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Pediatric Pulmonology Fellowship Program
at the Washington University School of Medicine
The multidisciplinary Division of Pediatric Allergy, Immunology and Pulmonary Medicine at St. Louis Children’s Hospital remains strong and productive, pursuing its academic mission to advance knowledge of the bases of pulmonary and allergic diseases and to develop novel diagnostic and treatment approaches for our patients. Its commitment to excellence in patient care, teaching, and research was recognized by our Division's inclusion as one of America's best pulmonary services, according to Parent magazine's 2008 survey and the 2009 US & World Report Best Hospitals ranking. Nine faculty members from the Division were listed as Best Doctors in America this year.
The ACGME-accredited pediatric pulmonology fellowship training program continues to attract promising pediatric candidates for subspecialty training and to develop the next generation of academic pulmonologists, as evidenced by their recent grant and publication record (see below).
In our Division you will find:
- a center that is participating in National Institutes of Health-funded childhood asthma research programs, including the Children’s Asthma Management Program (CAMP), Children’s Asthma Research and Education Program (CARE), and AsthmaNet that are helping us understand the benefits and long-term effects of asthma treatment in children,
- clinical investigators who are intimately involved in minority programs designed to impact asthma morbidity,
- a National Institues of Health-sponsored, multidisciplinary center examining pulmonary complications leading to morbidities and mortality of sickle cell disease
- a cystic fibrosis center that cares for nearly five hundred patients and an active part of the Therapeutic Development Network, a Cystic Fibrosis Foundation-supported program designed to rapidly bring new therapies to syctic fibrosis patients,
- a pediatric lung transplantation program that cares for the largest cohort of lung and heart-lung transplant patients in North America, providing the framework for the interdisciplinary National Institutes of Health-funded project examining the role of respiratory viruses and associated immune response on graft dysfunction,
- a center for the Genetic Determinants of Mucociliary Clearance Consortium, part of the National Institutes of Health Rare Diseases Clinical Research Network, which was created to better define pathogenesis, natural history, and treatment of primary ciliary dyskinesia and atypical forms of cystic fibrosis,
- a clinical research program studying the prevention of sudden infant death syndrome, funded by the Gates Foundation,
- an evolving multispecialty clinic for chronically ill children who are technology-dependent,
- a bronchoscopy center where more than 500 procedures are performed annually,
- a busy multidisciplinary pediatric sleep diagnostics center and fully automated laboratory,
- a state-of-the-art pulmonary function laboratory proficient in performing both pediatric and infant studies, and
- renowned, well-funded basic and translational research programs that are examining the cellular and molecular mechanisms and disease processes of asthma, cystic fibrosis, surfactant deficiencies, ciliopathies, emphysema, and respiratory infections. Moreover, research opportunities are not limited to the Division, and numerous collaborations exist throughout the medical center.
The Division of Pediatric Allergy and Pulmonary Medicine offers challenging medical goals and unparalleled research potential. If you are interested in pursuing a career in pediatric pulmonary medicine here at Washington University in St. Louis, please contact us at:
Thomas Ferkol, MD
Associate Professor of Pediatrics, Cell Biology and Physiology
Director, Division of Allergy and Pulmonary Medicine
One Children’s Place
St Louis, Missouri 63110
Telephone: 314 286-2886
E-mail address: ferkol_t@kids.wustl.edu
Evaluation and Promotion of Residents and Clinical Fellows
a. Evaluation
The program director and faculty meet biannually to evaluate the educational and professional progress and achievement of each clinical fellow. The program director also meets with each clinical fellow individually to discuss a written summary of the evaluations every six months, or more frequently as dictated by the individual fellow’s performance.
The evaluations are based on achieving competency in the following elements:
- Fund of knowledge concerning cell and molecular biology of the lung, pulmonary physiology and lung mechanics, lung pathophysiology, and clinical topics, and the application of that knowledge to patient care and diagnostic testing.
- Clinical and technical skills, including expertise in fiberoptic bronchoscopy, bronchoalveolar lavage, and transbronchial biopsy.
- Clinical and scientific judgment.
- Personal character traits displayed; interpersonal skills.
- Teaching skills.
- Ability to assume increased responsibility for patient care.
An evaluation file shall be maintained by the program director for each clinical fellow and treated as confidential. The file may be reviewed by the resident and by divisional/departmental faculty and staff with legitimate educational and administrative purposes. The Standing Committee on Graduate Medical Education (GME) Program Evaluation will review the evaluation plan of a program at the time of the Internal Review. The reviewer who meets with program faculty may ask to review a representative set of trainee files.
