Clinical Training at Veterans Affairs Medical Center (VAMC)
The San Francisco Veterans Affairs Medical Center (SFVAMC) is a 250-bed facility that is an integral part of the UCSF teaching and research programs. The hospital serves as the major referral center for outpatient VA clinics in Northern California and Nevada. Due to the nature of the population served, there are a large number of patients with chronic obstructive pulmonary disease, lung cancer, and asthma as well as interstitial lung diseases, pleural disorders, sleep disorders, pulmonary infections and AIDS, and pulmonary vascular diseases.
The two clinical rotations for first-year pulmonary fellows at VAMC are:
Pulmonary Consultation Service
Working one-on-one with an attending pulmonary physician, fellows on this rotation serve as inpatient consultants for the Medical and Surgical Services. In addition, they provide rapid turn-around evaluations in ambulatory care for patients referred for lung cancer and receive intensive instruction in performing bronchoscopic procedures including bronchoalveolar lavage, transbronchial, airway mucosal, and bronchoscopic fine needle biopsies, and endobronchial ultrasound-guided bioposies. At weekly meetings, biopsies are reviewed with a pathologist, and diagnostic and therapeutic approaches are discussed at a Medical-Surgical-Oncologic Chest Conference. Fellows also receive instruction in interpretation of chest imaging studies from a chest radiologist and are responsible for reviewing sleep and pulmonary function studies.
Under a new closed-unit model, the ICU Team provides comprehensive care for MICU patients and participates actively and daily in the care of SICU patients. Two faculty members serve as attendings at all times, usually a pulmonologist and a surgeon or anesthesiologist. The pulmonary fellow on this rotation works with UCSF medical, surgical, and anesthesiology residents to provide a multidisciplinary approach to the care of these patients.