Parkland Pulmonary Consult: 
The pulmonary consult service at Parkland Memorial Hospital (the county hospital) consists of the fellow and a faculty attending who is based at the institution.  In addition there is usually an internal medicine resident (PGY 2 or 3).  The service responds to inpatient consultation requests including all non-MICU intensive care units.  Teaching rounds are held daily with ad-hoc with other ad hoc rounds as well.  The fellow performs bronchoscopy and other pulmonary disease related procedures with appropriate supervision.  The fellow participates in continuity clinic and the chest malignancy clinic.  The fellow attends all division conferences and Parkland's multidisciplinary chest conferences. 

VAMC Pulmonary Consult:

The pulmonary consult service at the Dallas VA Medical Center consists of the fellow and a faculty attending who is based at the institution. The service responds to inpatient consultation requests including all non-MICU intensive care units. Teaching rounds, procedural responsibilities, clinic and conference participation are analogous to the Parkland consult service. Fellows also gain experience in sleep disorders through the Sleep Evaluation clinic and sleep lab, both part of UT Southwestern's accredited Sleep Fellowship program.

Parkland MICU:

The MICU/Pulmonary inpatient service at Parkland Memorial Hospital consists of the fellow, a faculty attending who is based at the institution and four internal medicine intern/resident teams.  There are 20 designated MICU beds.  The service has direct management responsibility for all patients requiring admission/transfer to the MICU (it is a “closed” unit).  The fellow has significant responsibility in the direct management of these patients, performs/supervises ICU procedures ICU procedures, helps supervise the internal medicine residents, assists with triage decisions, etc.   Patients in the MICU have a wide variety of critical care problems and generally have a very high level of severity of illness.  Teach rounds are held daily.  The fellow is responsible for rounding with half the housestaff each day and with the attending reviews the care for all MICU patients on a daily basis. 

VAMC MICU:

The MICU/Pulmonary service at the VA Medical Center consists of the fellow, a faculty attending who is based at the institution and four internal medicine intern/resident teams.   The functioning of the service is analogous to the Parkland MICU rotation.   The fellow participates in continuity clinic and the VA Pulmonary Disease Clinic.  The fellow attends all division conferences. 

Zale Lipshy Pulmonary/Critical Care:

The rotation at Zale Lipshy University Hospital provides exposure to both pulmonary disease and critical care in roughly equal proportion.  The service consists of a fellow and a single assigned faculty member who is based at the institution.  All patients are private patients of Southwestern’s faculty.  Patients are seen both in the intensive care and general medical/surgical ward areas.  Approximately 25% of patients are managed primarily by the team, the team serves in a consultative capacity in the remainder.  Teaching rounds are held daily with other ad hoc rounds as well.  The fellow performs bronchoscopy, other pulmonary related procedures and all relevant intensive care unit procedures under appropriate supervision.  In all situations the fellow has major patient care responsibilities.  The fellow attends all division conferences and VA’s multidisciplinary chest conference. 

St. Paul Pulmonary Specialties:

The rotation at St. Paul Medical Center (a major affiliated community hospital which may likely soon be incorporated with the Zale Lipshy University Hospital) is intended to provide the trainee with enhanced exposure to a variety of specialized areas of pulmonary medicine.  The service consists of the fellow who is primarily supervised by the local program director who is based at the institution.  The fellow also has teaching interactions with other members of the clinical faculty.  The fellow spends time in the pulmonary function lab, focusing both on the technical aspects of performing tests as well as interpretation.  The fellow conducts and interprets cardiopulmonary exercise tests.  The fellow attends transplant clinic and transplant conferences.  The fellow also follows inpatients being managed by the attending physician who are transplant patients, patients with cystic fibrosis, and other particularly interesting cases.  The patient has some, but fairly limited, responsibilities for direct patient care while on this rotation.  Subspecialty residents do not provide on-call coverage for St. Paul.

Ambulatory Care:

Fellows spend one to two half-days in the PMH or VAMC Outpatient Clinics.   Fellows attend the Parkland Outpatient Clinic when assigned to either the Parkland MICU or Consult rotation.   Fellows attend the VAMC Outpatient Clinic when assigned to either the VAMC MICU or Consult rotation.  Trainees assigned to the St. Paul Rotation attend both clinics while trainees usually attend one clinic each week during research periods. 

The primary focus of the Parkland and VA outpatient clinics is to provide sub-specialty evaluation for relevant pulmonary problems encountered in patients followed long-term in primary care settings or referred from outside facilities, as well as post-hospitalization follow-up when needed.  These patients are assigned to a specific trainee who continues to follow these patients while they remain in the Chest Clinic.  Transplantation clinic is held once per week at St. Paul. The Adult cystic Fibrosis Clinic is attended once per week with St. Paul faculty. A Suspected Bronchogenic Carcinoma Clinic is held with Thoracic Surgery once per week at Parkland.

Conferences

The following conferences are held recurrently:   Weekly Clinical Seminar presented by division members and invited speakers; case presentation conferences; research conferences; journal club; weekly multidisciplinary Thoracic Surgery Conferences at Parkland and DVAMC; weekly radiology and chest CT workshops with radiology faculty; didactic Pulmonary Functions and Physiology conferences, and weekly interinstitutional transplant conference.   In addition, a large number of conferences on topics of interest to the trainees are held by the Department of Internal Medicine and other medical school departments. 

Professional Meetings

The Division sponsors fellow attendance at both regional and national professional meetings throughout the three years of fellowship including meetings of the ATS and the ACCP.