Principle Teaching Methods

Principle Teaching Methods

Supervised Direct Patient Care Rounds: Fellows will be involved in initial consultations/ Triage/ admission and subsequent care of patients presenting to ORMC Emergency Room or admitted to ORMC. All fellows are supervised and staffed by full-time faculty pulmonary or critical care specialists.

Services:
  • Pulmonary Consult Service
  • Medical ICU service
  • Thoracic Oncology Elective
  • Thoracic Surgery Elective
  • Pediatric Pulmonary Elective 

Teaching Rounds: Teaching rounds will take place daily on patients being seen by the team comprising of fellow and/or the residents. After the fellow has examined the patient, formulated an assessment and treatment plan during the teaching round she/he will present the case to the attending teaching consultant. Both the Resident/fellow and the attending will examine the patient and discuss the fellow’s assessment and management plan on the basis of recent evidence and peer reviewed literature. Before the attending teaching round, the fellow will pre-round with the residents in the team and throughout the rotation, the fellow will supervise the team of residents and triage the patients.

Didactic educational activities of the consult service fellows will include the following
  • Monthly Pulmonary case conference – 1 hour every Month – Presenter – Pulmonary Fellows
  • Monthly Cardio-Pulmonary Joint Case Conference – 1 hour every Month – Presenter – Cardiology and Pulmonary Fellows
  • Monthly CCM Pulmonary fellows Joint Case conference –1 hour every month – Presenter Pulmonary and CCM fellows
  • Joint Pulmonary- CCM-ID conference – 1 hour a month. Presenter – Pulmonary, Critical Care and ID fellows 
  • Monthly Journal club – 1 hour / month – presenter- Pulmonary Fellow and attending
  • Monthly Critical Care Journal Club - 1 hour / month – presenter- Critical Care or Pulmonary Fellows and attending
  • Monthly chest Pathology conference – 1 hour/ month – Presenter – Specialty Attending of Pulmonary and Pathology departments as well as Pulmonary fellows and Pathology residents/ Fellows
  • Bi-Monthly chest Radiology conference - 1 hour/2 month – Presenter- Specialty attending
  • Pulmonary Fellows grand round – Monthly – 1 hour/month – Presenter- Pulmonary Fellow
  • Core didactic series –5 hours/ Week – July, 2 hours/week –August and September, 1 Hour/Week – October-June. – Presenter attending faculty
  • Fellows board Review – 1 hour a week – October through June – Presenter Attending Faculty
  • Ambulatory care conference – 30 minute /week
  • Thoracic oncology multidisciplinary tumor board – 1 hour/week- Presenter – Multiple faculty

In addition to the core curriculum conferences, 
  • Special one to one rotation lectures on specific pulmonary pathology seen during rounds will be presented by the faculty two to three times per week 

Procedures:
  • Hands on training on Bronchoscopy, EBUS, Tube Thoracostomy, Central Venous Catheterization etc at ORMC Simulation lab
  • Didactic teaching of basic principles, hands on training and direct close supervision of entire procedures of Central Venous Catheter inseeion, Arterial Line insertion, Thoracentesis, Tube Thoracostomy, tracheostomy management, PleurX catheter placement, General diagnostic bronchoscopy and interventional bronchoscopy. 
  • Essential Bronchoscopist Only learning Module 
  • New England Journal of Medicine Procedure Video Series 

Teaching Skills
  • Fellows will be expected to teach the residents about basic pulmonary topic. The attending faculty will facilitate and supervise such teaching 
  • Fellows, under the mentorship of an attending, will take pulmonary and Critical Acre didactic lectures for internal medicine residents 