Finally, using a computer-based system, the fellows anonymously evaluate the performance of supervising attending physicians during the course of the academic year. These faculty evaluations are forwarded to the Chief of the Division of Pediatric Allergy and Pulmonary Medicine and considered in their annual evaluations.
b. Promotion
Promotion of clinical pulmonology fellows to the next level of the program depends upon the fellow's performance and qualifications. The fellow should achieve at least average overall scores in their clinical and research evaluations. Decisions about promotion or reappointment of clinical fellows by the program director are communicated to the trainee as soon as reasonably practicable under the circumstances. In cases where reappointment letters or contracts are issued, communication between program directors and the Graduate Medical Education (GME) office will occur at least three months in advance of a new appointment year.
Disciplinary Action, Suspension, or Termination
a. Informal Procedures
The program director will use informal efforts to resolve minor instances of poor performance or misconduct. In any case in which a pattern of deficient performance has emerged, informal efforts by the Program Director shall include notifying the fellow in writing of the nature of the pattern of deficient performance and remediation steps, if appropriate, to be taken by the fellow to address it. If these informal efforts are unsuccessful or where performance or misconduct is of a serious nature, the division chief or fellowship program director may impose formal disciplinary action.
b. Formal Disciplinary Action
Disciplinary action may be taken for due cause, including but not limited to any of the following:
- Failure to satisfy the academic or clinical requirements of the training program.
- Professional incompetence, misconduct, or conduct that might be inconsistent with or harmful to patient care or safety.
- Conduct that is detrimental to the professional reputation of the Hospital or School of Medicine.
- Conduct that calls into question the professional qualifications, ethics, or judgment of the resident/clinical fellow, or that could prove detrimental to the Hospital's or School of Medicine's patients, staff, employees, volunteers, or operations.
- Violation of the bylaws, rules, regulations, policies, or procedures of the Washington University School of Medicine, St. Louis Children’s Hospital, Department of Pediatrics, Division of Pediatric Allergy and Pulmonary Medicine, including violation of the Responsibilities of Clinical Fellows set forth by the Department of Pediatrics.
- Scientific misconduct.
c. Specific Procedures
Formal disciplinary action includes:
- Suspension, termination, or non-reappointment.
- Reduction, limitation, or restriction of the resident's clinical responsibilities.
- Extension of the pulmonology fellowship or denial of academic credit that has the effect of increasing the number of clinical service months or extending the fellowship.
- Denial of certification of satisfactory completion of the residency program.
The division chief or the fellowship training program director shall notify the clinical fellow in writing of the action taken and the specific reasons. The fellow will be notified in writing of any disciplinary action that would require extension of training or delays in promotion no later than four months before the end of the fellow’s current contract. A copy of the notification shall be furnished to the Associate Dean for Medical Education. The notification should advise the clinical fellow of his or her right to request a review of the action in accordance with the grievance procedure set forth below.
In the case of a suspension, written notification will precede the effective date of the suspension unless the division chief or program director determines in good faith that continued appointment of the clinical fellow places safety or well-being of patients or personnel in jeopardy, or immediate suspension is required by law or necessary in order to prevent imminent or further disruption of activities at the Washington University School of Medicine, St. Louis Children’s Hospital, or Department of Pediatrics, in which case the notice will be provided at the time of suspension.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Duty Hours
The pediatric pulmonology fellowship program has adopted the following policy on duty hours. Graduate medical education in many specialties requires a commitment to continuity of patient care. At the same time as such continuity of care must take precedence (without regard to time of day, hours already worked, predefined call schedules etc), patients have the right to expect their care is being delivered by alert, healthy, responsible and responsive physicians. The program respects that the necessary balance between patient care and education is delicate and has endorsed the following minimal requirement.
We follow the recommendations of the Graduate Medical Education (GME) Consortium, which states that excluding exceptional patient care needs, clinical fellows should have, on average, at least one day out of seven free from routine responsibilities, and be on call in-house no more frequently than every third night. The latter does not apply to fellows in the pediatric pulmonology training program at Washington University, since we do not have required in-house call. Specifically,
- The inpatient fellow is responsible for calls regarding current pulmonary inpatients on weeknights.
- Calls from outpatients are rotated among pediatric pulmonology and allergy fellows on a daily basis. Outpatient call coverage begins at 4:30 PM and runs through 8:00 AM.
- All outpatient calls handled by a fellow are reviewed by divisional faculty and staff the following morning.
- The pulmonology fellows rotate their weekend coverage responsibilities, typically every 3 to 6 weekends. Coverage during the weekends and holidays includes both the lung transplantation and pulmonary services.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Moonlighting
Moonlighting is not required, but is permitted provided that such activities do not interfere with the pediatric pulmonology fellow’s clinical responsibilities or hinder their research performance. Authorization for the fellow to moonlight, however, must be approved by the program director in writing and retained on file.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Vacations
A total of 15 days per year of vacation time is allotted according to Washington University School of Medicine and Department of Pediatrics guidelines for post-graduate clinical fellows.
