POSTDOCTORAL FELLOWSHIPS
Research and Clinical Training

Clinical Training Program

All clinical activities of the Pulmonary and Critical Care Medicine Division are supervised by either full-time UCLA-based faculty or other highly qualified pulmonary clinician-teachers who are either full time at affiliated hospitals or in private practice as members of the UCLA Clinical Faculty.

The clinical training program makes use of both inpatients and outpatients. While traditionally more time is spent on in-patient activities, ambulatory medicine is considered an increasingly important part of the training program.

Clinically-oriented fellows generally spend all their time in clinical activities during the first year and a minimum of 6 months during the remaining years, providing necessary experience for Board eligibility in both pulmonary medicine and critical care. Additional clinical rotations may occasionally be required since schedules are determined in part by service needs as well as the number of available fellows.

The second and third years of the training program consist of both research and clinical activities. Fellows funded by NIH or other extramural sources have fewer clinical responsibilities than others. More clinically-oriented fellows have approximately 6 months of clinical responsibilities during each year; the rest of the year is spent in research.

The two clinical rotations at the UCLA Medical Center are (1) the Inpatient Consult and Procedures Service and (2) the Medical Intensive Care Unit (MICU), Pulmonary Function Laboratory Service. While on these services, fellows also participate in weekly ambulatory care chest clinics.

The Consult and Procedures Service provides subspecialty consultations to the entire medical center and has direct responsibility for patients admitted to the hospital's general medicine wards by the division faculty. The service does 50 to 100 new consultations each month. Initial work-ups are shared by the fellow, one or two medical residents and occasionally medical students, who then follow the patients on consultation rounds conducted on all new patients and follow-ups with a faculty member seven days a week.

The Medical Intensive Care Unit (MICU) has 12 beds and has access to 26 intermediate care beds in a nearby unit. Approximately 30% of MICU patients are admitted for lung disease. Others have a wide range of medical problems requiring intensive care. The MICU employs a collaborative, multidisciplinary team approach to patient care, integrating the efforts of the faculty, house staff, nurses, respiratory therapists, pharmacists, social workers, chaplains, ethicists and psychiatrists. Fellows assist the attending faculty member by supervising rounds and instructing house staff, students, and nurses rotating through the unit. They perform many procedures in the ICU, including right heart catheterization, endotracheal intubation, tube thorascostomy and flexible fiberoptic bronchoscopy. These functions are facilitated by back-up from the Respiratory Therapy Department, which supplies both staff therapists and a clinical specialist to the unit full time

During the MICU and Pulmonary Function Laboratory Service rotation, fellows assist in the daily operation and supervision of both inpatient and outpatient Pulmonary Function Laboratories. They supervise exercise studies and participate in bronchial challenge procedures with the laboratory technicians. Results of all Pulmonary Function Laboratory studies are discussed with the faculty before fellows dictate final reports. The laboratory performs about 200 sets of pulmonary function tests each month, including exercise tests, bronchoprovocation, hypoxia-altitude simulation studies and metabolic rate determinations by indirect calorimetry. The most interesting studies are discussed at the Pulmonary Physiology Conference (see below).

The Procedure Service¾ covered by a fellow concurrently with the Pulmonary Consult Service¾ performs fiberoptic bronchcoscopies, thoracenteses, closed pleural biopsies and chest tube insertions on patients referred from other services. Fellows perform approximately 300 flexible fiberoptic bronchoscopies each year (70-100 bronchoscopies per year per fellow) under the supervision of a faculty member. Both inpatient and outpatient bronchoscopy suites are fully staffed and equipped with flouroscopy and video cameras. Outside these suites, many bedside diagnostic and therapeutic bronchoscopies are performed on seriously ill patients. Procedures performed in conjunction with bronchoscopy include transbronchial biopsy, bronchoalveolar lavage, transbronchial needle aspiration and bronchoscopy-facilitated intubation. Although the consult/procedure service fellows perform most procedures, other clinical fellows perform bronchoscopies involving their own clinic or MICU patients or when they are on call for the service.

In addition to its inpatient activities the division regularly schedules outpatients every day. Each fellow evaluates and manages his or her own patients one afternoon per week. Faculty supervise all new work-ups, follow-ups and diagnostic-management problems with the fellows. A dedicated clinical nurse specialist assists in outpatient case management and patient/family education programs. There is also a full-time coordinator for the pulmonary rehabilitation program.

Conferences and Rounds of the Pulmonary and Critical Care Medicine Division include the following:

• Daily work rounds of the Consult and MICU services.
• Clinical Pulmonary Conference. A weekly teaching conference for fellows and faculty covers topics related to instructive cases with pulmonary or critical care problems. A Chest Radiology faculty member attends the conferences. Each month one session is held jointly with the Infectious Disease Division, and another with the Department of Pathology, covering clinical-radiological-pathological correlations which are discussed by faculty from Pathology and Radiology. The voluntary clinical faculty frequently present informative teaching cases.
• Critical Care Conference. Weekly didactic or case-based discussions presented by Division and other faculty cover critical care physiology, clinical topics and administrative aspects of critical care.
• Pulmonary Physiology Conferences. Didactic lectures cover both clinical and basic topics and cases from the Pulmonary Function Laboratory are discussed. The conference is held jointly with the staff and fellows from the Pulmonary Division at the Wadsworth VA Medical Center.
• Pulmonary Histopathology Conference. Members of the Procedure and Consult Service meet monthly to review cytologic and histopathologic findings of bronchoscopies, pleural biopsies and other procedures. Faculty of the Pathology Department review microscopic diagnoses and discuss appropriate handling and adequacy of specimens.
• Surgical Chest Conference. A conference is held weekly with thoracic surgeons, radiation therapists and oncologists, and members of other specialties. Although these conferences emphasize surgical management of various pulmonary problems, they emphasize the multidisciplinary management of thoracic neoplasms. A chest radiologist attends the conferences.
• Cell Biology of the Lung. Cellular, molecular biological and immunological aspects of the respiratory system are reviewed and important new techniques are discussed. This series of lectures is held during alternate academic years.
• Pulmonary Core Curriculum. In-depth seminars on important respiratory disease processes are presented weekly by faculty and fellows. The conference focuses on the cellular mechanisms, pathophysiology, diagnosis and management of major diseases such as the adult respiratory distress syndrome (ARDS), interstitial lung disease, asthma, emphysema and chronic bronchitis.
• Research Conferences. Faculty and fellows present their research in informal seminars. Investigators from other institutions are invited. These are held twice monthly from September through June.
• Pulmonary Grand Rounds. A clinical conference is held twice a month. Fellows and faculties attend and present interesting and instructional cases.
  
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