• Rotation Director:    Steve Escobar, M.D.
• Rotation Location:   Scripps La Jolla, Anderson Medical Pavilion
• Rotation Duration:   One 4-week block for PGY5-6  
• Trainees/month:  One

Rotation Description: 

The Pulmonary Special Procedures Service provides diagnostic and therapeutic interventional services related to the upper and lower airways, pulmonary parenchyma, and the pleural space.  The fellow will work under the direct supervision of Dr. Escobar while performing invasive pulmonary procedures on adult male and female patients in the pulmonary procedures unit, hospital ICUs, and operating room.   

Rotation Objectives: 

1. Knowledge based objectives:
   • Gain in-depth knowledge of the anatomy of the upper and lower airways.
   • Understand the indications, risks, and benefits of interventional pulmonary procedures.
   • Gain familiarity with instrumentation related to interventional pulmonary medicine (flexible and rigid bronchoscopes, light sources, biopsy forceps, transbronchial needles, protected brush catheters, Cope biopsy needle, thoracostomy tubes, suction devices, endobronchial tubes, etc.)
   • Formulate differential diagnoses based on clinical presentation and results of laboratory and radiographic data.
   • Interpret chest radiographs and chest computed tomographic studies.
2. Gain clinical experience in flexible fiberoptic bronchoscopy and associated skills:
   • endobronchial needle aspiration and biopsy
   • transbronchial needle aspiration and biopsy
   • bronchoalveolar lavage
   • protected brush catheter
   • bronchoscopic intubation
   • foreign body retrieval   
   • Gain clinical experience with pleural procedures:
   • thoracentesis
   • ultra-sound guided thoracentesis
   • pleural biopsy
   • chest tube insertion and management
   • pleurodesis
3. Gain clinical experience with miscellaneous pulmonary interventional procedures: 
   • transtracheal aspiration
   • percutaneous tracheostomy
   • transtracheal oxygen catheter placement
   • transthoracic needle aspiration
   • Observe and assist in advanced pulmonary interventional procedures:
   • stent placement
   • rigid bronchoscopy
   • laser bronchoscopy
   • brachytherapy

Learning Venues and Teaching Methods:

Direct Patient Care:

• Special Procedures Unit Scripps La Jolla
• NMCSD Pulmonary Clinic

Task Trainer:

• Bronchoscopy chest model.  Special Procedures Unit.

Suggested reading:

1. Flexible Bronchoscopy, Edited by Ko-Pen Wang and Atul C. Mehta, Publisher: Blackwell Science
2. Manual of Pleural Procedures, Edited by Colt and Mathur, Publisher, Lippincott, Williams and Williams, Philadelphia
3. Textbook of Respiratory Medicine.  Edited by Murray and Nadel.  W.B. Saunders and Company.

Evaluation:

The Trainee will receive a written evaluation at the end of the rotation based on cognitive, patient management, procedural and humanistic skills.  This evaluation, including areas for improvement, will be discussed personally with the trainee at the end of the rotation and then forwarded to the Program Director for inclusion in the trainee’s permanent file.