A.
University Hospital
The
primary teaching hospital of NJMS is University Hospital . This 466-bed
general hospital located in Newark , New Jersey , was constructed in
the mid-1970's. It is designated as a Level 1 Trauma Center and has
special units for diagnosis and treatment of diseases in each of the
subspecialties in internal medicine, surgery, neurology, psychiatry,
pediatrics, obstetrics-gynecology, radiology, pathology, and rehabilitative
medicine.
1.
Pulmonary Consultation Service
The
Pulmonary and Critical Care Medicine Division at University Hospital
consists of both full-time and part-time members. We maintain an active
inpatient consultation service. Our patients encompass a broad spectrum
of clinical problems. Trainees are responsible for the evaluation and
for provision of management recommendations for these patients. We make
daily teaching and service rounds.
We
have well-equipped pulmonary physiology laboratories at the University
Hospital . During the first year of training while at University Hospital
, the trainees evaluate the patients referred to this laboratory. Each
day the laboratory work is presented to one of the staff physicians.
During the rotation through the consultation Pulmonary Service, the
trainee learns theory, techniques, and maintenance of pulmonary function
equipment including, computerized spirometry, diffusion testing, inhalational
challenge, and exercise testing.
University
Hospital has a procedure room for performing fiberoptic bronchoscopy.
Bronchoscopic techniques generally include bronchoalveolar lavage, brush
biopsies, transbronchial forceps biopsies and Wang needle transbronchial
biopsies of mediastinal lymph nodes. This equipment can be moved to
the bedside or to the fluoroscopy suite, if necessary, to monitor transbronchial
biopsies. Fellows perform bronchoscopy under the direction of the Pulmonary
and Critical Care staff physicians. Fellows also gain experience in
other special procedures such as pleural biopsies, lung needle aspiration,
Swan-Ganz catheterization, chest tube insertion, intubation, and brachyradiotherapy.
2.
Medical Intensive Care Unit (MICU) Service
The
Medical Intensive Care Unit of University Hospital consists of 15 beds
with a companion Coronary Care Unit of 15 beds. These combined units
have a total of about 1800 admissions per year. The MICU provides a
major resource for teaching critical care medicine and pulmonary disease
in critically ill patients. The MICU as a “closed” unit and the MICU
team consists of the critical care attending, PCCM fellow, 3 senior
residents, 3 interns and variable number of medical students. The faculty
rotates on a weekly basis, whereas the fellows and residents rotate
on a monthly basis. Fellows participate in all clinical and academic
activities within the unit. This unit has state-of-the-art monitoring
facilities, ventilators, and a nurse-to-patient ratio of between 1:3
and 1:1.
3.
Outpatient Clinical Service
Throughout
their training, fellows participate in a weekly outpatient clinic. Emphasis
in this clinic is placed on teaching rather than providing primary care
for a large number of patients. Fellows also use this clinic to follow
selected inpatients after discharge from the hospital. This design provides
fellows with the opportunity to see unusual cases, as well as the chance
to gain experience in the long-term management of selected patients
with chronic respiratory diseases.
4.
Other Clinical Opportunities
The
division maintains a close association with the New Jersey Medical School
National Tuberculosis Center , directed by Dr. Lee Reichman. This nationally
recognized facility provides a unique opportunity for the fellow to
learn about the diagnosis, treatment, and research related to Mycobacterium
tuberculosis. The flexibility of the program permits fellows to arrange
for elective rotations on Cardiology (including the catheterization
laboratory), Infectious Diseases, Immunology and Allergy, other medical
subspecialties, the Cardiothoracic Surgery Division, the Cystic Fibrosis
Service, Pediatric Allergy, and the Neonatology Division.
5.
Conferences at University Hospital
Our
conference schedule is listed below. In addition to didactic teaching,
these conferences provide an opportunity for fellows to learn the techniques
of effective scientific communication, including public speaking and
the proper use of audio-visual aids.
a.