Pediatric Pulmonology Fellowship Program
at the Washington University School of Medicine
The multidisciplinary Division of Pediatric Allergy, Immunology and Pulmonary Medicine at St. Louis Children’s Hospital remains strong and productive, pursuing its academic mission to advance knowledge of the bases of pulmonary and allergic diseases and to develop novel diagnostic and treatment approaches for our patients. Its commitment to excellence in patient care, teaching, and research was recognized by our Division's inclusion as one of America's best pulmonary services, according to Parent magazine's 2008 survey and the 2009 US & World Report Best Hospitals ranking. Nine faculty members from the Division were listed as Best Doctors in America this year.
The ACGME-accredited pediatric pulmonology fellowship training program continues to attract promising pediatric candidates for subspecialty training and to develop the next generation of academic pulmonologists, as evidenced by their recent grant and publication record (see below).
In our Division you will find:
- a center that is participating in National Institutes of Health-funded childhood asthma research programs, including the Children’s Asthma Management Program (CAMP), Children’s Asthma Research and Education Program (CARE), and AsthmaNet that are helping us understand the benefits and long-term effects of asthma treatment in children,
- clinical investigators who are intimately involved in minority programs designed to impact asthma morbidity,
- a National Institues of Health-sponsored, multidisciplinary center examining pulmonary complications leading to morbidities and mortality of sickle cell disease
- a cystic fibrosis center that cares for nearly five hundred patients and an active part of the Therapeutic Development Network, a Cystic Fibrosis Foundation-supported program designed to rapidly bring new therapies to syctic fibrosis patients,
- a pediatric lung transplantation program that cares for the largest cohort of lung and heart-lung transplant patients in North America, providing the framework for the interdisciplinary National Institutes of Health-funded project examining the role of respiratory viruses and associated immune response on graft dysfunction,
- a center for the Genetic Determinants of Mucociliary Clearance Consortium, part of the National Institutes of Health Rare Diseases Clinical Research Network, which was created to better define pathogenesis, natural history, and treatment of primary ciliary dyskinesia and atypical forms of cystic fibrosis,
- a clinical research program studying the prevention of sudden infant death syndrome, funded by the Gates Foundation,
- an evolving multispecialty clinic for chronically ill children who are technology-dependent,
- a bronchoscopy center where more than 500 procedures are performed annually,
- a busy multidisciplinary pediatric sleep diagnostics center and fully automated laboratory,
- a state-of-the-art pulmonary function laboratory proficient in performing both pediatric and infant studies, and
- renowned, well-funded basic and translational research programs that are examining the cellular and molecular mechanisms and disease processes of asthma, cystic fibrosis, surfactant deficiencies, ciliopathies, emphysema, and respiratory infections. Moreover, research opportunities are not limited to the Division, and numerous collaborations exist throughout the medical center.
The Division of Pediatric Allergy and Pulmonary Medicine offers challenging medical goals and unparalleled research potential. If you are interested in pursuing a career in pediatric pulmonary medicine here at Washington University in St. Louis, please contact us at:
Thomas Ferkol, MD
Associate Professor of Pediatrics, Cell Biology and Physiology
Director, Division of Allergy and Pulmonary Medicine
One Children’s Place
St Louis, Missouri 63110
Telephone: 314 286-2886
E-mail address: ferkol_t@kids.wustl.edu
Evaluation and Promotion of Residents and Clinical Fellows
a. Evaluation
The program director and faculty meet biannually to evaluate the educational and professional progress and achievement of each clinical fellow. The program director also meets with each clinical fellow individually to discuss a written summary of the evaluations every six months, or more frequently as dictated by the individual fellow’s performance.
The evaluations are based on achieving competency in the following elements:
- Fund of knowledge concerning cell and molecular biology of the lung, pulmonary physiology and lung mechanics, lung pathophysiology, and clinical topics, and the application of that knowledge to patient care and diagnostic testing.
- Clinical and technical skills, including expertise in fiberoptic bronchoscopy, bronchoalveolar lavage, and transbronchial biopsy.
- Clinical and scientific judgment.
- Personal character traits displayed; interpersonal skills.
- Teaching skills.
- Ability to assume increased responsibility for patient care.
An evaluation file shall be maintained by the program director for each clinical fellow and treated as confidential. The file may be reviewed by the resident and by divisional/departmental faculty and staff with legitimate educational and administrative purposes. The Standing Committee on Graduate Medical Education (GME) Program Evaluation will review the evaluation plan of a program at the time of the Internal Review. The reviewer who meets with program faculty may ask to review a representative set of trainee files.