Pulmonary Fellowship Core Didactic Lecture Series

  • The Core Curriculum Conference Series will be conducted throughout the Academic Year. 
  • The Core curriculum topics to be covered in First Three months will be the following- ( A majority of these core didactics will take place during Orientation month of the fellows) 
  • Combined Core Lectures- Pulmonary, Cardiology, Critical Care fellows combined lecture
    • Differential Diagnosis, etiology of Common respiratory symptoms like dyspnea, cough, hemoptysis – 
    • Obstructive Airway Disease: Different phenotypes, Pathology, Pathogenesis and Epidemiology of COPD 
    • Obstructive Airway Disease: Management of COPD and exacerbation 
    • Management of Severe Asthma 
    • Pulmonary Embolism and Deep Venous Thrombosis 
    • Respiratory failure and supplemental oxygen 
    • Noninvasive modes of ventilation for Acute Respiratory Failure 
    • Mechanical ventilation: Basic 
    • Unstable Angina and Myocardial Infarction I 
    • Unstable Angina and Myocardial Infarction II 
    • Congestive Heart Failure I 
    • Congestive Heart Failure II 
    • Cardiac Arrhythmia I 
    • Cardiac Arrhythmia II 
    • Pulmonary Vascular Disease: Pulmonary hypertension 
    • Acute Circulatory Failure and Shock = I
    • Acute Circulatory Failure and Shock – II
    • Sepsis – Epidemiology, Pathology and Management 
    • Hemodynamic Monitoring – I 
    • Hemodynamic Monitoring II
    • Hemodynamic Monitoring III
    • Resuscitation I – Principles of Fluid Management in shock 
    • Resuscitation II – Vasopressors and Inotropes 
    • Cardiogenic Shock and mechanical Circulatory Support 
    • ARDS 
    • Pulmonary complications of radiation, inhalation, and trauma
    • Bioterrorism – Circulatory and Cardiopulmonary perspective 
  • Pulmonary, Critical Care and Infectious Disease fellows combined lectures 
    • Pneumonia: Infections in the immunocompromised host 
    • Community Acquired Pneumonia – 
    • Mycobacterial Infections : Tuberculosis 
    • Mycobacterial Infections: Non Tuberculous infections 
    • Pulmonary Infections – fungal and Parasites
    • Pulmonary Infections of the immunocompromised host 
  • All Orlando Health Subspecialty Fellows Combined session 
    • One hour didactic session on medical Information gathering titled “A primer to Medical Intelligence” given by the Orlando Health Librarian. 
  • This one hour didactic will be followed by a three hour hands on session at ORMC library where each fellow will be asked to complete a small project to practice their skill to locate, appraise, and assimilate evidence from scientific studies using information technology services available at ORMC and apply it to their patients' health problems. 
    • One hour didactic session titled, “Teaching Methodology”
    • Fundamentals of Effective Healthcare communication. 42 module web based communication learning tool for the residents/fellows called DocCom. DocCom is a web-based curriculum resource for healthcare communication skills. The 42 multimedia earning modules teaches key principles, evidence-based recommendations, and a behavior skills checklist. 400 videos clips demonstrate interactional skills in encounters with standardized patients and provide video and text commentary on them; additional video vignettes serve as triggers for discussion. 
    • Understanding Healthcare disparity and the value of diversity 
  • Cultural Competency – Latino/ Hispanic Consideration 
  • Cultural Competency – African American Considerations
  • Cultural Competency- Religious Minority Considerations 
    • There would be annual workshops that would include Team Building Exercise and practical sessions to build Communication Skill. In this team building exercise, the fellows will learn and practice the skills to be an effective team member and also gain experience of playing the role of the team leader. The workshop would be participated by physicians, nurses, respiratory therapists and other ancillary providers. The workshops would be facilitated by the faculty and human resources personnel where the group will be divided into smaller teams comprising of a diverse group of professionals.
  • Pulmonary Fellows Core Lectures - 
    • Asthma of varying severity, Occupational asthma, Asthma COPD overlap Syndrome– Phenotypes and pathogenesis 
    • Mechanical Ventilation: Advanced - 
    • Health Care Acquired Pneumonia
    • Restrictive Lung Diseases: Concept, approach and differential of Interstitial Lung Diseases 
    • Diffuse Parenchymal Lung Disease: Interstitial Pneumonias and other diffuse lung diseases
    • Pleural diseases, pleural effusion, asbestosis
    • Sleep-disordered breathing
    • Diffuse Parenchymal Lung Disease: Sarciodosis
    • Tracheostomy Management
    • Chest Radiology: Basic Concepts 
    • Pulmonary Function Testing – I
    • Pulmonary Function Testing - II
  • Core Curriculum Topics to be completed within the next Nine Months - 
    • UIP, IPF and Combined Pulmonary Fibrosis emphysema syndrome
    • Pulmonary manifestations of systemic diseases, including collagen vascular disease and diseases that are primary in other organs
    • Diffuse Parenchymal Lung Disease: Hypersensitivity pneumonitis and Eosinophilic pneumonia 
    • Diffuse Parenchymal Lung Disease: Rare lung disorders like LAM, LCH
    • Occupational Lung Diseases – Pneumoconiosis, Silicosis
    • Pulmonary Vascular Disease: Overview of Vasculitis, Wagner’s Granulomatosis, Microscopic Polyangitis, Pulmonary Renal Syndrome 
    • Pulmonary Vascular Disease: Diffuse Alveolar Hemorrhage and other Pulmonary Hemorrhage Syndrome
    • Pulmonary problems associated with immunocompromised state 
    • Obesity Related Respiratory Disorders 
    • Pulmonary Rehabilitation
    • Sleep Disorders: Narcolepsy, Cataplexy, PLMS, RLS 
    • Sleep Disorders: Insomnia, Parasomnia 
    • Home Noninvasive Ventilation 
    • Allergy, URIs, rational of allergy tests and immunotherapy
    • Thoracic malignancy, Lung Cancer
    • Mediastinal disorders and tumors 
    • Bronchiectasis: Non-Cystic fibrosis
    • Genetic and developmental disorders of the respiratory system, including cystic fibrosis 
    • Iatrogenic respiratory diseases - Drug Induced Lung Disease
    • Tracheostomy Management 
    • Lung transplantation
    • Neuromuscular Respiratory Disorders 
    • Chest radiology: Case based discussion 
    • Altitude and Deep See Physiology 
  • Pulmonary Physiology Series – 
    • Pulmonary physiology – I 
    • Pulmonary physiology – II - Biochemistry and physiology, including cell and molecular biology and immunology, as they relate to pulmonary disease
    • Developmental biology, Genetics and molecular biology - pulmonary aspects 
  • IHI Open School Courses – Mandatory For fellows and to be completed within the first six months of Fellowship 
    • Patient Safety
  • PS 100: Introduction to Patient Safety 
  • PS 101: Fundamentals of Patient Safety 
  • PS 102: Human Factors and Safety 
  • PS 103: Teamwork and Communication
  • PS 104: Root Cause and Systems Analysis
  • PS 105: Communicating with Patients after Adverse Events
  • PS 106: Introduction to the Culture of Safety
  • PS 201: Partnering to Heal: Teaming Up Against Healthcare-Associated Infections
  • PS 202: Preventing Pressure Ulcers
    • Improvement Capability
  • QI 101: Fundamentals of Improvement
  • QI 102: The Model for Improvement: Your Engine for Change
  • QI 103: Measuring for Improvement
  • QI 104: The Life Cycle of a Quality Improvement Project
  • QI 105: The Human Side of Quality Improvement
  • QI 106: Mastering PDSA Cycles and Run Charts
  • QI 201: Guide to the IHI Open School QI Practicum
  • QI 202: Quality Improvement in Action: Stories from the Field
    • Quality, Cost, and Value
  • QCV 100: An Introduction to Quality, Cost, and Value in Health Care
  • QCV 101: Achieving Breakthrough Quality, Access, and Affordability
    • Person- and Family-Centered Care
  • PFC 101: Dignity and Respect
  • PFC 102: A Guide to Shadowing: Seeing Care Through the Eyes of Patients and Families
  • PFC 103: Having the Conversation: Basic Skills for Conversations about End-of-Life Care
    • Triple Aim for Populations
  • TA 101: Introduction to Population Health
  • TA 102: Improving Health Equity
    • Leadership
  • L 101: Becoming a Leader in Health Care 
  • Research Lecture Series- 
    • An Overview of Research methodology 
    • Understanding Medical Literature
    • Manuscript and Grant Writing 
    • An Introduction to Basic Science Research 
  • Essential Bronchscopist – Online interactive Modules, Module 1, 2,3,4,5,6 – To be completed within First month and certificate of completion submitted 
  • There will be one month long orientation for the first year fellows to make them familiar with the different healthcare settings and systems they will be working in
  • There will be two daylong sessions on electric medical record systems the fellows will be using
  • Fellows will complete the online modules of AAIM-ACP High Value Care Curriculum 
  • The fellows will be recommended ‘Choosing Wisely” Video Series as well as “Choosing Wisely” website 
  • The Faculty and topic Specific invited speakers will take the sessions 
  • An electronic copy( Preferably Audiovisual) of the core lectures will be stored in a shared folder for later view by the fellows. IHI Open School courses, DocCom and AAIMACP module will be web based self-learning and fellows will need to submit the completion certificate or report whichever is applicable.

