Course/Rotation Title: RESPIRATORY CARE UNIT (RCU)



Course/Rotation Title: RESPIRATORY CARE UNIT (RCU)

Date of Last Review/Update:

3/07

Course/Rotation Director: Jack Ringler, MD

Location of Clinical Encounters

Inpatient % time = 97%

(Check all that apply)

[ ] Wards

[ ] ICU

[X] ED

[X] Other: Chronic Respiratory Care Unit

Outpatient % time = 3%

Course/Rotation description with educational purpose/value

The Respiratory Care Unit is a subspecialty block inpatient rotation required yearly for all residents at Berkshire Medical Center. The Respiratory Care Unit has been designed to optimize multidisciplinary care for patients with acute non-critical respiratory issues (both ventilated and non-ventilated) which require subspecialty pulmonary / nursing / and respiratory therapy input on at least a daily basis.

The goal of this rotation is to prepare future general internists with the skills and knowledge to appropriately evaluate, treat, and refer in a timely fashion patients with systemic illnesses with a respiratory component as well as acute and chronic respiratory illnesses.

During this rotation the Trainee will round daily at the bedside with a Pulmonologist, respiratory therapist and nurse as part of a multidisciplinary team.

Residents should review all appropriate policies within the curriculum which may apply to this rotation.

There is no overnight call during this rotation. The long day/short day schedule will be the same as the Ward Medicine rotation with the exception that if it is a two intern team the long day will occur every third rather than every second.

On the intern long day they will be supervised by the ICU resident after the RCU senior has gone home.

Types of Clinical Encounters: Patients are seen primarily in the hospital and ED settings. Clinical encounters include admissions, transfers, procedures, discharges, end-of life discussions, family meetings, multidisciplinary team meetings, etc.

Types of Patients: (PLEASE SPECIFY)

[X] Adults of all ages

[X] Male

[X] Female

[X] Other: Primarily respiratory illnesses as described above

Mix of Diseases: (PLEASE SPECIFY ANY ADDITIONAL DISEASES

See above under rotation description

Types of Procedures: (PLEASE SPECIFY):

• Endotracheal intubation

• Airway management

• Diagnostic and therapeutic thoracentesis

• Tracheostomy tube care and changes

• Arterial blood gas sampling

• Nasogastric tube insertion.

• PFT interpretation

• Central venous catheter placement

Describe the level of supervision by faculty:

[X] Attending staff will supervise and precept all patient care activity directly or indirectly.

[X] Attending staff will provide mid rotation feedback

[X] Attending staff will provide end-of-rotation feedback

[X] Other: Teaching Rounds: A Pulmonologist is responsible for Teaching Rounds.

Teaching Rounds occur at a minimum of 3 days per week and total at least 4.5 hours per week. Format is generally bedside teaching involving a multidisciplinary team and fulfills the RRCIM Program Requirements V.E.1. “Teaching, or attending, rounds must be patient-based sessions in which current cases are presented as a basis for discussion of such points as interpretation of clinical data, pathophysiology, differential diagnosis, specific management of the patient, the appropriate use of technology, the incorporation of evidence and patient values in clinical decision-making, and disease prevention." "Teaching rounds must include direct resident and attending interaction with the patient, and must include bedside teaching and the demonstration of interview and physical examination techniques.”

Graded expectations:

Please see Roman numeral III.

Please see General Medicine Ward Rotation

Team Census

Please see Team Census Regulations (RCU)

Other:

All rules and regulations applicable to Ward Medicine months apply to this rotation please review Ward Medicine Curriculum you will be accountable to these regulations.

Competency Based Objectives/Expectations. Please see Roman Numeral II with additional items specific to this rotation as below:

Patient Care:

• Work up admissions and care for patients with acute and chronic respiratory problems

• Perform Procedures as outline above

• Present patients on rounds to multidisciplinary team caring for patient

• Participate in family meetings discussing end of life care

• Gains ability to integrate history, physical, data into a cohesive assessment and care plan

Medical Knowledge:

• Approach to the evaluation and management of acute respiratory disorders including hypoxic and hypoventilatory respiratory failure, chronic obstructive pulmonary disease, asthma, bronchiectasis, respiratory infections including pneumonia, & empyema, pulmonary embolism, obstructive sleep apnea, acute respiratory distress syndrome, and lung cancer and its complications.