Finally, using a computer-based system, the fellows anonymously evaluate the performance of supervising attending physicians during the course of the academic year. These faculty evaluations are forwarded to the Chief of the Division of Pediatric Allergy and Pulmonary Medicine and considered in their annual evaluations.
b. Promotion
Promotion of clinical pulmonology fellows to the next level of the program depends upon the fellow's performance and qualifications. The fellow should achieve at least average overall scores in their clinical and research evaluations. Decisions about promotion or reappointment of clinical fellows by the program director are communicated to the trainee as soon as reasonably practicable under the circumstances. In cases where reappointment letters or contracts are issued, communication between program directors and the Graduate Medical Education (GME) office will occur at least three months in advance of a new appointment year.
Disciplinary Action, Suspension, or Termination
a. Informal Procedures
The program director will use informal efforts to resolve minor instances of poor performance or misconduct. In any case in which a pattern of deficient performance has emerged, informal efforts by the Program Director shall include notifying the fellow in writing of the nature of the pattern of deficient performance and remediation steps, if appropriate, to be taken by the fellow to address it. If these informal efforts are unsuccessful or where performance or misconduct is of a serious nature, the division chief or fellowship program director may impose formal disciplinary action.
b. Formal Disciplinary Action
Disciplinary action may be taken for due cause, including but not limited to any of the following:
- Failure to satisfy the academic or clinical requirements of the training program.
- Professional incompetence, misconduct, or conduct that might be inconsistent with or harmful to patient care or safety.
- Conduct that is detrimental to the professional reputation of the Hospital or School of Medicine.
- Conduct that calls into question the professional qualifications, ethics, or judgment of the resident/clinical fellow, or that could prove detrimental to the Hospital's or School of Medicine's patients, staff, employees, volunteers, or operations.
- Violation of the bylaws, rules, regulations, policies, or procedures of the Washington University School of Medicine, St. Louis Children’s Hospital, Department of Pediatrics, Division of Pediatric Allergy and Pulmonary Medicine, including violation of the Responsibilities of Clinical Fellows set forth by the Department of Pediatrics.
- Scientific misconduct.
c. Specific Procedures
Formal disciplinary action includes:
- Suspension, termination, or non-reappointment.
- Reduction, limitation, or restriction of the resident's clinical responsibilities.
- Extension of the pulmonology fellowship or denial of academic credit that has the effect of increasing the number of clinical service months or extending the fellowship.
- Denial of certification of satisfactory completion of the residency program.
The division chief or the fellowship training program director shall notify the clinical fellow in writing of the action taken and the specific reasons. The fellow will be notified in writing of any disciplinary action that would require extension of training or delays in promotion no later than four months before the end of the fellow’s current contract. A copy of the notification shall be furnished to the Associate Dean for Medical Education. The notification should advise the clinical fellow of his or her right to request a review of the action in accordance with the grievance procedure set forth below.
In the case of a suspension, written notification will precede the effective date of the suspension unless the division chief or program director determines in good faith that continued appointment of the clinical fellow places safety or well-being of patients or personnel in jeopardy, or immediate suspension is required by law or necessary in order to prevent imminent or further disruption of activities at the Washington University School of Medicine, St. Louis Children’s Hospital, or Department of Pediatrics, in which case the notice will be provided at the time of suspension.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Duty Hours
The pediatric pulmonology fellowship program has adopted the following policy on duty hours. Graduate medical education in many specialties requires a commitment to continuity of patient care. At the same time as such continuity of care must take precedence (without regard to time of day, hours already worked, predefined call schedules etc), patients have the right to expect their care is being delivered by alert, healthy, responsible and responsive physicians. The program respects that the necessary balance between patient care and education is delicate and has endorsed the following minimal requirement.
We follow the recommendations of the Graduate Medical Education (GME) Consortium, which states that excluding exceptional patient care needs, clinical fellows should have, on average, at least one day out of seven free from routine responsibilities, and be on call in-house no more frequently than every third night. The latter does not apply to fellows in the pediatric pulmonology training program at Washington University, since we do not have required in-house call. Specifically,
- The inpatient fellow is responsible for calls regarding current pulmonary inpatients on weeknights.
- Calls from outpatients are rotated among pediatric pulmonology and allergy fellows on a daily basis. Outpatient call coverage begins at 4:30 PM and runs through 8:00 AM.
- All outpatient calls handled by a fellow are reviewed by divisional faculty and staff the following morning.
- The pulmonology fellows rotate their weekend coverage responsibilities, typically every 3 to 6 weekends. Coverage during the weekends and holidays includes both the lung transplantation and pulmonary services.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Moonlighting
Moonlighting is not required, but is permitted provided that such activities do not interfere with the pediatric pulmonology fellow’s clinical responsibilities or hinder their research performance. Authorization for the fellow to moonlight, however, must be approved by the program director in writing and retained on file.
Division of Pediatric Allergy and Pulmonary Medicine Policy on Vacations
A total of 15 days per year of vacation time is allotted according to Washington University School of Medicine and Department of Pediatrics guidelines for post-graduate clinical fellows.
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