Division of
Pulmonary & Critical Care Medicine
Division Director: Guillermo Gutierrez, MD, PhD
Fellowship Director: Guillermo Gutierrez, MD, PhD
At GWU Hospital, the clinical services of the division include busy outpatient clinics with emphasis upon asthma, chronic airways and interstitial lung diseases, sleep medicine, HIV-related lung disease and respiratory dysfunction in chronic neuromuscular disease.
The inpatient consultative service provides assistance in diagnosis and therapy of pulmonary and allergic problems in medical and surgical patients, as well as the management of critically ill patients in the Medical Concentrated Care Unit, the CCU and ICU.
Bronchoscopy with all attendant diagnostic techniques is performed daily at GWU Hospital. Other routinely performed procedures include percutaneous needle aspiration biopsy of lung lesions, pleural biopsy, pulmonary artery catheterization, endotracheal intubation, chest tube placement and non-invasive ventilation.
The division also performs laser and photodynamic therapy for endobronchial lesions. The pulmonary function laboratory offers complete physiologic evaluation of lung function, including exercise studies and bronchoprovocation challenges. Excellent radiologic support capabilities are available at all facilities.
Introduction
The George Washington University Medical Center, Division of Pulmonary and Critical Care Medicine, and its affiliated hospitals offer a three-year training program in pulmonary and critical care medicine. The medical school faculty of 12 full-time hospital-based pulmonary and critical care clinicians and academic scholars is supplemented by the full-time staff of the Surgical Critical Care Department at the Washington Hospital Center. Interaction within this team provides a broad and diverse environment for clinical education and research training. Three hospitals participate in the clinical program: The George Washington University Hospital (GWUH), The Washington Hospital Center (WHC), and the Washington Veterans Affairs Medical Center (VAMC).
Philosophy and Goals
The purpose of the Fellowship Training Program is to prepare board-eligible internists for a career in clinical or academic pulmonary and critical care medicine. The educational program provides the physicians with the basic science and clinical knowledge to become respected consultants in pulmonary and critical care medicine and to perform the appropriate invasive procedures expected of a pulmonary and critical care specialist. Training is carried out in a scholarly, structured academic atmosphere and will expose the individual to a variety of clinical problems. Furthermore, the program encourages each trainee to pursue research projects with faculty supervision. Upon completion of the program, each individual will have a sufficient knowledge base to pass the American Board of Internal Medicine Sub-Specialty Examinations in Pulmonary Diseases and Critical Care Medicine.
Education
The educational program includes experience in inpatient and outpatient care, pulmonary rehabilitation, formal chest X-ray reading sessions, pulmonary pathology sessions, pulmonary-radiology-surgical chest conferences, pulmonary physiology conferences, sleep-related pulmonary conferences, critical care medicine conferences, and journal club-research conferences. During training, fellows receive close supervision by the faculty. The ratio of faculty to trainees exceeds 1:1 at each of the institutions.
Inpatient Clinical Experience
Approximately six months of each year of the training program are spent providing pulmonary consultations on inpatient services at the GWUH, VAMC and WHC under the direct supervision of the full-time faculty. Two months are spent at each of the medical centers, providing the opportunity to observe and manage patients with a wide array of pulmonary diseases. During these months, training in practical aspects of pulmonary procedures, including fiberoptic broncoscopy and related techniques, pleural biopsy, chest tube placement and transthoracic needle aspiration biopsy of the lung, is provided as a part of an inpatient consultation. Guidance is also provided in examination and interpretation of sputum, bronchopulmonary secretions, pleural fluid/tissue, and lung tissue for infectious agents, cytology, and histopathology. An elective rotation through the Pediatric Pulmonary Division at the Children’s Hospital National Medical Center is also available.
Outpatient and Longitudinal Follow-Up Patient Care
Each trainee obtains experience in providing consultation and managing pulmonary patients in an outpatient setting at GWUH, VAMC, and the WHC with supervision provided by the attending staff. These clinics also provide an opportunity to follow patients after they are discharged from the hospital. In addition, each trainee obtains longitudinal patient care experience by following pulmonary patients in a weekly pulmonary clinic at the VAMC. Several attending physicians are available to provide onsite consultation to the fellow during the clinic. At the end of the clinic, chest X-rays and the clinical cases are reviewed.