• Interpretation of data from arterial blood gases and pulmonary function testing in a critical care setting

• Develops medical knowledge and clinical skills to be able to discern between chronic disease states and acute exacerbations and their interrelationships

Practice-Based Learning:

• Seeks out resources independently to gain increased knowledge and understanding of disease states with which the trainee is unfamiliar

• Demonstrates facility with hospital based online databases (OVID, Cochrane, PubMed)

Interpersonal and Communication Skills:

• Develops a therapeutic relationship with patients such that they look to the resident as their primary physician contact

Professionalism

• Develops a true sense of ownership and responsibility for all care their patients receive

• Shows respect to and is able to learn from Respiratory Therapy, Nursing and other ancillary RCU staff

Systems Based Practice

• Ability to work as part of a multidisciplinary team in caring for patients with respiratory illness

• Understanding the principles of withholding/withdrawing life support and advanced directives.

Check Any Methods Used For Teaching and Assessment:

[ ] Ambulatory Clinic (feedback written & verbal)

[ ] Annual In-service Exam (feedback written)

[X] Attending Rounds (feedback written & verbal)

[ ] Board Review (feedback written examination)

[ ] Cancer Conference

[X] Case Management Evaluation (360 degree written evaluation)

[X] Chart Stimulated Recall & Feedback (feedback verbal)

[X] Direct Observation and Feedback (feedback written & verbal)

[ ] GME Core Curriculum

[ ] Interns Report (feedback written & verbal)

[ ] Journal Club (feedback written & verbal)

[X] Medical Record Review (feedback written & verbal)

[ ] Mentor Feedback (feedback written & verbal)

[ ] Monthly End of Elective Exam (feedback written)

[X] Monthly Mini CEX (feedback written & verbal)

[X] Monthly Competency Based Written Evaluation

[X] Morning Report (feedback written & verbal)

[ ] Multidisciplinary Rounds Feedback (feedback verbal)

[X] Nursing Evaluation (360 degree written evaluation)

[X] Patient Evaluation (360 degree written evaluation)

[X] Patient Management Discussions (feedback written & verbal)

[X] Procedure Logs

[ ] Performance improvement Multidisciplinary Morbidity and Mortality (feedback written & verbal)

[ ] Semi Annual Program Director Feedback (feedback written & verbal)

[ ] Student Evaluation (feedback written & verbal)

[ ] Supervised Sign-In Rounds (feedback written & verbal)

[ ] Supervised Sign-Out Rounds (feedback verbal)

[ ] Other _______________________________

[ ] Other _______________________________

[ ] Other _______________________________

[ ] Other _______________________________

Other Policies:

The Course Director recognizes that the trainee is accountable to all BMC Residency and GME Personnel Policies and Procedures. The Course Director recognizes that the residents are expected to attend all continuity clinics and mandatory educational conferences unless excused by the Program Director or Chief Medical Resident with advanced notice.

Check The Educational Materials Used (beyond direct patient care):

[X] Reading List (Please Specify):

Required

• Rotation Goals & Objectives

• Appendix to Curriculum: Communicating with Patients to Enhance the Patient Experience and Coordination of Care

• Overview chapters on Respiratory Disease in UpToDate™

Resources

• ACCP and ATS guidelines

• Saunders: Weinberg.S. Pulmonary Medicine

[X] Review of Appropriate Radiology Images (Please Specify):

• Daily radiology rounds where all appropriate studies are reviewed either with the Pulmonologist on service or with attending radiologist

[X] Review of Appropriate Pathology (Please Specify):

• Review with Pathologists any biopsy material obtained

• Review sputum Gram Stain C&S as appropriate

[X] Review of Appropriate Laboratory Data (Please Specify):

• Any ordered lab must be personally reviewed by the resident team with appropriate differential diagnosis and action plan to address lab findings documented in the medical record.

[ ] Articles from the Literature (Please Specify):

[ ] Case Studies

[ ] Other (Please Specify):

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