To the new incoming Pulmonary Medicine fellows, welcome to the specialty! Here are my 10 tips for success.

Inspired by @AndrewJSauer’s tips for cardiology fellows.

Please feel free to add to them! @KerriBerriKerri @srpendharkar @CTS_SCT @accpchest @atsearlycareer

1. Read West’s “Respiratory Physiology: the essentials” in your first month. Pulmonary is still a physiology-based specialty at its heart. When there isn’t great evidence, you fall back on physiologic principles.

2. Imaging. Practice, practice, practice looking at CXRs and CTs. Spend time with chest radiologists and interventional radiologists if you can. Consult with radiologists and ask them for their opinion. Learn from them. Walk down and talk to them face-to-face!

3. Listen to the nurses and Respiratory Therapists. They have lots of experience and lots of tips for you about managing chest tubes and oxygen delivery methods and so much more.

4. If you can, spend time with palliative care docs and nurses. Even if you can’t do a full elective, learn how to palliate symptoms of end-stage lung disease and learn techniques to discuss goals of care early on.

5. Chest tubes. Depending on the hospital where you work, you might be the go-to chest tube person at night. Before your first night on call, refresh how to do a chest tube by Seldinger technique or surgical approach. https://www.nejm.org/doi/full/10.1056/NEJMvcm071974

6. Find several mentors in different areas and with different types practices early on. Community practice can be very different than a hospital-based or academic practice. Get exposed to all possibilities.

7. Try to spend time with Thoracic Surgeons and Fellows. If you can, go to the OR and see post-op patients. You need to understand the operations you are sending people for.

8. Before you say “My differential for this pattern is ...”, Spend time to think and order your DDx by probability. Of course it could be TB or LAM, but tell us what’s most likely first.

9. Paraphrasing this one from @AndrewJSauer b/c so important: Know the limits of your knowledge & experience. Know when to call for help and do it. Even at 2 AM. I have never yelled at a fellow for calling at 2AM. I will get upset for calling at 8AM when they deteriorated at 2AM.

10. Pulmonary Hypertension is my passion, but remember most PH on echo is left heart disease, even when the LV “looks” normal. Look at the whole echo report, look at the LA volume and diastolic parameters. Work it up, rule out lung disease, and CTEPH before you refer for cath.