Clinic and Integrated Multi-Morbidity Care Programs have developed from the application of a collaborative and creative approach to management of complex pulmonary disease within VISN-20.
The Interventional Pulmonology service provides a broad range of minimally invasive diagnostic and therapeutic procedures. This department operates to provide foundational services within the construct of nodule management and diagnosis and staging of lung cancer. Additionally, a variety of benign diseases such as idiopathic tracheal stenosis, tracheobronchial amyloidosis and recurrent respiratory papillomatosis are managed with minimally invasive interventions by this service.
Collaboration between the faculty and fellows of the General and Interventional Teams, in addition to other specialties such as Radiologyand Pathology, allows for the application of a systematic, pragmatic and multidisciplinary approach to the management of nodules and lung cancer at the VAPORHCS. Fellows actively participate in the following programs: Unsuspected Radiographic Findings Pathway, Diagnosis and Staging (advanced bronchoscopy), Multidisciplinary Lung Clinic and Interventional Pulmonology Service for palliation of malignant central airway obstruction and symptomatic thoracic oncologic disease. Fellows have opportunities to participate in lung cancer screening depending upon their clinical/research interests and future career goals. Fellows can also learn how to deliver Lung Cancer Care through a Telemedicine platform at the VAPORHCS.