Clinical Conferences
Conferences dealing with pulmonary physiology and exercise testing, sleep-related pulmonary problems, and pulmonary pathology supplement what is learned during consultations. Several radiology conferences througout the week help fellows develop skills in interpretating chest radiographs, computed tomography and various radioisotope scans. Multi-institutional pulmonary-radiology-surgery conferences are held weekly at GWUH and WHC. They are attended by the pulmonary and critical care faculty. Faculty from radiology, cardiothoracic surgery and occasionally infectious diseases and pathology are in attendance. At these conferences, interesting clinical cases are presented by both full-time and part-time members of the faculty. Journal club-research conferences are held monthly. A core-curriculum conference is held weekly with faculty members. Over a period of three years, all major topics related to pulmonary and critical care medicine are covered. Pulmonary and critical care Grand Rounds by visiting faculty are held several times a year.
Physiology
All participating hospitals have pulmonary function laboratories capable of doing spirometry, flow volume studies, lung volumes, diffusing capacity, arterial blood gas analysis and exercise studies. During the course of three years, two to three months are spent in the pulmonary function lab at the VAMC learning how to perform tests, evaluate acceptability and reproductibility of tests, and interpret them. Fellows supervise inhalation challenge and exercise tests. Fellows are expected to intitiate clinical research protocols during this rotation. During this rotation, trainees attend Sleep Study Clinic with the neurology attending and also gain experience in endotracheal intubation with anesthesiologists. Fellows are also expected to give conferences to respiratory therapists and pulmonary function laboratory personnel.
Lung Transplantation
Fellows rotate through the INOVA Lung Transplant Service during their third year of fellowship for a month and are involved in all aspects of care—evaluation of potential lung transplantation candidates, evaluation of potential lung donors, observation of lung transplant surgery and management of lung transplant recipients in the peri-operative period and in outpatient setting. Experience is also gained in management of patients with pulmonary hypertension receiving continuous infusion of prostacyclin.
Pathology
Fellows rotate for a month through the Armed Forces Institute of Pathology. Clinical history, radiographs and pathology of pulmonary cases referred for opinion are reviewed. Also available is a vast collection of teaching slides showing radiologic and pathologic correlation.
Research
Direct involvement of the trainee in a research program will enhance their scholarly development, provide a foundation for logical and critical thinking and encourage life-long habits of continuing scholarship. Through their research experience, each trainee will learn the design and interpretation of research studies, the evaluation of investigative methods, and the interpretation of data to develop competence in critical assessment of the medical literature
During the first year, the trainees are introduced to the research interest of the faculty. It is expected that during the early fall of the first year, each trainee will discuss projects with various faculty members and then decide on a research theme. One faculty member will act as a preceptor for the project and will meet frequently with the trainee to review his or her work. It is fully expected that a trainee will initiate and complete one or two projects during the fellowship training. Funding will be available to permit each trainee to present an accepted paper or abstract at regional and national meetings and to pursue a wide range of individual studies. Teaching
Fellows are encouraged and expected to participate in the pulmonary physiology course given to first year medical students and also in case conferences given to second year medical students. These are usually small group sessions and are beneficial to trainees in strengthening the understanding of fundamentals of physiology and how to convey such concepts to others. Several times during the year, city-wide pulmonary case conferences involving faculty from local teaching institutions are held under the sponsorship of the District of Columbia Thoracic Society. Annually, fellows present cases at these conferences. Fellows also give one or two conferences to internal medicine house staff at the VA Medical Center during the three years of training.
