The clinical focus of our program is to provide comprehensive training in Pediatric Pulmonology to allow the graduate to independently manage all problems that would fall under the purview of a pulmonary subspecialist. Fellows rotate primarily through Children’s Hospital Colorado (Children's Colorado). Children's Colorado is a new, state of the art facility which opened in 2007. Additional clinical experience is gained at the National Jewish Hospital and during outpatient clinics at several outreach clinics. Fellows also rotate through the pediatric intensive care unit (PICU) to develop further expertise in managing severely ill children. Under the supervision of a large and diverse faculty, trainees gain exposure to patients with a broad spectrum of clinical problems. Learning from direct patient care is augmented by a comprehensive series of lectures and conferences focused on Pediatric Pulmonary Medicine. Fellows receive ample opportunities for the long term management of patients through their weekly continuity clinic.
Fellows in our program develop the clinical skills necessary to prepare them to competently and confidently manage the broad spectrum of conditions that fall within the practice of pediatric pulmonology. The inpatient clinical experience is divided between two services, one covering the large inpatient pulmonary service and the other on consults. The inpatient pulmonary service includes a resident team covering about 20 patients, all of whom have primary pulmonary problems such as cystic fibrosis, asthma, pneumonia, empyema, chronic ventilator dependency, bronchoilitis, and interstitial lung disease. The care of cystic fibrosis patients involves a well developed team approach including nurses, advanced practice nurses, dieticians, respiratory therapists, and social workers. The fellow is responsible for helping coordinate this team approach to care on a daily basis. During this experience the fellow functions as the leader of the inpatient service as well as providing education for the general pediatric residents.
The consult pulmonary service is heavily involved in the pediatric and neonatal intensive care units, assisting with the management of infants and children with pulmonary hypertension, chronic respiratory failure, congenital anomalies of the lung, interstitial lung disease, and acute exacerbations of chronic pulmonary diseases. Consultation is also provided for respiratory problems occurring on the general medical and surgical services, as well as the oncology and bone marrow transplant services where pneumonia is a frequent complication in the immunocompromised patient. The consult fellow also assists with flexible bronchoscopies (over 500 annually) and the evaluation of various airway abnormalities.
The PICU and pediatric anesthesia experiences are focused on additional experience in critically ill children. All trainees are expected to complete PALS training and receive sedation privileges. Fellows are encouraged to get experience in intubation and airway management plus the insertion of small diameter chest tubes, central lines, and arterial catheters. During these rotations the fellow works closely with the faculty in the anesthesia and critical care sections and helps coordinate care provided by the pediatric and anesthesia residents.
Early in their training, fellows are encouraged to learn (and demonstrate proficiency in) the interpretation of pulmonary function tests including the spirometry, MEFV curves, lung volumes, diffusion, exercise studies, bronchodilator studies, nitric oxide measurements, and the whole spectrum of infant pulmonary function testing. Additionally, are exposed early in their training to basic indications and interpretation of polysomnography and overnight oxygen monitoring for patients with sleep disorders. Additional training is provided later in the fellowship and trainees particularly interested in sleep medicine are encouraged to take an additional year of training to obtain certification in sleep medicine as well as pediatric pulmonology.
To prepare trainees to function independently as pediatric pulmonologists following completion of their fellowship, fellows are encouraged to assume graduated responsibility for patient care over the course of their three years. Late in the first year, and certainly during the second and third years, fellows are expected to direct clinical care during rounds, with the supervision of a faculty attending. Fellows are expected to actively seek the most up-to-date information to guide clinical care whenever possible. Likewise, fellows are expected to take an active role in teaching the pediatric housestaff, both through didactic lectures and extemporaneous bedside teaching.
At all times, the fellow is directly supervised by a full-time member of the faculty. During the daytime, two attending physicians are available to cover the two services at Children’s Colorado. During night, fellows take call from home and are backed up by an attending pediatric pulmonologist, also on call from home. At each stage of training, the goal is to provide a level of supervision that ensures patient safety and maximizes education, while promoting the trainee’s sense of independence and autonomy.
Approximately 9 months of the first year and 2 months in each of the second and third year of training are devoted to clinical training. In addition, trainees have a one half day per week continuity clinic for the three year duration of training. Training is divided into 26 two week blocks. Fellows have seven (7) blocks on the inpatient pulmonary service (three in the first and two in each of the second and third years) and 11 blocks on the consult service (seven in the first year and two each in the second and third years). Only one month (2+ blocks) in the PICU is required, although fellows frequently elect to take a second month during their training. In addition to this inpatient time, during the first year trainees also spend two blocks at the National Jewish Hospital outpatient clinics, one block on anesthesia, and the equivalent of four blocks rotating among the various pulmonary and allergy faculty clinics. These outpatient clinics are scheduled throughout the year at the convenience of the fellow and occur both at Children's Colorado and in outreach clinics throughout the state. Finally, first year fellows spend two blocks on the sleep service.
Weekday night call occurs only when the fellow is on either the inpatient or consult service. Weekend call is shared between all of the fellows, with a decreasing number of weekends on call occurring as the trainee progresses through the fellowship. All call occurs from home and fellows infrequently have to return to the hospital at night. During the weekend the fellow conducts inpatient rounds with the residents and reviews all consults and inpatients with the attending faculty.
As with all aspects of clinical training, the program encourages progressive responsibility and increasing autonomy when on-call. Fellows are expected, however, to discuss and review all patient contacts with the appropriate attending faculty.