care and feeding of chest tubes

Pulmonary/Critical Care Fellowship Program

Phoenix VA/BGSMC

History

Fellowship started in 1980 Three Year Fellowship Program Leads to certification in :

– Pulmonary Disease– Critical Care

History

As of June 2008, ALL graduated fellows: Board Certified

Graduated Fellows: primarily in Private Practice

Staff Members VAMC Richard A. Robbins

– Program Director, Chief Pulmonary/Critical Care VAMC

Owen Austrheim– Associate Section Chief & Director, Sleep Medicine

VAMC Lillibeth Pineda Patricia Rocha John Roehrs Clement Singarajah

– Director Critical Care VAMC Allen Thomas

– Director Pulmonary VAMC

Staff Members (BGSMC)

Pulmonary Associates– David Baratz (Director Pulmonary BGSMC)– Mark Gottfried– Manny Mathew– Da-Wei Liao

SAFA (Critical Care BGSMC)– Robert Rashke (Director Critical Care BGSMC)– Huw Owen-Reece– Thomas Bajo

Arizona Center Chest Diseases – Arcot Premkuar– Cameron Dick

Other Affiliated Hospitals Mayo Clinic

– Pulmonary Pathology St. Josephs Medical Center

– Pulmonary transplant– SICU/Trauma

Scottsdale Shea– Pulmonary radiology

JC Lincoln– Trauma

Maricopa Medical Center– Pulmonary – MICU

Current Fellows

Kevin Park (Third Year Fellow) Evan Schmitz (Third Year Fellow) Roxanne Garcia-Orr (Second Year

Fellow) Jessica Hurley (Second Year Fellow) Christian Jivcu (First Year Fellow) Henry Leudy (First Year Fellow) Emad Wissa (First Year Fellow)

Pulmonary Fellows (2011) Tonya Whiting (Good Samaritan) Joshua Jewell (University of

Nevada)

Current Fellow Demographics (includes 2011 fellows)

4 /9 are from the Good Samaritan residency program

Other institutions include University of Massachusetts, Rutgers, St. Joseph’s in Phoenix, Maricopa in Phoenix.

3 / 9 are international graduates.

VA Staff

Fellowship coordinator (Nancy Brown) 1 research PhD 1 physician assistant 1 research coordinator Multiple respiratory therapists including

– Bronchoscopy– Oxygen/CPAP

2 section secretaries

VA PulmonaryCritical Care Section

Endoscopy suite (flouro, Super Dimension)

Sleep Lab (3 beds) MICU (10 beds) 3 pulmonary function labs (>1000

PFTs per year)

Fellowship Program Structure 3 year Program (Clinical)

– 6 months research– 30 months clinical (below is

approximate and can be varied) 10 months VA

– Half pulmonary/half ICU 10 months BGSMC

– Half pulmonary/half ICU 10 months electives

Fellowship Program Structure - VA Consultations (in-patients) Pulmonary Clinic (1/2 day once a

week at VAMC and 1/2 day once a week at private office).

MICU (closed unit with primary care responsibility).

Fellowship Program Structure - BGSMC Pulmonary

–Consultation and primary care

ICU–Primary care

Fellowship Program Structure Most Popular Electives

Pathology Mayo Clinic Sleep (both VA and BGSMC) Infectious disease (BGSMC) Toxicology (BGSMC) Pulmonary transplant (St.

Josephs) Pulmonary radiology (Shea)

Clinical and Basic Research Biostatitics/Epidemiology (Dr

Gerkin BGSMC) Areas of interest:

–COPD–Pulmonary inflammation–Nitric oxide and oxidants–Clinical research

Fellowship Program Structure

– Most fellows present at national meetings (ATS or ACCP).

– Case presentations at both Arizona ATS and National ATS

Pulmonary/Critical Care Conferences

Wednesdays (2-4 hours)– Journal Club– Pulmonary presentation– Critical care presentations

Monthly-Arizona ATS multidisciplinary conference

Every 2 weeks-tumor board

FellowshipWeekend Call 2 fellows BGSMC

– One in ICU– One in Pulmonary

1 fellow at VA (AM only) BGSMC pulmonary fellow covers

nights at VA.

Fellowship Governance Fellowship Committee

–5 faculty Robbins, Baratz, Rashke, Singarajah,

Thomas

–3 fellows one from each year

–Meets monthly

VA Pulmonary Fellowship Consults & Procedures Consultations: >3000 Bronchoscopies: >200 Sleep studies: >500 Other frequent procedures

– Needle biopsies ─ Chest tubes– Thoracentesis ─ Central lines– Pleural biopsies ─ Pleurex

cathers

Average ICU census ~ 7 Critical Care Consults: ~50 Procedures in ICU per year

– Percutaneous tracheostomies: ~50– Bronchoscopies: ~120– Intubations: ~120– Variety of other ICU procedures (lines,

thoracentesis, paracentesis, etc) done mostly by residents with fellow supervision

VA Critical Care Fellowship Census & Procedures

Banner GSMC Pulmonary Rotation Average Daily Census - 25

7 ICU patients18 ward patients

Average Consults / Day – 5 Supervision of Residents / Medical

Students that are on service

Banner GSMC Pulmonary Rotation Procedures per year

– Percutaneous tracheostomies: ~50– Bronchoscopies: ~200 – Intubations: ~ 100– Variety of other ICU procedures

(lines, thoracentesis, paracentesis, etc)

Pulmonary Associates Continuity Clinic Each fellow works a half day per

week in the Pulmonary Associates office seeing private practice patients with a wide variety of pulmonary diseases.

Fellows will have direct responsibility for patients on an ongoing basis over 3 years.

An opportunity to interact with private practice pulmonary medicine

GOALS

Board Certification Consultant in Pulmonary and Critical

Care Clinical Research Provide direct patient care especially

in ICU Competence in bronchoscopy and

other procedures Teaching

Ultimate Goal

LEADER IN PULMONARY and CRITICAL CARE !!!