The fellows provide care for four to ten inpatients on the pediatric pulmonary service; the inpatient rotations are at the American Family Children's Hospital. In concert with the philosophy of graduated responsibility with increasing experience, first-year trainees provide supervision of patient care to the pediatric residents with close supervision by the attending faculty. In the second year of training, the fellow takes a more primary role in supervision of inpatient care. The attending physician is involved daily in decision making and is available as needed for extra supervision and input. In the third year of training, the fellow generally assumes responsibility for the care of inpatients and consults with the attending faculty on complex cases.
The fellow is expected to take primary responsibility for the care of patients whom he or she sees in the outpatient clinic. Given that many of the patients who are followed on the pediatric pulmonary service are children with chronic diseases, developing a longitudinal relationship with patients and families is a critical part of training. As with inpatient experiences, a philosophy of graduated responsibility is followed.
A variety of disorders and complications to be seen include cystic fibrosis, asthma, children with tracheostomies, ventilator-dependent children, congenital lung abnormalities, pneumonias, chronic lung disease, sleep disorders, and children with neuromuscular disorders. We are an accredited Cystic fibrosis Center.
In the first year of fellowship, the fellow explores areas of research that would be of interest. The fellow then commits to a research project and there is protected time in the second and third years for the fellow to complete the research study. Potential research projects are available both within the pediatric pulmonology division and in collaboration with other divisions (allergy, neonatalogy, pediatric infectious disease and adult pulmonology). Current research projects within our division are:
- A randomized controlled trial of cystic fibrosis newborn screening
- Determining the outcomes of cystic fibrosis newborn screening in a routine clinical program
- Clinical trials of new drug therapies for cystic fibrosis
- Longitudinal prediction of lung disease severity in children with cystic fibrosis
- Rhinovirus infection and childhood asthma
- Clinical trials in AsthmaNet network
- Non-invasive serial determination of Hemoglobin in subjects with sickle cell anemia undergoing routine invasive determination of hemoglobin at a scheduled outpatient visit
- Development of a database of respiratory care for patients with spinal muscular atrophy
- Clinical trial evaluating the combination of valproic acid and L-carnitine for treatment of infants with spinal muscular atrophy type I
Pediatric pulmonology fellows enhance the teaching program of the department by their interactions with medical students and residents on the wards and in the clinics. The fellows present lectures within the pediatric pulmonary conference schedule, and they are invited to present lectures to other divisions, including the critical care and allergy divisions. A pediatric grand-rounds presentation is required in the third year of fellowship.