{"id":22076,"date":"2019-08-21T14:04:12","date_gmt":"2019-08-21T18:04:12","guid":{"rendered":"https:\/\/www.med.unc.edu\/pediatrics\/education\/?page_id=22076"},"modified":"2024-01-24T08:34:02","modified_gmt":"2024-01-24T13:34:02","slug":"pulmonology-peds-406","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/pediatrics\/education\/clerkship\/individualization-phase\/pulmonology-peds-406\/","title":{"rendered":"Pulmonology (Peds 406)"},"content":{"rendered":"
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Introduction<\/h2>\n<\/div>\n
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The Pulmonary Division of the Department of Pediatrics at the University of North Carolina School of Medicine provides evaluation and management services for children with chronic respiratory diseases. The faculty and fellows in the division have expertise in the diagnosis and treatment of these disorders, and are also active in clinical, translational, and basic science research.<\/p>\n

The clinical activities of the division consist of the Inpatient and Consultation Service, Bronchoscopy Service, Outpatient Clinics and Pediatric Pulmonary Function Testing. Separate attending pulmonologists are assigned to cover each of these areas. Fellows routinely cover the Inpatient and Consult services, as well as the Bronchoscopy service on certain days. Attending and Fellow schedules for the period of time of your elective are available in the divison offices on Amion<\/a> (access code: ºÚÁÏÍøPedsPulm!)<\/p>\n

For this elective, you already have a list of specific objectives and criteria for evaluation. A more detailed list for each of our services is attached. Your individual goals may vary depending on your current stage of training and future plans. However, during your month on elective, it is suggested that you try to accomplish the tasks listed on the attached pages, at a minimum.<\/p>\n

Dr. William Stoudemire; (email: william_stoudemire@med.unc.edu<\/a>) coordinates the resident and medical student electives. You should meet (in persor or virtually) with Dr. Stoudemire at the start of your elective to define goals for the month, and again at the end of the month to determine whether they were met. Additionally, questions about the rotation which arise during the month can be addressed to Dr. Stoudemire at any time.<\/p>\n

First Day<\/h3>\n

Please page the fellow on service when you arrive. You can find the current fellow on the hospital directory.<\/p>\n

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Objectives and Criteria for Evaluation<\/h2>\n<\/div>\n
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Specific objectives and criteria for evaluation of medical students and residents<\/p>\n

I. Overall Educational Goal<\/h3>\n

The medical student and\/or resident is expected to participate in the clinical management of pediatric patients with pulmonary disease under the direct supervision of a pediatric pulmonary attending, and to gain evaluative skills necessary for general pediatric practice. The clinical settings include the inpatient ward service, pediatric intensive care unit, neonatal intensive care unit, the pediatric pulmonary outpatient clinics, pediatric pulmonary function testing and the pediatric bronchoscopy service.<\/p>\n

II. Specific Objectives<\/h3>\n
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  1. Develop and demonstrate competent skills in obtaining a history and performing a physical examination focused on the pulmonary system, including but not limited to evaluation of breath sounds, work of breathing, lung consolidation and pleural effusion.<\/li>\n
  2. Develop and demonstrate ability to interpret chest radiographs, arterial blood gas, pulse oximetry, pulmonary function tests, and respiratory tract cultures in the context of the overall pulmonary evaluation.<\/li>\n
  3. Understand the capabilities and limitations of specialized techniques (e.g., bronchoscopy, fluoroscopy, chest CT, lung ultrasound, chest MRI) to characterize airway, lung, pleural, and mediastinal disease.<\/li>\n
  4. Develop and demonstrate an orderly approach to evaluate pediatric patients with pulmonary disorders such as stridor, wheezing, chronic cough, apnea, recurrent pneumonia, chest pain and hemoptysis.<\/li>\n
  5. Understand the natural history and recognize exacerbations of chronic lung diseases such as cystic fibrosis, asthma, interstitial lung diseases and bronchopulmonary dysplasia.<\/li>\n
  6. Understand the appropriate use, risks and benefits of commonly used therapeutic modalities such as supplemental oxygen, airway clearance techniques, bronchodilators, diuretics, systemic and inhaled corticosteroids, and antibiotics.<\/li>\n
  7. Understand the indications for performing tracheostomies in children and the inpatient\/outpatient management of these children.<\/li>\n
  8. Recognize obstructive sleep apnea and understand the evaluation, management and adverse effects of this disorder.<\/li>\n<\/ol>\n

    III. Learning Activities of the Rotation<\/h3>\n

    The principal learning activity of residents and medical students during the Pediatric Pulmonary rotation involves assessment of inpatients and outpatients with prompt review by a pediatric pulmonologist. Immediate feedback on the learner’s assessment and treatment plan is provided. Experience in the bronchoscopy laboratory is primarily observational, to expose the student or resident to the structural correlates of respiratory symptoms.<\/p>\n

    Medical students and residents attend the biweekly Chest Conference, a multidisciplinary conference attended regularly by students, residents, and numerous subspecialists, including pediatric pulmonologists, pediatric infectious disease specialists, and pediatric radiologists, with occasional attendance by pediatric cardiologists, pediatric surgeons, cardiothoracic surgeons, and pathologists. The resident or medical student on the Pulmonary rotation is expected to prepare a short presentation for one Chest Conference, reviewing a topic that is mutually agreeable to the resident\/student and the attending, and preferably relates to a current pulmonary patient. Please discuss the topic of your presentation with the on-service fellow, attending or Dr. Stoudemire.<\/strong><\/p>\n

    Other conferences attended by residents\/students on the Pulmonary rotation are a weekly pulmonary division clinical conference (pediatric pulmonary faculty and fellows discuss interesting patients, outpatients, and bronchoscopies), a weekly pediatric pulmonary division conference (faculty and fellows discuss pulmonary topics in depth), weekly BPD Huddles (with Neonatology) and a weekly Children\u2019s Airway Center conference (multidisciplinary review of patients with complex airway issues).<\/p>\n

    Residents are expected to perform literature searches on topics pertaining to the patients they encounter in the inpatient and outpatient setting and review articles suggested to them by fellows\/attendings.<\/p>\n

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    Schedule<\/h2>\n<\/div>\n
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    Most of the learner’s time will be spent in clinic, consults, bronchoscopy, educational conferences<\/p>\n

    Residents\/Students are asked to tailor their elective to their wishes and needs based on career plans. For example, primary care-bound residents should spend more time in clinic, those planning PICU fellowship should focus on consults (Especially in PICU) and bronchoscopy.<\/p>\n

    Raleigh (Blue Ridge) Pulmonary Clinic is recommended to all residents\/students. Schedule there varies so much of it must be arranged with faculty leader.<\/p>\n

    Faculty leader can assist with arrangement of additional experiences (observing sweat chloride testing, cardiopulmonary exercise challenge, home ventilator team, ENT clinic and OR for airway cases, etc.)<\/p>\n

    If rotation is overscheduled with learners, faculty leader will draft schedule for the month with input from learners and then allow residents and students to make trades depending on level of interest and any changes in their availability that may arise (interviews, back-up, etc.).<\/p>\n

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    Inpatient and Consultation Service<\/h2>\n<\/div>\n
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    The Attending or Fellow on the inpatient service (and Fellow, if there is one on service) will be one of your supervisors for the elective, and will help fill out your evaluation at the end of the month. Input will also be obtained from other faculty members.<\/p>\n

    Suggested activities include:<\/p>\n