The following are areas identified as "needs improvement" on the self assessment as of May 2019

Complex airway management:

• I think competence is a difficult word because I have witnessed some airways that are difficult even for trained anesthesia staff. Also, easy intubations do not offer the same amount of learning as difficult ones. I feel competent in doing "Easy" intubations but I hope to do at least 20 "difficult" intubations by the end of fellowship.

Complex airway procedures:

• Unfotunately, a lot of the complex airway issues I had occurred overnight and I still don't feel comfortable managing it without the help of anesthesia. Often, the anesthesia residents also bring their staff, who end up supervising them in the case.

 

Advanced Diagnostic Bronch:

• I have not had enough opportunity to practice endobronchial biopsy this year. Usually I do the diagnostic scope and a 2nd or 3rd year do the ultrasound portion.

Areas of weakness:

• I am someone that loves learning/reading based on cases I encounter, in particular looking at primary literature during pulmonary consult rotations, which always brings up interesting questions. However, I also need to devote time to reading and studying outside of clinical cases, which have been hard to do this year. I greatly enjoy this activity when I do set the time to do it.

• I would like to work more on my research. Ih has been difficult, since my second half of the year had 6 months of ICU/consults in 7 months total.

• 1st year does not have enough time to explore clinics due to the volume of calls and ICU months. I feel much better in inpatient pulmonary consult and ICU but I still need much more experience in outpatient pulmonary medicine.

How will you improve:

• I will build in afternoons to do reading during elective time. I will continue to incorporate reading primary literature to Chest Conferences, journal clubs, and other presentations at state/national conferences. I plan in 2nd year on giving lectures to residents when I run consults and during ICU time. I have done a lecture and simulation on ventilator alarms to medical students and plan on doing this again in the fall.

• Plan on working more on research during elective time second year

• I hope to use elective time to do more clinics in the 2nd and 3rd year

Strengths:

• I think I have been fairly good this year about patient-family centered medicine - overnight, families are notified and updated. I have lead family meetings many times overnight and I have improved a lot through experience on helping families make critical decisions even when there is not a lot of time to establish rapport. I think for the most part my plan of care overnight have been thorough and my triage decisions overnight have been consistent with the follow-up team on chart review. I avoid making medical decisions that are not evidence based if I can. I try to read on cases, even overnight in the ICU. I think I run the consult service efficiently and effectively and the learners on the service have an enjoyable experience without experiencing too much burnout. I do think I can work on doing more teaching on the service.