Inpatient/Outpatient US Clinical Experience in Pulmonology in Los Angeles

Information about this clinical experience:

You will be under the supervision of a physician board-certified in internal medicine, pulmonary / critical care, and sleep medicine. Although you will be seeing patients in the office, you will also spend part of your time observing hospitalized patients with pulmonary problems. This physician holds staff appointments at multiple hospitals, including hospitals within the MemorialCare Health System. Following residency training in internal medicine and fellowship training in pulmonary medicine, critical care, and sleep medicine, this preceptor worked for nearly five years as a faculty member at a top medical school in California before leaving academic medicine for a career in private practice. 

The hospital component of this clinical experience will be spent at a long-term acute care hospital. This is a facility which cares for patients with complex situations and acute medical needs. These patients are admitted here after discharge from an acute care hospital when they have high medical needs that prevent them from going home or to a nursing home. The most common admitting diagnoses include respiratory disease requiring ventilator support, skin ulcers, sepsis, pulmonary edema and respiratory failure, respiratory infections, chronic obstructive pulmonary disease, renal disease, and postoperative infections. You will be involved in the care of these patients. On a typical day, the patient census will include approximately 10-15 patients and, on average, two of these patients will be in the ICU. As many patients on the service will require tracheostomy and/or ventilator care, this will be an excellent opportunity to become familiar with the care of these patients, including ventilator management.

Monday - Wednesday

This preceptor has clinic two to three days per week (Monday through Wednesday). On clinic days, you will start with hospital rounds at 9 AM with the attending and nurse practitioner. Following hospital rounds, you will see outpatients in the clinic with a range of pulmonary conditions. The most encountered problems will be obstructive, interstitial, and neoplastic lung disease. These patients may present with acute symptoms or for monitoring of chronic disease. As you evaluate these patients, you will develop a deeper foundation in the evaluation and management of pulmonary disease. You will also understand the indications for testing in pulmonary medicine (e.g., pulmonary function tests, imaging, etc.) and learn how to interpret these studies. Please note that on these days you will see some patients with the preceptor’s colleagues who are specialized in internal medicine.

Thursday - Friday

On these days, the doctor does not see patients in the clinic. You will begin your day with hospital rounds in the morning at about 10 AM and then join the preceptor’s colleagues in the clinic to see outpatients at Noon. Please note that the colleagues are specialized in internal medicine and not in pulmonary medicine.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision (please note that this experience remains within the regulations of California pertaining to the unlicensed practice of medicine):

• Taking patient histories under supervision.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Writing or entering clinic progress notes under supervision (Practice Fusion EMR).

• Interpreting pulmonary function tests and thoracic imaging.

• Researching the literature to answer clinical questions at the point of care.

The activities above will mostly take place in the outpatient setting. As a result of hospital policies, inpatient activities will be more observational.