UAMS Medical Center
The UAMS Medical Center is an academic, Level 1 Trauma, tertiary care center that offers a wide range of experiences in pulmonary and critical care medicine, supporting patient care, research, and Quality improvement. The hospital operates very active essential units of care for medical, cardiothoracic, neuro, and surgical patients and receives numerous emergent referrals from throughout the state. At UAMS, the fellow’s inpatient rotations are Pulmonary Consults, Medical ICU (MICU), and electives.
UAMS MICU
The MICU team is comprised of a Pulmonary/Critical Care Medicine faculty, a fellow, three Internal Medicine Residents, and several interns. The PCCM fellow meets with the team before attending rounds to identify potential problems and transfers; participates in morning team rounds, supervises and/or performs invasive procedures. Key clinical scenarios include all typical MICU patient care issues, such as airway and ventilator management, shock, sepsis, multi-organ failure, ARDS, coordination of and interaction with multiple consultative services, and end-of-life care. The fellow receives training and experience in multiple types of mechanical ventilation, including standard modes, rescue modes, and home ventilator equipment. The ECMO program was started in early 2021, which helps fellows gain experience in ECMO support for critically ill patients.
UAMS Pulmonary and Critical Care Consult/Cystic Fibrosis Service
The PCCM Consult is comprised of a faculty member, a fellow +/- a resident. The fellow evaluates and directs the day-to-day consultative care of patients with a variety of pulmonary problems such as community-acquired pneumonia, pleural effusions, pulmonary hypertension, and undiagnosed pulmonary diseases (e.g., lung masses or nodules, interstitial lung disease, chronic/persistent pulmonary infiltrates, unexplained dyspnea, etc.). The team also serves as the consulting team for all cystic fibrosis patients admitted to the hospital. The consultation team also evaluates non-medical critically ill patients (trauma, neurosurgery, surgery) in a consultative capacity for pulmonary problems and ventilator management. Interpretation of chest radiographs, CTs, ABG’s and PFT’s are stressed, and procedures such as fiber optic bronchoscopy, thoracentesis, chest tubes, and pleurodesis are the key procedures done by the fellow during this rotation.
Fellows’ UAMS Continuity Clinics
All fellows have a UAMS Continuity Clinic twice a month where they evaluate, manage, and follow up patients with a wide variety of pulmonary disorders.
Specialty Clinics
UAMS offers specialized clinics and/or centers in Cystic Fibrosis, Pulmonary Hypertension, Chronic Respiratory Diseases, Asthma, lung cancer, and Interstitial lung diseases. Fellows attend several CF clinics and can see patients with faculty in other clinics if desired.
Cystic Fibrosis Experience
UAMS operates an accredited Adult Cystic Fibrosis Center and provides inpatient and outpatient care and teaching experiences with CF patients, who are now surviving well in adulthood and will need increasing access to pulmonologists in the community. The CF Center has ongoing clinical trials and opportunities for clinical research and case reports, which enable participating fellows to attend the annual Cystic Fibrosis national meeting.
John L. McClellan Memorial Veterans Hospital
This is one of the busiest hospitals in the U.S. VA system, serving as a tertiary referral center and offering numerous educational opportunities for PCCM trainees in both inpatient and outpatient settings, including conferences and research. There are two inpatient rotations at the VA Hospital: Pulmonary Consults and the Medical Intensive Care Unit. All fellows have a twice-monthly Continuity Clinic at the VA.
VA Pulmonary Consultation
Inpatients with respiratory disorders in the Medicine Service are cared for by the General Medicine Services. The fellow provides detailed consultations for patients with significant respiratory problems. The fellow sees some consultations in the Surgical ICU as well. The VA 6B Diagnostic Unit provides a unique venue for expedited outpatient workups and handles large numbers of patients with suspected lung cancer as well as a variety of other undiagnosed pulmonary diseases, e.g., interstitial lung disease, chronic/persistent pulmonary infiltrates, and unexplained dyspnea. Bronchoscopy, including TBNA for staging lung cancer or diagnosis of mediastinal adenopathy, chest tubes, and interpretation of PFTs, CPET, and chest CT are areas of emphasis. The Consult fellow attends the weekly multidisciplinary VA Lung Cancer Conference.
VA MICU
The MICU is a closed unit staffed by the PCCM faculty, PCCM fellow, Internal Medicine resident, and several Interns from Emergency Medicine, anesthesiology, and Internal Medicine are an integral part of the MICU team.
MICU Senior Fellow Month
In the final year of training, each fellow does one VA ICU and one UAMS ICU rotation as a sort of “junior attending” with an increased level of responsibility and more autonomy in patient care, as appropriate to provide progression over the years of training for the advanced-level trainee. During this month, the fellow independently leads morning ICU team rounds while the faculty member is available as needed. The fellow is responsible for teaching during rounds and for providing feedback to the more junior team members regarding their performances. After “fellow rounds” each day, the fellow and faculty review all the patients, plans, team performance, and make modifications as necessary.
Fellows’ VA Continuity Clinics
All fellows have a VA Continuity Clinic twice a month, which provides training and experience in the diagnosis and management of COPD, interstitial lung diseases, lung masses, chronic pulmonary infections, dyspnea, cough, and pleural disorders; interpretation of PFTs, chest imaging, and CPET; and a variety of other pulmonary diseases and disorders.
Sleep Disorders
Under the direction of Dr. David Davilla and Dr. Khaled Khasawneh, VA operates the Sleep Disorders Center and Laboratory. Fellows rotate in the sleep clinic for two weeks during the second year of fellowship and are allowed to read sleep studies under their supervision. Fellows see patients in the VA Sleep Clinic during selected months
Electives
Elective rotations include sleep, ECHO lab, CVICU, Neuro ICU, surgical ICU, palliative care, Pulmonary function lab, and Interventional Pulmonary service. The rotations are distributed in the UAMS and VA medical centers.