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Description of the Pediatric Pulmonology Training Program In our Pediatric Pulmonary Medicine Training Program, clinical training is emphasized during the first year of the fellowship, but some research training is intermingled so that the scholarly approach is incorporated into the fellow’s education early in the process. Clinical training accounts for 12 months of the fellowship, with 7 to 8 months of service or elective time the first year of training, and 4 or 5 months total during the final 2 years. Research activity is scheduled in long, uninterrupted blocks, usually 6 to 10 months in duration. Pediatric-trained allergy fellows can share responsibility for this service with junior or senior pediatric pulmonology fellows at St. Louis Children’s Hospital. On average, the pulmonary fellows are on call every 3 to 5 weeks and handle outpatient calls from home, including months covering the inpatient rotation service rotation. In addition, the fellow will be on call to answer calls from parents and other caregivers of children and adolescents with chronic lung disease who receive care from the Division of Allergy and Pulmonary Medicine approximately one night every 2 weeks and distribute electronic communication regarding these calls the following day. After completion of their fellowship training, our fellows are eligible for the Pediatric Pulmonology Subboard Examination of the American Board of Pediatrics. The training program is fully accredited, and we can accommodate as many as 6 fellows (2 per year) in the program. The clinical service consists of the fellow taking responsibility of Pediatric Pulmonary Service and Pediatric Lung Transplantation Service, consultations, bronchoscopies, and emergency outpatient visits. The complexity and volume of the pediatric pulmonology service vary. The service cares for children who have remarkable variety of lung diseases, like cystic fibrosis, asthma, bronchopulmonary dysplasia, acute and obliterative bronchiolitis, pneumonia, dyskinetic cilia syndrome, bronchiectasis, interstitial lung diseases, granulomatous diseases of the lung, lung tumors, surfactant deficiencies, sleep-disordered breathing, apnea, central hypoventilation, and congenital lung anomalies. Many of these patients are admitted to our new 7 East Respiratory Unit. While on this service, the fellows interpret (with supervision) pulmonary function studies (including infant testing), and polysomnograms. Because Washington University has an active lung transplantation service, fellows are exposed to the pre-operative evaluation and post-operative care of these patients. During their time on the lung transplantation service, fellows have the opportunity to learn and perform a variety of bronchoscopic techniques, including bronchoalveolar lavage, endobronchial brush biopsy, and transbronchial biopsy. The pediatric pulmonary fellow also has non-service rotations that are required parts of their clinical training, including (i) Pediatric Intensive Care Unit, (ii) Pediatric Pulmonary Function Laboratory, and (iii) Pediatric Sleep Laboratory, during the first year. The Pediatric Pulmonary Continuity Clinic, supervised by the pulmonary faculty, begins at the onset of the fellowship. All of the fellows are assigned one half-day weekly in Pediatric Ambulatory Clinic located in St. Louis Children’s Hospital. Individual fellows have primary responsibility for their patients and attend the clinic with a full complement of nurses and ancillary staff. Located in proximity to the clinic on the second floor, the Pulmonary Function Laboratory performs a large repertoire of tests including bronchoprovocation, exercise studies, and infant pulmonary function measurements. The Pediatric Clinical Laboratories are adjacent to the clinic, and Pediatric Radiology is located on the floor below. Early in the fellow’s clinical training, the attending physician assumes much of the responsibility for the service and performance of procedures. However, as their skill and confidence increases, the trainees assume most of the responsibility for patient care while still being supervised by faculty from the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine. Several conferences are required parts of the clinical training, providing the fellows with a comprehensive understanding of pulmonary physiology, pathophysiology, and clinical care. In addition to the clinical and research lecture series scheduled by the Department of Pediatrics (Case Management Conference, Pediatric Departmental Forum, and Pediatric Grand Rounds), which frequently cover pulmonary topics, and sessions held by the Division of Pulmonary and Critical Care Medicine at Barnes-Jewish Hospital (Lung Biology Conference and Division of Pulmonary and Critical Care Medicine Grand Rounds), the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine has clinical conferences essential to our educational mission: (i) the Pediatric Pulmonary Physiology Conference, (ii) Pediatric Pulmonary Pathology Conference, and (iii) Pediatric Pulmonary Clinical Conference, (iv) Respiratory Physiology Review; and (v) Pediatric Allergy, Immunology, and Pulmonary Medicine Journal Club. Beginning the first year, Research Training is highlighted, and the fellows are provided with protected time during which they develop and hone skills necessary to