Principle Ancillary Educational Materials

  • At the beginning of the specific rotation, fellows will receive an electronic folder containing pre-test questions, reading material including text book chapters, review articles and pivotal articles relevant to that specific rotation or specific concentration of pulmonary medicine. All residents are expected to read independently and finish reading the material provided in the electronic folder
  • Computerized educational resources will be available to all fellows in dedicated workstations at fellows designated work areas, fellow on call rooms, hospitals and ambulatory clinic sites where the fellow will be working and other designated locations across different training sites. The onlines resources availavle now are - 
    •  Up to date
    • Cinical Key
    • MDConsult
  • Full online and print subscription of select journals including New England Journal of Medicine, The Lancet, Chest, AJRCCM, JAMA, Thorax, European respiratory Journal, Critical Care Mediicne will be made available to the patients 
  • Procedure Video Library of New England Journal of Medicine will be made available for the fellows 
  • Through the onsite ORMC library, fellows will have access to any full text journal article on request
  • Board Review Material (Print. electronic and audio-visual) will be purchased through the program and mae available for the fellow 24/7
  • Fellows will be subscribed and Mandated to complete Institute of Healthcare Improvement Modules and DocCom training Modules
  • All the fellows will complete the IHI Quality Improvement learning modules titled Improvement Capability and submit completion certificate and posttest to the program director. 
    • In the light of above training, each fellow will have to decide on a quality improvement project by the end of their first year of training and complete the project within the next six months. 
    • The fellow and an assigned Faculty supervisor will plan on a project and submit the proposal to a joint committee comprised of relevant quality officers of Orlando Health/ORMC, Internal Medicine Program Director and the Pulmonary Fellowship Program Director. 
    • Once approved by the above committee, the fellow will implement the project under the supervision of the assigned faculty supervisor. The fellow may use her/his research rotation months to implement the project. The fellow will give the assigned faculty supervisor a Bi-weekly update on the project. 
  • Once completed, the fellow will present the report in a session attended by the entire faculty, fellows as well as the relevant Quality officers of Orlando Health and ORMC.