Critical Care
Over a three-year period, 12 months will be devoted to critical care experience with rotations through the following ICUs:
- Medical Intensive Care Unit—Washington Hospital Center
- Surgical Intensive Care Unit—Wasington Hospital Center
- Medical Intensive Care/Coronary Care Unit—Veterans Affairs Medical Center
Each intensive care unit has a high turnover of acutely ill patients with multisystem failure. Rotations through the combined Medical-Surgical Intensive Care Unit at GWUH are also available. Trainees rotating through VAMC MICU-CCU are expected to participate in CCU rounds conducted by cardiologists. The training in critical care medicine is designed to provide each trainee with sufficient exposure to critically ill patients. This learning process includes evaluation of critically ill patients, guiding care of these patients with the house staff, learning procedural skills used in intensive care medicine such as endotracheal intubation, right heart catheterization, and
intraaortic balloon pump and ventricular assist device under the supervision of an attending staff. Methods of weaning, ventilator management and hemodynamic monitoring are emphasized during daily teaching rounds. The Critical Care Training Program is truly an interdisciplinary medical program. Trainees come into contact with a wide range of subspecialties in such fields as general surgery, neurology, thoracic surgery, anesthesia and obstetrics-gynecology.
Faculty
Guillermo Gutierrez, MD, PhD
Professor of Medicine and of Anesthesiology
Division Director, Pulmonary Diseases and Critical Care Medicine
Prashant K. Rohatgi, MD
Professor of Medicine
Co-director of Pulmonary and Critical Care Fellowship
Director, Division of Pulmonary Disease and Allergy, Veterans Affairs Medical Center Gene L. Colice, MD
Co-director of Pulmonary and Critical Care Fellowship
Director of Pulmonary and Critical Care Medicine Section, Washington Hospital Center
Fields of Interest: Pleural Diseases, Lung Cancer Staging, COPD and Asthma
Morgan D. Delaney, MD
Associate Professor of Medicine, George Washington University Medical Center
Fields of Interest: Sarcoidosis, Interstitial Lung Diseases, Bronchial Asthma
Susan M. Hasselquist, MD
Assistant Professor of Medicine, George Washington University Medical Center
Fields of Interest: Sleep Physiology, Sleep-Related Breathing Disorders
Vinayak Jha, MD
Assistant Professor of Medicine, George Washington University Medical Center
Field of Interest: Weaning from Mechanical Ventilation
Burton Lee, MD
Medical Director, MICU, Washington Hospital Center
Field of Interest: Evidence-based Medicine
Peter D. Levit, MD, FCCP
Assistant Professor of Medicine, George Washington University Medical Center
Director, Pulmonary Function Laboratory, Washington Hospital Center
Fields of Interest: Pulmonary Physiology, Critical Care Medicine
Ann E. Medinger, MD, FACP, FCCP
Associate Professor of Medicine and Physiology, George Washington University Medical Center
Director, Pulmonary Physiology Laboratory, Veterans Affairs Medical Center, Washington, DC
Field of Interest: Pulmonary Physiology
Samuel V. Spagnolo, MD, FACP, FCCP
Professor of Medicine, George Washington University Medical Center
Fields of Interest: Clinical pulmonary disease, tuberculosis, percutaneous lung aspiration.
Immunology and Allergy Faculty, GWUMC
Daniel Ein, MD
Clinical Professor of Medicine, George Washington University Medical Center
Director, Allergy & Sinus Center
Richard Nicklas, MD
Clinical Professor of Medicine, George Washington University Medical Center
Surgical Critical Care Faculty, Washington Hospital Center
Arthur St. Andre, MD
Director Surgical Critical Care Services, Washington Hospital Center
Associate Clinical Professor of Medicine, George Washington University Medical Center
Fields of Interest: Information Database
Raymond DiPhillips, MD
Medical Director, SICU, Washington Hospital Center
Associate Clinical Professor of Medicine, George Washington University Medical Center
Daniel L. Herr, MD
Medical Director, MEDSTAR
Assistant Clinical Professor of Neurosurgery, George Washington University Medical Center
Michael Hockstein, MD
Senior Staff Physician, SICU, Washington Hospital Center
George Sample, MD
Senior Staff, MEDSTAR, Washington Hospital Center
Associate Clinical Professor of Medicine, George Washington University Medical Center
Lung Transplant Faculty at INOVA Transplant Center
Steven Nathan, MD
Medical Director, Lung Program
Nelson Burton, MD
Surgical Director, Heart and Lung Program
Last
Updated: November 5, 2006 |