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Palmetto Health Richland is the primary teaching site for this fellowship. We have state of the art facilities for pulmonary laboratory, bronchoscopy, common pulmonary procedures, and critical care. The Pulmonary/Critical Care Division offices are adjacent to the Palmetto Health Heart Hospital in 8 Medical Park. Fellow continuity clinic will be in this location as well as super specialty pulmonary clinics in sleep disorders, interstitial lung disease, sarcoidosis, pulmonary hypertension, asthma, pulmonary rehabilitation, cough, and pulmonary nodules. The pulmonary rehabilitation program is based at 8 Medical Park as well. It is a fully operational modern rehabilitation program in which the fellows are actively involved.
There are pulmonary function laboratories at the USC Pulmonology clinic offices, Palmetto Health Richland and at the WJB Dorn VA Medical Center. The fellow will be trained in all advanced techniques of pulmonary function testing including methacholine challenge testing and cardiopulmonary stress testing.
A new service with Interventional Pulmonology has been initiated at Palmetto Health Richland. This includes bronchoscopy with photocoagulation, laser procedures, stints, ultra sound bronchoscopy, and soon to come, medical pleuroscopy.
A weekly continuity clinic is required and is at the University Pulmonology offices. Two months of outpatient niche clinics are included in the rotations.
A monthly interdisciplinary Thoracic Oncology conference occurs at Palmetto Health Richland. Pulmonary function test conference, case conferences, state of the art reviews, and patient based conferences are all included in the curriculum. There are approximately four conferences per week. Fellows are encouraged to be involved in the teaching of residents and medical students as well.
USC is intimately involved in the development of hand help ultrasound and in the teaching of medical students, residents, and fellows. Ultrasound technology will be heavily used in evaluation of pulmonary and pleural lesions as well as in critical care units.
Active research is presently ongoing in pulmonary, critical care and sleep areas. In addition we have liaisons with basic science researchers within the School of Medicine Basic Science Faculty. We are also developing programs with the School of Public Health on USC main campus. A great wealth of research opportunities is present. Currently six months of research are planned for the second year of fellowship.
Ours is a very comprehensive pulmonary medicine training program in which the fellow will be exposed to sleep disorders, cystic fibrosis, pulmonary hypertension, tuberculoses, and other unusual infections, HIV and all of its manifestations, and a wide breadth of critical care. Electives are available in Allergy, chest radiology, cardiothoracic surgery, and pediatric pulmonology.
The most critically ill patients are admitted to the 12-bed Medical Intensive Care Unit at Palmetto Health Richland. Typical patients in the MICU include those with intracerebral hemorrhage, severe infections, respiratory failure, shock, gastrointestinal hemorrhage, status asthmaticus, and status epilepticus. In the MICU, the most advanced technologies available are employed to reverse organ system failure. This includes both conventional and advanced modes of mechanical ventilation, continuous renal replacement therapy, therapeutic hypothermia, and invasive hemodynamic monitoring. In addition, multicenter clinical trials and other clinical research projects are a part of patient care in the MICU. Recently, we have been involved with trials exploring new treatments for septic shock and prevention of ventilator-associated pneumonia.
Nursing-to-patient ratios are 1:2 at most and there is a dedicated respiratory therapist assigned to the MICU. The physician team consists of an attending physician who has received fellowship training in Critical Care Medicine, a Pulmonary Medicine fellow, three upper-level residents (from both Internal Medicine and Emergency Medicine), and two to three first-year residents from Internal Medicine. One of the upper-level residents is always in the hospital, and the attending physician and fellow are available by phone for any questions 24 hours a day.
Multidisciplinary rounds take place every day in the MICU. The physician team is joined by the Critical Care pharmacist, MICU charge nurse, patient's nurse, respiratory therapist, and case manager. Each patient is seen and a care plan for the day is created. Progress is monitored by the use of daily goal sheets which are kept in each patient's room.