Pulmonary Consult Service
Trainees provide inpatient pulmonary consultation services at two training venues. The consult services are comprised of a pulmonary/critical care attending physician and a pulmonary/critical fellow, with or without Internal Medicine residents. The service provides consultation to floor patients with pulmonary disorders and ICU patients with non-medical critical illnesses. The pulmonary/critical care trainee gains experience with a wide variety of pulmonary disorders and their pathophysiology, pathogenesis, diagnosis and management. Procedures such as thoracentesis, small and large bore chest tube insertion, pleurodesis, flexible bronchoscopy with washings, brushings, bronchial or transbronchial biopsies, and bronchoalveolar lavage are performed as part of the consult rotation. Selected patients may undergo navigational bronchoscopy or bronchoscopy with EBUS, rigid bronchoscopy or other Interventional pulmonary procedures as clinically indicated. Chest radiographs, ventilation-perfusion lung scans, CT scans, and CT angiograms are reviewed jointly with the pulmonary/critical care attending and/or staff radiologist. The pulmonary/critical care trainee is responsible for interpretation of pulmonary function tests performed at OU Medical Center (OUMC) or the Department of Veterans Affairs Medical Center (DVAMC). These include spirometry, flow-volume loops, MVV, diffusing capacity for carbon monoxide, plethysmographic lung volumes, arterial blood gases, bronchodilator responsiveness, methacholine inhalation challenge, and exercise tests with expired gas measurements.
Requests for consultation on non-medical ICU patients come from surgical specialties and the cardiology service and may involve diagnostic evaluation, procedures such as bronchoscopy or thoracentesis, ventilator management, and/or management of medical problems. These consults frequently require direct and longitudinal care of the patient by the pulmonary/critical care trainee and attending.
The program provides each trainee with experience in an ambulatory care setting consisting of two half-day clinics each week. Continuity clinics run continuously throughout the period of training, but fellows assigned to ICU services or night float are exempt. Clinics are supervised by faculty members who assist the trainees with evaluation and management issues. These clinics serve patients with a variety of pulmonary problems who are followed in a longitudinal fashion.
DVAMC Chest Medicine Clinic
The Chest medicine clinic consist of a half-day clinic that occurs on Monday afternoon. The clinic accommodates veterans referred for various pulmonary conditions, including interstitial lung disease, COPD, asthma, sarcoidosis, bronchiectasis, pre-operative evaluation as well as undiagnosed dyspnea.
OU Pulmonary Clinic
OU pulmonary clinic consists of a half-day clinic that occurs on Wednesday afternoons. The clinic accommodate patients referred for various pulmonary conditions including lung nodules, interstitial lung disease, COPD, asthma, sarcoidosis, bronchiectasis, mycobacterial disease, pre-operative evaluation as well as undiagnosed dyspnea.
Fellows rotate through various specialty clinics that are focused on providing expert care to specific patient groups. These clinics include a Thoracic Oncology Clinic, Pulmonary Hypertension Clinic, Sleep Disorders Clinic, and Cystic Fibrosis Clinic at Children’s Hospital. Trainees also rotate on a Sleep Medicine Service that provides opportunities for outpatient experience with patients who have a variety of sleep disorders and sleep studies interpretation.
Sleep Medicine Clinic
The Sleep clinic is held on Tuesday afternoons at the DVAMC. The fellows in this clinic evaluate patients with various sleep disorders that include sleep apnea, insomnia, hypersomnia, narcolepsy, parasomnia, restless leg syndrome as well as REM behavioral disorder.
Pulmonary Oncology Clinic
The pulmonary oncology clinic is held on Tuesday afternoons at the DVAMC. The pulmonary fellow on the VA pulmonary consult rotation as well as the fellow on the outpatient procedure rotation evaluate patients referred for newly found lung nodules, masses, lymphadenopathies as well as preexisting pulmonary malignancy.
Adult Cystic Fibrosis Clinic
The adult cystic fibrosis clinic is held on Thursday afternoons at the OU Children's Hospital. The pulmonary fellow on the outpatient pulmonary rotation assists in the evaluation and management of patients diagnosed with Cystic Fibrosis as part of a Multidisciplinary team.
Pulmonary Hypertension Clinic
The Pulmonary Hypertension Clinic is held on Tuesday mornings at the OU Heart, Lung and Vascular Clinic. The pulmonary fellow on the outpatient pulmonary rotation assist in the evaluation and management of these patients under the direct supervision of Dr. Himanshu Bhardwaj.
Amyotrophic Lateral Sclerosis Clinic
The ALS clinic is held each Thursday at the DVAMC. The pulmonary fellow on the pulmonary rehabilitation rotation assists in the evaluation and management of ALS patients as part of a
multidisciplinary team that include, neurology, pulmonary, dietician, speech pathology, prosthetics, respiratory and a social worker.
Outpatient Procedure/Interventional Pulmonary Rotation
Second- and third-year fellows will perform advanced diagnostic bronchoscopic procedures such as navigational bronchoscopy, linear and radial EBUS as well as transbronchial cryobiopsy. The fellows will assist in performing advanced therapeutic procedures such rigid bronchoscopy, endobronchial tumor ablation, stent deployment in the airway, chest tubes and indwelling pleural catheter placement, as well as percutaneous tracheostomy placement.
Point of Care Ultrasound
A dedicated full day workshop on bedside ultrasound that includes didactics as well as hands-on training is conducted each year at the University of Oklahoma Health Sciences Center. Skills are reinforced by having a bi-weekly ultrasound round in the ICU through in which direct feedback is provided to the fellows about their bedside ultrasound skills and interpretation.
Bronchoscopy/EBUS Simulation Training
A bronchoscopy workshop is conducted at the beginning of each year. Fellows are provided with the necessary didactics as well as the hands-on training on a high-fidelity bronchoscopy/EBUS simulator.