- Educational Rationale for Change. We are seeking to have fellows in the Pulmonary and Critical Care Fellowship program round on the inpatient pulmonary service (F2) to increase the educational opportunities for our fellows. We seek to do this by:
- Enhancing the curriculum. Fellows cite a need for increased education in pulmonary topics, and this is an area of focus on trainee performance on our current annual performance evaluation of the program. One way to enhance fellow education in pulmonary medicine and accomplish this aim is to have a dedicated rotation on the inpatient pulmonary service. The curriculum would focus on common pulmonary diseases: pneumonia, asthma, COPD, pulmonary embolism/DVT; with the fellow responsible for teaching these basic topics to residents.
- Enhancing the clinical exposure. Henry Ford Hospital provides a wealth and depth of cases in the medical ICU and outpatient pulmonary clinics that are unparalleled. Fellows desire more exposure to pulmonary medicine, as their current experiences are limited to outpatient clinic. Due to the number of ICU months, their outpatient pulmonary experiences are discontinuous, as they do not have clinic while on an ICU service. Current ACGME guidelines state “For programs with at least 24 months of clinical rotations, fellows must complete a minimum of 24 months of one half-day weekly ambulatory care clinic during the 36 month fellowship.” Currently our fellows surpass that requirement, with both a biweekly ambulatory ½ day clinic on K17 and a weekly ½ day longitudinal clinic at a satellite facility (six ½ day clinics monthly). While they do not participate in clinic during the 12 months of critical care medicine rotations, they still supersede the minimum requirement. Having a one-month clinical experience on an inpatient pulmonary service would allow them to have a continuous and focused experience in pulmonary medicine and enhance their exposure to non-critically ill inpatients with pulmonary diseases. This would provide an experience for them to focus on the pathophysiology of pulmonary disease in a non-ICU setting and allow them to manage patients along the continuum of disease.
- Enhancing the clinical experience for residents. With changing clinical demands, it has been challenging to provide continuity on service with two faculty on F2. On occasion one resident service is left with discontinuous staff, with frequently changing rounders for two weeks. With one faculty and one fellow providing care for the entire service, this eliminates the frequent turnover of rounders on a resident service. By having a senior fellow round in a junior faculty role, they are able to provide continuous care for a two week period with a resident service. During their month-long rotation they would be able to round with each resident service for two weeks, with staff rounding on the other resident service for two weeks.
- Capstone experience. As a third year rotation, fellows would be afforded this graduated level of independence commensurate with their level of training, and begin to develop rounding skills while still in training. Faculty will maintain supervision, while nurturing greater fellow independence. Faculty will provide direct feedback to the fellow.
- Rotation Structure
- Limited to third year and some second year Pulmonary and Critical Care medicine fellows. This rotation would not be offered to EM/IM/CCM fellows or any other fellow that does not have combined training in pulmonary medicine.
- Clinical volume: Our inpatient pulmonary service has sufficient patient volume to accommodate one fellow. Currently, two senior staff round on our 24-bed inpatient service in two week intervals. The new model would have one senior staff rounder responsible for the entire service for their two week assignment. One fellow would round for the entire month, but with each of the resident services for two weeks at a time (ie Team A the first two weeks, Team B the second two weeks). The staff rounder would be available to discuss cases with the fellow in the late morning and provide feedback regarding care plans. Both faculty and fellow would be available in the afternoons not spent in clinic to provide teaching to the residents.
- Evaluation: fellows would receive formative and summative feedback from residents and faculty for each two week interval. Resident evaluations will be anonymous and aggregated. They will be available for fellow review after a threshold number are received. Faculty evaluations will be milestones based and available for review immediately after completion.
III. Implementation Plan
We would begin the rotation in January 2015, with select third year pulmonary critical care medicine fellows. For academic year 2015-2016, third year fellows would round on alternating months, providing coverage 6-7 months out of the academic year.
F2 Attending Evaluation of Fellow
Manage the care of patients as junior faculty
- Manages patients with progressive responsibility and independence (Patient care)
- Develops and achieves comprehensive management plan for each patient (Patient care)
- Possesses clinical knowledge (Medical knowledge)
Improves clinical practice
- Learns and improves via feedback (Practice based learning and improvement)
Care for non-critically ill inpatients
- Has knowledge of diagnostic testing and procedures (Medical knowledge)
- Learns and improves at the point of care (Practice based learning and improvement)
Demonstrates effective leadership
- Works effectively within an interprofessional team (Systems based practice)
- Communicates effectively with patients and caregivers (Interpersonal and communication skills)
- Has professional and respectful interactions with patients, caregivers, and members of the interprofessional team (Professionalism)