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Clinical Residency Training
The clinical rotations are devoted to training in the diagnosis and management of patients with a broad spectrum of pulmonary diseases and acute multisystem disorders. Training occurs in the following areas:
- Pulmonary Function Laboratory
A fully equipped pulmonary function and exercise lab with a treadmill and bicycle ergometer is available. Residents receive intensive instruction in the performance and interpretation of spirometry, flow volume loops, techniques of lung volume determination, expired gas analysis, performance of cardiopulmonary exercise tests. Overnight oximetry studies and metabolic cart analysis are also reviewed. Cardiopulmonary exercise tests with measurement of exhaled gases, arterial and mixed blood gases and invasive hemodynamics are performed in this laboratory. Residents have a one-month dedicated rotation in the Pulmonary Function Laboratory in addition to their close involvement with laboratory personnel during clinical rotations. - Medical Intensive Care Unit
The MICU is an 11-bed fully equipped unit which provides 24-hour comprehensive care to patients with life-threatening or potentially life-threatening medical illnesses of all major organ systems. Working closely with the MICU attending physicians, the MICU subspecialty resident in Pulmonary Disease/Critical Care medicine is the team leader for the monthly rotation block-assigned medical residents; and in conjunction with the MICU attending physician, directs and actively participates in patient care including performance and supervision of all ICU-related invasive procedures including pulmonary artery catheterization and chest tube thoracostomy. Pulmonary artery catheterization is performed in the MICU in a patient with ARDS. - Flexible Fiberoptic Bronchoscopy and Interventional Pulmonary Medicine
A modern endoscopy suite with fluoroscopy is available for outpatient and inpatient bronchoscopy. Divisional personnel have access to a variety of instruments used in the endoscopy unit and at the bedside with video monitoring and still photography. The subspecialty resident has ample opportunity to develop skills in performing broncho-alveolar lavages, bronchial, transbronchial and Wang needle biopsies. ND-YAG laser therapy, argon plasma coagulator and brachytherapy catheter treatment of endobronchial lesions from intrathoracic malignancy. Endo-bronchial stents, balloon broncho-plasty, and other procedures are performed in lung transplant patients when appropriate. Percutaneous tracheostomies are performed at the bedside on patients with chronic respiratory failure during bronchoscopic guidance. In addition, the resident gains experience in a number of other invasive diagnostic and therapeutic techniques used in pulmonary medicine, such as pleural biopsy, placement and management of chest tubes. - Pulmonary Consult Service
Under the mentorship of the attending physician, the subspecialty resident is responsible for directing the Internal Medicine resident(s) and student team assigned to the Pulmonary Consult Service in addition to providing pulmonary consultations directly during this month-long rotation. Out-Patient Pulmonary Clinic
All residents gain experience in the outpatient management of a broad diversity of respiratory disorders. Longitudinal patient follow-up and new referrals are seen one half-day per week in pulmonary clinic, located in the ambulatory care center across the street from Saint Louis University Hospital. Residents also rotate through the adult cystic fibrosis and lung transplant clinics.- Polysomnography and Sleep Lab
Residents receive training in the diagnosis and evaluation of various sleep disorders in conjunction with affiliated divisional faculty. Aspects of training include taking a comprehensive sleep history, establishing the differential diagnosis of respiratory-related sleep disorders (e.g. narcolepsy, periodic leg movements, schedule-related disorders, insomnia, and excessive daytime sleepiness), and reviewing polysonograms with faculty. Saint Louis University is accredited by the American Sleep Disorders Association (ASDA). Dr. Shettar (right) discussing a sleep study with a Pulmonary Disease/Critical Care Medicine fellow. - Adult Cystic Fibrosis Clinic
Dr. Ravi Nayak directs the adult cystic fibrosis clinic, which is sponsored by the Cystic Fibrosis Foundation. This clinic offers residents the opportunity to participate in the outpatient management of adult patients with CF. This is a rotation available on an elective basis.
Teaching and Communication Training
Residents develop communication skills on ward rounds, ICU rounds and at the various conferences. The residents teach second-year medical students physical diagnosis of the chest during two afternoon sessions of the Respiratory Module curriculum.
Residents are expected to write and submit for publication the results of their research projects under the guidance of their faculty advisors. Ample opportunity is given to present data at national meetings. Individuals completing the Pulmonary Disease/Critical Care track are well-trained in clinical pulmonology and research techniques related to pulmonary diseases and critical care medicine. Competence will be gained in intensive care medicine, consultative chest medicine as well as the ability to compete successfully for research funds and academic positions in pulmonary disease medicine or critical care medicine.
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