The principle of progressive responsibility discussed above also applies to fellows while rotating on pulmonary consult service.

First-Year Fellows: Day of patient evaluation, they must consult with the staff. Mostly at the bedside, daily rounds are conducted with first-year fellows.

Second-Year Fellows: They need to formally present all new in-patient consultations to the staff within a day of evaluating the patient, demonstrating a more proactive role. Bedside rounds with the fellow and attending may occur as little as twice a week.

Third-Year Fellows: By their third year, they’re expected to operate with increased independence, performing much like junior faculty. They’re responsible for overseeing the consult service and a lower-year fellow. Staff should be informed about all patients within a day of evaluation, but for straightforward cases, formal presentations aren’t needed.