be successful as a physician-scientist. Indeed, an emphasis of fellowship training here at Washington University is supervised research experience. The fellow, with mentoring and guidance, is responsible for experimental design, collection of data, as well as subsequent data analysis and interpretation. The fellow selects a research mentor who is responsible for assisting the trainee in the design and execution of a research project and provides laboratory resources necessary for the completion of the project in a timely fashion. The mentor is involved in the day-to-day supervision of the laboratory and meets regularly with the fellow to review data and research progress. The mentor also supervises other related aspects of research training, such as preparation and presentation of the results of the fellow’s work. Every trainee, in consultation with the mentor, fellowship program director, and the Director of the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, will constitute a research committee of four faculty members for his or her project to regularly evaluate research progress, discuss difficulties, and provide advice. Written reports will be prepared by the committee and submitted to the program director. Any concerns regarding the fellow’s progress are discussed at that time, and appropriate measures will be taken to ensure the fellow’s completion of the project. It is expected that as he or she progresses through their project, the trainee will prepare and submit grant applications, scientific abstracts, and first-authored papers that pertain to their work. With time, the fellow will become increasingly independent, and it is up to the mentor, program director, and division director to assure that satisfactory progress toward independence is made. In addition to our research conference, numerous research seminars are held throughout Washington University School of Medicine and are available for fellows to attend. Specifically, 3 research conferences are conducted within the Department of Pediatrics. The Pediatric Research Seminar series is held weekly in the new McDonnell Pediatric Research Building, and investigators from the different research units within the department present their recent work. The required Pediatric Fellows Conference is held weekly, again in the McDonnell Pediatric Research Building, during which trainees are exposed to research from outside the division as well as formal courses in clinical research, statistics and study design, and the responsible conduct of research. Finally, fellows also have the opportunity to take additional graduate courses at the Washington University School of Medicine relevant to their research.
Description of the Pediatric Pulmonology Training Program In our Pediatric Pulmonary Medicine Training Program, clinical training is emphasized during the first year of the fellowship, but some research training is intermingled so that the scholarly approach is incorporated into the fellow’s education early in the process. Clinical training accounts for 12 months of the fellowship, with 7 to 8 months of service or elective time the first year of training, and 4 or 5 months total during the final 2 years. Research activity is scheduled in long, uninterrupted blocks, usually 6 to 10 months in duration. Pediatric-trained allergy fellows can share responsibility for this service with junior or senior pediatric pulmonology fellows at St. Louis Children’s Hospital. On average, the pulmonary fellows are on call every 3 to 5 weeks and handle outpatient calls from home, including months covering the inpatient rotation service rotation. In addition, the fellow will be on call to answer calls from parents and other caregivers of children and adolescents with chronic lung disease who receive care from the Division of Allergy and Pulmonary Medicine approximately one night every 2 weeks and distribute electronic communication regarding these calls the following day. After completion of their fellowship training, our fellows are eligible for the Pediatric Pulmonology Subboard Examination of the American Board of Pediatrics. The training program is fully accredited, and we can accommodate as many as 6 fellows (2 per year) in the program. The clinical service consists of the fellow taking responsibility of Pediatric Pulmonary Service and Pediatric Lung Transplantation Service, consultations, bronchoscopies, and emergency outpatient visits. The complexity and volume of the pediatric pulmonology service vary. The service cares for children who have remarkable variety of lung diseases, like cystic fibrosis, asthma, bronchopulmonary dysplasia, acute and obliterative bronchiolitis, pneumonia, dyskinetic cilia syndrome, bronchiectasis, interstitial lung diseases, granulomatous diseases of the lung, lung tumors, surfactant deficiencies, sleep-disordered breathing, apnea, central hypoventilation, and congenital lung anomalies. Many of these patients are admitted to our new 7 East Respiratory Unit. While on this service, the fellows interpret (with supervision) pulmonary function studies (including infant testing), and polysomnograms. Because Washington University has an active lung transplantation service, fellows are exposed to the pre-operative evaluation and post-operative care of these patients. During their time on the lung transplantation service, fellows have the opportunity to