UAMS Medical Center
UAMS Medical Center is an academic, tertiary care center that provides a wide array of experiences in pulmonary diseases and critical care medicine for patient care, research, and QI. The experience in pulmonary diseases is varied and complex. The hospital operates very active critical care units for medical and surgical patients and receives numerous emergent referrals from throughout the state. As a Level I trauma center, it is the site for the fellows’ required surgical ICU and trauma training. At UAMS, the fellow’s inpatient rotations are Pulmonary/CCM Consults, MICU, and a one-month surgical selective.
The MICU service team is comprised of a Pulmonary/Critical Care Medicine attending, fellow, three Internal Medicine Residents, and several interns. The Pulmonary/Critical Care Medicine fellow meets with the team before attending rounds to identify potential problems and routine discharges; participates in morning attending rounds; holds daily afternoon work rounds with the MICU team, supervises and/or performs invasive procedures. Key clinical scenarios include all typical MICU patient care issues such airway and ventilator management, shock, sepsis, multi-organ failure, ARDS, coordination of and interaction with multiple consultative services, and end of life issues. The fellow receives training and experience in multiple types of mechanical ventilation including standard modes, rescue modes and home ventilator equipment. Induced hypothermia for patients surviving cardiac arrest is also utilized as appropriate. We initiated an ECMO program 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 Pulmonary/CCM Consult is comprised of an attending, a fellow, and a resident. The fellow evaluates and directs the day-to-day consultative care of patients with 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 consult 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, CT’s, ABG’s and PFT’s are stressed, and procedures such as fiber optic bronchoscopy, 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 patients with a wide variety of pulmonary disorders.
UAMS offers specialized clinics and/or centers in Cystic Fibrosis, Pulmonary Hypertension, Chronic Respiratory Diseases, and Sleep Disorders. Fellows attend several CF clinics and sleep clinics per year and have the opportunity to see patients with the faculty in other clinics if desired.
Cystic Fibrosis Experience
Under the direction of Dr. Larry Johnson, 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 into 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 meetings.
Under the direction of Dr. Khaled Khasawneh, UAMS operates Sleep Disorders Center and Laboratory. Fellows rotate in the sleep clinic and are given the opportunity to rotate in the sleep clinic for two weeks during the second year of fellowship and also allowed read sleep studies under his supervision.
John L. McClellan Memorial Veterans Hospital
This is one of the busiest hospitals in the U.S. VA system, is a tertiary referral center and provides a wealth of educational opportunities for P/CCM trainees in both inpatient and outpatient settings, conferences, and research. There are two inpatient rotations at the VA Hospital: Pulmonary Consults and Medical Intensive Care Unit. All fellows have a twice-monthly Continuity Clinic at the VA. In collaboration with CAVHS Invasive Cardiology faculty, P/CCM fellows have an added experience with right-heart cardiac catheterization and interpretation of data.
VA Pulmonary Consultation
Inpatients with respiratory disorders on 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 Coronary Care unit and 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, unexplained dyspnea. Bronchoscopy, including TBNA for staging of 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.
The MICU is a closed unit staffed by the P/CCM attendings, and the P/CCM fellows are an integral part of the MICU team. The VA also is the site of a special CCM learning activity in which the fellows, in the latter part of the third year, spend one month in the VA MICU in a role much like a “junior attending.” During this month, the fellow has a higher level of responsibility and more autonomy in patient care as appropriate to provide progression over the years of training for the advanced level trainee.
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 PFT’s, chest imaging, and CPET; and a variety of other pulmonary diseases and disorders.
Under the direction of Dr. David Davila, the VA hospital operates a certified Sleep Disorders Center and Laboratory and provides the required basic pulmonary training in Sleep Disorders. Fellows see patients in the VA Sleep Clinic during selected months.