NJMS-Wide Clinical Pulmonary and Critical Care Conference (weekly on
Wednesdays, 7-9AM):
This
conference consists of two sections, approximately 1 hour each. The
fellows are excused from the non-emergency patient care during the conference
and are expected to be present. Majority of the faculty from the UH,
VA and the HUMC, as well as some private physicians from the community
are also often present.
The
first hour is usually a didactic lecture by the PCCM faculty. Occasionally,
distinguished speakers both within and outside of the New Jersey Medical
School present topics related to Pulmonary and Critical Care Medicine.
We have monthly journal club every second week of the month, as well
as research conference every third week of the month.
The
second hour is the clinical case conference. Fellows select and present
interesting, unusual or challenging clinical cases they have encountered
during their clinical rotations. This is rather informal part of the
conference and usually leads to a lively discussion.
During
the summer months (between the Independence Day and the Labor Day),
this format is replaced by the “Summer Lecture Series”. Both hours of
the conference are replaced by didactic lectures on the core topics
of pulmonary and critical care medicine. This serves as the introduction
for the first year fellows as well as repetition for the third year
fellows gearing up for the pulmonary board examination.
b.
Tuberculosis Conference (weekly on Tuesdays 4-5PM):
This
conference is held in conjunction with the Global Tuberculosis Institute.
Cases, topics, and research related to tuberculosis are presented.
c.
Clinical Pulmonary Function Laboratory Review (each week day):
Patients
evaluated in the Pulmonary Laboratory are reviewed in this conference
with one of the staff physicians.
d.
Pulmonary/Thoracic Surgery/Oncology Conference (weekly on Tuesdays,
12-1PM):
This
interdisciplinary clinical conference reviews management of oncological
diseases involving the thorax and the lungs. Challenging clinical cases
are presented and discussed by the numerous faculty members from pulmonary,
medical oncology, radiation oncology, radiology and thoracic surgery
departments.
(Back)
B.
Department of Veteran Affairs Medical Center , East Orange and Lyons
Campuses
The
Department of Veterans Affairs New Jersey Health Care System (VANJHCS)
consists of two medical centers, East Orange and Lyons . The East Orange
VA Medical Center is a 500-bed tertiary referral facility within the
Department of Veterans Affairs. VA hospitals and outpatient facilities
from eastern Pennsylvania , New York and New Jersey utilize the cardiac
catheterization, medical and surgical oncology and radiation therapy
services of the East Orange VA Medical Center in care of their patients.
In addition, the East Orange VA Medical Center serves as a referral
center for a variety of medical and surgical problems. The Lyons VA
Medical Center is a general medical and neuropsychiatric facility.
1.
Consultation and Inpatient Service
Four
full-time attending physicians staff the Pulmonary/Critical Care Section.
The division provides pulmonary consultation for the entire medical
center, both on an inpatient and outpatient basis. Pulmonary malignancies,
chronic obstructive lung disease, interstitial diseases, sarcoidosis,
tuberculosis make up the majority of the referrals to this center. Fellows
gain experience in the performance of fiberoptic bronchoscopy with transbronchial
lung biopsy, thoracentesis with closed pleural biopsy, transbronchial
lung aspiration and biopsy. The East Orange VA Medical Center performs
about 180 bronchoscopies annually, all performed by pulmonary fellows
with faculty supervision.
The
Pulmonary Section supervises and works closely with the Respiratory
Therapy Section. Pulmonary fellows are active in providing in-service
programs on the operation of ventilators and in the basic aspects of
respiratory therapy. A fully equipped Pulmonary Function Laboratory
is available. Measurements of lung volumes, flow rates, diffusion capacity,
body plethysmography, methacholine challenge and pulmonary exercise
stress testing are all performed. There is also a sleep laboratory for
the evaluation of sleep apnea. The ICU is a combined ten bed MICU/CCU.