learn and perform a variety of bronchoscopic techniques, including bronchoalveolar lavage, endobronchial brush biopsy, and transbronchial biopsy. The pediatric pulmonary fellow also has non-service rotations that are required parts of their clinical training, including (i) Pediatric Intensive Care Unit, (ii) Pediatric Pulmonary Function Laboratory, and (iii) Pediatric Sleep Laboratory, during the first year. The Pediatric Pulmonary Continuity Clinic, supervised by the pulmonary faculty, begins at the onset of the fellowship. All of the fellows are assigned one half-day weekly in Pediatric Ambulatory Clinic located in St. Louis Children’s Hospital. Individual fellows have primary responsibility for their patients and attend the clinic with a full complement of nurses and ancillary staff. Located in proximity to the clinic on the second floor, the Pulmonary Function Laboratory performs a large repertoire of tests including bronchoprovocation, exercise studies, and infant pulmonary function measurements. The Pediatric Clinical Laboratories are adjacent to the clinic, and Pediatric Radiology is located on the floor below. Early in the fellow’s clinical training, the attending physician assumes much of the responsibility for the service and performance of procedures. However, as their skill and confidence increases, the trainees assume most of the responsibility for patient care while still being supervised by faculty from the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine. Several conferences are required parts of the clinical training, providing the fellows with a comprehensive understanding of pulmonary physiology, pathophysiology, and clinical care. In addition to the clinical and research lecture series scheduled by the Department of Pediatrics (Case Management Conference, Pediatric Departmental Forum, and Pediatric Grand Rounds), which frequently cover pulmonary topics, and sessions held by the Division of Pulmonary and Critical Care Medicine at Barnes-Jewish Hospital (Lung Biology Conference and Division of Pulmonary and Critical Care Medicine Grand Rounds), the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine has clinical conferences essential to our educational mission: (i) the Pediatric Pulmonary Physiology Conference, (ii) Pediatric Pulmonary Pathology Conference, and (iii) Pediatric Pulmonary Clinical Conference, (iv) Respiratory Physiology Review; and (v) Pediatric Allergy, Immunology, and Pulmonary Medicine Journal Club. Beginning the first year, Research Training is highlighted, and the fellows are provided with protected time during which they develop and hone skills necessary to be successful as a physician-scientist. Indeed, an emphasis of fellowship training here at Washington University is supervised research experience. The fellow, with mentoring and guidance, is responsible for experimental design, collection of data, as well as subsequent data analysis and interpretation. The fellow selects a research mentor who is responsible for assisting the trainee in the design and execution of a research project and provides laboratory resources necessary for the completion of the project in a timely fashion. The mentor is involved in the day-to-day supervision of the laboratory and meets regularly with the fellow to review data and research progress. The mentor also supervises other related aspects of research training, such as preparation and presentation of the results of the fellow’s work. Every trainee, in consultation with the mentor, fellowship program director, and the Director of the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, will constitute a research committee of four faculty members for his or her project to regularly evaluate research progress, discuss difficulties, and provide advice. Written reports will be prepared by the committee and submitted to the program director. Any concerns regarding the fellow’s progress are discussed at that time, and appropriate measures will be taken to ensure the fellow’s completion of the project. It is expected that as he or she progresses through their project, the trainee will prepare and submit grant applications, scientific abstracts, and first-authored papers that pertain to their work. With time, the fellow will become increasingly independent, and it is up to the mentor, program director, and division director to assure that satisfactory progress toward independence is made. In addition to our research conference, numerous research seminars are held throughout Washington University School of Medicine and are available for fellows to attend. Specifically, 3 research conferences are conducted within the Department of Pediatrics. The Pediatric Research Seminar series is held weekly in the new McDonnell Pediatric Research Building, and investigators from the different research units within the department present their recent work. The required Pediatric Fellows Conference is held weekly, again in the McDonnell Pediatric Research Building, during which trainees are exposed to research from outside the division as well as formal courses in clinical research, statistics and study design, and the responsible conduct of research. Finally, fellows also have the opportunity to take additional graduate courses at the Washington University School of Medicine relevant to their research.
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