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Division of Chest Medicine

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Fellowship Training in the Division of Chest Medicine

Training program	(1) Patient care General ward: In the first year of fellowship training, trainees need to participate in the ward round with attending physicians, and need to supervise and help the residents, nurse practitioners and clerks with patient care and invasive procedures. Intensive care unit: In the second year of fellowship training, trainees need to participate in the daily ward round with attending physicians and the weekly ventilator round with respiratory therapists, learning the managements for critically-ill patients with respiratory failure and the principles of mechanical ventilation. Consultation: In the first year of fellowship training, the trainees are in charge of the consult requests from the general ward and the emergency room. In the second year of fellowship training, the trainees are assigned to manage the consult requests from the intensive care unit. All consult recommendations need to be confirmed with attending physicians. Out-patient department: In the second year of fellowship training, trainees need to attend attending physicians’ weekly out-patient services, learning patient care in the out-patient department. (2) Examinations for pulmonary disease Interpretation of chest image study: Trainees need to attend weekly chest X-ray teaching program held by senior attending physicians and enter the monthly challenge for chest X-ray interpretation. For the training of interpretation of chest computerized tomography, trainees are encouraged to attend weekly multidisciplinary lung cancer symposium and monthly multidisciplinary interstitial lung disease symposium. Interpretation of pulmonary function test: Trainees should learn the indications for various pulmonary function tests, including screen spirometry, plethysmography, diffusing capacity for carbon monoxide, bronchial provocation test and exercise pulmonary function test. In the second year of fellowship training, the trainees need to write a formal pulmonary function report under the supervision of attending physicians. Bronchoscopy: In the first year of fellowship training, the trainees learn to practice simple bronchoscopy for the general ward and the out-patient department (bronchoalveolar lavage, brushing and biopsy) under the supervision of attending physicians. In the second year of fellowship training, the trainees are in charge of the bronchoscopy for intensive care unit. The learning of complicated bronchoscopy (EBUS-TBNA, cryobiopsy, tracheostomy creation, stent insertion) and pleuroscopy are encouraged. Interpretation of chest sonography Other invasive procedures:Trainees should learn pleural biopsy by Abram’s needle, pig-tail and chest tube insertion, and echo guided lung biopsy. (3) Respiratory therapy and intensive care medicine Respiratory therapy: Trainees need to learn the functions and operations of respiratory therapy equipment, including mechanical ventilator, oxygen device and moisture therapy, and help respiratory therapists to resolve clinical problems. Case discussion and journal reading: In the second year of fellowship training, the trainees will be assigned to assist respiratory therapists in preparing case discussions and journal reading for morning meetings. Host morning meeting: In the second year of fellowship training, the trainees need to host the weekly morning meeting of intensive care division under the supervision of attending physicians. (4) Medical research Critical appraisal for research papers: Under the supervision of attending physicians, the trainees are assigned to present clinical research papers published in top journals of in chest medicine on a weekly basis. Study design and process: The trainees are also encouraged to conduct clinical or laboratory research under the supervision of attending physicians. Participation in laboratory research is limited to second year of fellowship training. Manuscript writing: Trainees need to complete a poster for clinical case report or research in the first year of fellowship training, and to publish an article in medical journal before the completion of the fellowship training.
Assessment	The attending physicians regularly assess the trainees’ learning, and working attitude, professional knowledge, clinical judgment skills, special examination skills, the ability to communicate with patients and family members. Chief of chest medicine concludes assessments for trainees from all attending physicians, the trainee will receive training certificate after meeting the required standards.

Training program

(1) Patient care

General ward: In the first year of fellowship training, trainees need to participate in the ward round with attending physicians, and need to supervise and help the residents, nurse practitioners and clerks with patient care and invasive procedures.
Intensive care unit: In the second year of fellowship training, trainees need to participate in the daily ward round with attending physicians and the weekly ventilator round with respiratory therapists, learning the managements for critically-ill patients with respiratory failure and the principles of mechanical ventilation.
Consultation: In the first year of fellowship training, the trainees are in charge of the consult requests from the general ward and the emergency room. In the second year of fellowship training, the trainees are assigned to manage the consult requests from the intensive care unit. All consult recommendations need to be confirmed with attending physicians.
Out-patient department: In the second year of fellowship training, trainees need to attend attending physicians’ weekly out-patient services, learning patient care in the out-patient department.

(2) Examinations for pulmonary disease

Interpretation of chest image study: Trainees need to attend weekly chest X-ray teaching program held by senior attending physicians and enter the monthly challenge for chest X-ray interpretation. For the training of interpretation of chest computerized tomography, trainees are encouraged to attend weekly multidisciplinary lung cancer symposium and monthly multidisciplinary interstitial lung disease symposium.
Interpretation of pulmonary function test: Trainees should learn the indications for various pulmonary function tests, including screen spirometry, plethysmography, diffusing capacity for carbon monoxide, bronchial provocation test and exercise pulmonary function test. In the second year of fellowship training, the trainees need to write a formal pulmonary function report under the supervision of attending physicians.
Bronchoscopy: In the first year of fellowship training, the trainees learn to practice simple bronchoscopy for the general ward and the out-patient department (bronchoalveolar lavage, brushing and biopsy) under the supervision of attending physicians. In the second year of fellowship training, the trainees are in charge of the bronchoscopy for intensive care unit. The learning of complicated bronchoscopy (EBUS-TBNA, cryobiopsy, tracheostomy creation, stent insertion) and pleuroscopy are encouraged.
Interpretation of chest sonography
Other invasive procedures:Trainees should learn pleural biopsy by Abram’s needle, pig-tail and chest tube insertion, and echo guided lung biopsy.

(3) Respiratory therapy and intensive care medicine

Respiratory therapy: Trainees need to learn the functions and operations of respiratory therapy equipment, including mechanical ventilator, oxygen device and moisture therapy, and help respiratory therapists to resolve clinical problems.
Case discussion and journal reading: In the second year of fellowship training, the trainees will be assigned to assist respiratory therapists in preparing case discussions and journal reading for morning meetings.
Host morning meeting: In the second year of fellowship training, the trainees need to host the weekly morning meeting of intensive care division under the supervision of attending physicians.

(4) Medical research

Critical appraisal for research papers: Under the supervision of attending physicians, the trainees are assigned to present clinical research papers published in top journals of in chest medicine on a weekly basis.

Study design and process: The trainees are also encouraged to conduct clinical or laboratory research under the supervision of attending physicians. Participation in laboratory research is limited to second year of fellowship training.

Manuscript writing: Trainees need to complete a poster for clinical case report or research in the first year of fellowship training, and to publish an article in medical journal before the completion of the fellowship training.

Assessment

The attending physicians regularly assess the trainees’ learning, and working attitude, professional knowledge, clinical judgment skills, special examination skills, the ability to communicate with patients and family members. Chief of chest medicine concludes assessments for trainees from all attending physicians, the trainee will receive training certificate after meeting the required standards.