Chronic ventilator patients are managed on one of the wards and are
followed by a pulmonary fellow.
The
Sleep Laboratory is directed by the Pulmonary Section. It is a four
bed sleep center. There is a weekly Sleep Disorder clinic which is attended
by 2 faculty members trained in sleep medicine, as well as pulmonary
fellows. Pulmonary fellows work closely with the Sleep Laboratory director
and are instructed in all aspects of sleep medicine, including interpretation
of polysomnography.
2.
Outpatient Clinics
The
Pulmonary Section conducts five outpatient clinics weekly, with an average
census of 80 out patient visits per week. The Section provides sub-specialty
and consultative care for the outpatients. This outpatient experience
allows fellows to follow patients longitudinally who are being treated
for tuberculosis, acute lung interstitial illnesses, as well as chronic
respiratory problems.
3.
Conferences
Pulmonary/Thoracic
Surgery Conference - weekly review and discussion of potential
surgical cases with thoracic surgeons
Pulmonary
Pathology - monthly review of active pulmonary pathology
(Back)
C.
Hackensack University Medical Center (HUMC)
Hackensack
University Medical Center has 718 beds. Recently, its pulmonary program
was cited as one of the 50 best in the country by US News and World
Report. It boasts the largest number of admissions in the State of New
Jersey . The hospital provides a level II Trauma Center, cardiac surgery,
bone marrow transplantation and a full range of acute medical, surgical,
pediatric and obstetrical and gynecological services.
1.
Consultation and Inpatient Service
The
Pulmonary Section has 3 full time and 6 part time members. They provide
a full range of Pulmonary and Critical Care services, including consultations,
pulmonary function and cardio-pulmonary exercise testing, pulmonary
rehabilitation, and a fully accredited sleep/wake disorders center.
The bronchoscopy service averages 600 bronchoscopies per year. Transbronchial
biopsies, Wang needle aspiration biopsies, and various procedures in
interventional bronchoscopy are available. The Section also participates
in providing Critical Care and Respiratory Care Services for the 10
medical, 7 respiratory, 14 surgical, 10 cardiac care and 18 cardiac
surgery beds.
2.
The Breath and Lung Institute
This
is a regional outpatient multidisciplinary service for the diagnosis
and treatment of disorders related to breathing or chest medicine. The
team includes Pulmonary, Allergy, Otorhinolaryngology, Cardiology, and
Gasteroenterology. Fellows have an opportunity to participate in the
care of patients evaluated in the Institute. Also, available is an extensive
pulmonary rehabilitation and smoking cessation program.
3.
The Institute for Sleep-Wake Disorders
The
Institute for Sleep-Wake Disorders at Hackensack University Medical
Center is dedicated to the diagnosis and treatment of the full spectrum
of sleep disorders. It is also a major site for teaching and research
in sleep disorders. The institute is the only facility in 5 neighboring
counties accredited by the American Sleep Disorders Association since
1994 and draws patients from a large referral area. PCCM fellows, rotating
through HUMC are exposed to broad range of sleep disorders at the Institute.
Many of our fellows interested in achieving credentialing in sleep medicine
do so at the Institute under the supervision of Dr. Hormoz Ashtyani.
4.
Conferences and Teaching Rounds
Faculty
members of the Section make daily rounds with the Fellows on both the
Pulmonary and Critical Care Services. In addition the following conferences
take place:
a.
Morning Report
The
attendings, fellows and residents meet each morning to review active
cases.
b.
Journal Club
Fellows
and faculty meet each week to review critically articles in the scientific
literature, which are of relevance to Pulmonary and Critical Care Medicine.
c.
Pulmonary Function Tests and Exercise Study Review
Fellows
meet on a daily basis with faculty to review these tests.
d.
Sleep Medicine Conference
Fellows
meet on a weekly basis to review interesting patients with sleep/wake
disorders. Interpretation of sleep studies is emphasized.
(Back)
