What you will do:

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 in the ICU of several hospitals. 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.

This preceptor has clinic two to three days per week. On clinic days, you will start with hospital rounds at 7 AM. For the next two hours, you will round with the attending and the nurse practitioner. These rounds will take place at two different hospitals. 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.

When this doctor is not in the clinic, you will spend those days entirely in the hospital. This doctor has a large census of patients in the ICU, typically 10-20 at a time, and you will accompany the doctor for rounds in the ICU and possibly the medicine floor if there are any patients or consults to be seen there. Goals for the ICU component of this clinical experience are becoming familiar with the evaluation and management of common critical care problems, including respiratory failure, gastrointestinal bleeding, sepsis, hypotension, altered mental status, pneumonia, DKA, AKI, and liver failure. Rotators will also have the opportunity to expand their knowledge of medications used in the ICU (e.g., antibiotics, insulin drips, benzodiazepines, propofol, and vasopressors). Since an important part of ICU care is the prevention of complications, rotators will be exposed to best practices (e.g., stress ulcer and VTE prophylaxis, prevention of VAP, decubitus ulcers, and line infections).

Being in the ICU will allow you to see how members of a multidisciplinary team come together to provide patients with high-quality care. You will observe how the preceptor interacts with patients and their families in a respectful and compassionate manner.

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.

• 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.