Pulmonary Fellowship
Curriculum

In accordance with the American Board of Pediatrics, fellows receive approximately 14 months of combined inpatient/outpatient pediatric pulmonary clinical training during the 3–year program.  We currently have 26 faculty members. The first year emphasizes clinical training and an introduction to research.  The clinical training is divided between the pulmonary inpatient and pulmonary consult services (separate services on weekdays and combined on the weekends.  There is an at home night call system (M-F 7pm-7am) to cover inpatient and consult attendings and fellows.  The fellow is responsible for an average census of 20 inpatients (range 8-26) per day while on the pulmonary service, and evaluation of 10-15 patients per day (3-7 new consults per day) while on the pulmonary consult service at Seattle Children's Hospital (SCH).  Inpatient experience in Year 1 has also includes a 2-week block in the ICU and 2-week ventilator training block.  The outpatient experience includes participating in continuity clinic (half day/week) and rotating in several sub-sub specialty clinics (1-2 half-days/week throughout the year when not on inpatient rotation) that include Chest, Sleep, Cystic Fibrosis, Aero-Digestive, Spine, Surgical Pulmonary Follow-up, Ventilator and/or Neuromuscular clinics.  There is a fully equipped clinical pulmonary function lab with body plethysmography, spirometry, and formal exercise testing.  There is also a state-of the-art Sleep Center, which performs approximately ~50 polysomnographic studies each week.  Fellows learn and perform interpretation of pulmonary function tests throughout the 3 years of training.  Fellows have a 1-month Sleep Medicine rotation in Year 1 and learn the basics of a rigorous sleep history, non-invasive ventilation for sleep disordered breathing, participate in sleep-medicine related clinics (Sleep, Aerodigestive, Craniofacial) and the basics of polysomnogram interpretation.  Trainees are instructed in flexible bronchoscopy and perform cases in the ICU and operating room.  Fellows are active participants in a respiratory physiology review each year.  Trainees are also mentored in quality improvement (QI) and participate in group and individual QI projects.  We have a weekly Journal Club, monthly Radiology/Chest conferences, monthly Faculty didactic lecture in area of clinical expertise, monthly challenging clinical case conference, monthly participation in Western States Clinical Conference, and intermittent “works in progress” discussions.  There is ongoing career mentorship throughout the 3-year program from within (and outside) the Division, and from the Department of Pediatrics Fellows College.  The Program Evaluation Committee, consulting of faculty and senior fellows, review the curriculum each year and make modifications for improvement.

 

First Year

Year 1 is primarily devoted to clinical training with 16 weeks of inpatient activities and outpatient clinics, but exposure and direction in quality improvement and research begins.  This research guidance includes discussions of research topics/areas of interest, identifying a primary research mentor, and forming a Scholarship Oversight Committee before the end of Year 1.  There are active clinical and translation research program within the Division of Pulmonary and Sleep Medicine. The Division has an active cystic fibrosis (CF)-related research program including Cystic Fibrosis Foundation-funded Therapeutics Development Center, a CF-Research Development Program, and several investigator-initiated studies. Our Division has an active, NIH-funded asthma and airway biology research program (Drs. Debley and Reeves), and opportunities to participate in clinical and/or translational studies in sleep medicine, primary ciliary dyskinesia, complex spine, quality improvement, and bronchopulmonary dysplasia.  The first-year fellows can rotate through basic laboratories within the University of Washington (UW) system (including Center for Lung Biology, Benaroya Research Institute), Seattle Children’s Research Institute, and the basic science laboratories of the Cystic Fibrosis Research Development Program at the UW.  Specifically, the laboratories that are performing lung cellular and molecular biology at the University of Washington provide excellent basic research opportunities for trainees.  

 

Examples of current pulmonary research interests among divisional and non–divisional faculty include, asthma, implementation science, respiratory mechanics, scoliosis/thoracic insufficiency syndromes, sleep medicine, clinical investigation of novel new therapies and outcome measures in cystic fibrosis, early CF lung disease and CF epidemiology global health related to lung disease, basic research on pseudomonas-host interactions in the CF airway, genetic modifiers of cystic fibrosis outcomes, neonatal lung injury, lower respiratory tract infections in underserved populations, and airway epithelial cell biology relevant to the pathophysiology of asthma.

 

Second Year

Year 2 is devoted primarily to research efforts, which can be clinical, translational and/or basic science in nature.  Fellows who are interested in clinical research are encouraged to apply for enrollment in the University of Washington School of Public Health programs (e.g. Master of Public Health or Master of Sciences [60 credits] a 1-year Maternal Child Health Certificate program (15 credits), or individual statistic and study design courses at UW.  Fellows with prior related Master’s degrees may be able to audit graduate level courses.  The goal is for each fellow to complete one research project during the second and third years that can be presented at a national meeting and submitted for publication.  Trainees are encouraged to work with faculty to seek extramural funding (e.g. CF Foundation, Firland Foundation, American Lung Association, Thrasher Foundation) for their later years of training to gain skills in grant preparation and foster new research activities.  Clinical activities in the second year include 8 weeks on the pulmonary inpatient or pulmonary consult service at SCH and weekly participation in continuity clinic and other subspecialty clinics (see above) for a total 5-6 half-days/month when not on the inpatient service.  We emphasize continuity of care and encourage fellows to manage a core group of patients identified from the first year in a continuity clinic.

 

Third Year

Year 3 is devoted to further research and clinical training, and team leadership skills.  A goal is for the trainee to continue to work with faculty on a focused research project, and senior fellows are encouraged to work with faculty and research mentors to seek extramural research funding for transition to faculty award or potentially additional post-doctoral training.  There is ongoing longitudinal participation in continuity clinics (half day per week) additional outpatient clinics 1-2 half days/month. To foster autonomy and leadership skills, third year fellows will have the opportunity to direct inpatient rounds at least 1 day/week (indirect supervision with direct supervision immediately available), and near the end of training have the opportunity of 1 inpatient service rotation in a supervisory role for inpatient rounds  (indirect supervision with direct supervision immediately available, faculty evaluating all patients with fellow each day and faculty contributing to team education in afternoons).