Pediatrics: Pulmonary and Sleep Medicine

Conferences

In addition to clinical and research rotations, there are a variety of conferences to enhance the fellows’ learning opportunity including daily inpatient rounds with the attending, intensive care unit ward team and general ward team; weekly inpatient sign-out rounds with all members of the pulmonary section; fellows conference where a pulmonary topic is reviewed, and monthly radiology/pathology, journal club, and research conference. Additionally, all fellows are expected to attend the monthly Joint Fellowship Curriculum, which is overseen by the Department of Pediatrics. Fellows are strongly encouraged to attend Pediatric Grand Rounds and Professors rounds and any other presentations or conferences they feel would benefit their education during the fellowship.

• Journal Club – fellows present a variety of journal articles on interesting Pulmonary related publications. Faculty and staff from the section attend.
• Radiology/Pathology Conference – a monthly conference to discuss interesting cases/films with the Radiology/Pathology department.
• Fellows Conference – a weekly case conference
• Joint Fellowship Curriculum – a monthly conference designed to address both the academic requirements mandated by the ACGME and the career and personal development of fellows within the Department of Pediatrics.

Joint Fellowship Curriculum

The Joint Fellowship Curriculum is overseen by the Department of Pediatrics and reviews certain basic concepts, including development of research design, abstract and manuscript preparation, basic biostatistics, quality improvement, professionalism, communication, teaching, administration and leadership, and career counseling, including the balance of work and family life. This core curriculum is designed to address both the academic requirements mandated by the American Council for Graduate Medical Education (ACGME) and the career and personal development goals expressed by our fellows.

The goal of the JFC is to provide an excellent educational experience to all fellows in the Department of Pediatrics through case-based, hands-on curriculum modules based on the needs of each year of fellowship (F1, F2, and F3)

Teaching Opportunities

As junior faculty members fellows are expected to supervise and teach pediatric residents and medical students in the case of hospitalized pediatric pulmonary patients. Several teaching and speaking opportunities are available to create a well rounded learning portfolio. As part of their fellowship training, fellows will be provided with instruction in clinical teaching skills. Fellows will supervise 2-4 residents each month and a variable number of medical students assigning tasks and reviewing consultation notes before presenting to the attending faculty. In the second and third years of the fellowship, fellows will present monthly on a variety of core lecture topics to rotating residents. They will develop necessary communication and teaching skills.

Yearly Lecture Topics                                             

July and August Topics (practical)                                             

1. PFTs
2. Chest physiotherapy devices
3. Tracheostomy
4. Polysomnography
5. Home ventilation and non-invasive ventilation
6. Inhaler devices and spacers

Physiology Topics

1. Exercise physiology and how to read cardiopulmonary physiology testing
2. Respiratory mechanics: compliance (lung and chest wall), airway resistance
3. Lung function test and correlation with physiology (what do they mean)

            a. Ventilation: Forced expiratory volumes, flow-volume, closing volume, measurement of alveolar ventilation (test of uneven ventilation)
            b. Gas Exchange:
                   i. Hypoxia
                  ii. Hypoventilation
                 iii. Acid – base balance
                 iv. Diffusion capacity
            c. Other tests:
                   i. Lung volumes
                  ii. Lung elasticity
                 iii. Airway resistance
                 iv. Control of breathing
                 v. Topographic differences of lung functions

     4.Blood flow to the lung (including: PVR) and pulmonary hypertension

Anatomy and correlation with CXR, CT, and Bronchoscopy

Every 2-3 Year Lecture Topics
Upper Airway Disease

1. Congenital malformation: choanal atresia; micrognathia; laryngeal (malacia, web, atresia, cyst); laryngotracheoesophageal cleft; vocal cord paralysis, subglottic pathology (stenosis, hemangioma)
2. Infectious causes of stridor: croup and trachitis

Lower Airway Disease

1. Congenital malformation: CDH, sequestration, TEF, bronchogenic cysts, lobar emphysema, agenesis
2. Malacia: trachea, bronchi with relation to vascular rings
3. Bronchiolitis: clinical picture, epidemiology, causes, treatment (role of steroid and bronchodilators), prognosis and long term consequences
4. Chronic cough: evaluation and management
5. Asthma:

             a. Mechanism of disease (including inflammatory cells and cytokines)
             b. Acute and chronic management (including detailed ICS differences)

Parenchymal Disease

1. Cystic Fibrosis:

              a. Genetics and disease mechanism (CFTR)
              b. Clinical manifestation, diagnosis (newborn screening) and prognosis

2. Recurrent pneumonia: evaluation and management
3. Chronic lung disease associated with prematurity: evaluation, management and long term outcome
4. GERD and Aspiration syndrome: respiratory complications
5. Pulmonary hemorrhage and hemoptysis
6. Lung abscess: evaluation and management
7. Cancer-related lung disease(opportunistic infections and post bone marrow transplant)
8. Sickle cell patients: acute chest syndrome
9. ARDS causes and management
10. Hypersensitivity pneumonitis
11. Alpha-1 antitrypsin deficiency and primary ciliary dyskinesia
12. Sarcoidosis, sickle cell disease, chronic granulomatous disease
13. SIDS
14. Respiratory disease and infections:

             a. Mycobacterial infections
             b. HIV
             c. Mycoses

Interstitial Lung Disease: When to suspect and how to diagnose

Pleural diseases:

1. Air and fluid in the chest: how to evaluate and manage (chest tube, VATS)

Chest Wall/Diaphragm:

1. Jeune Syndrome (asphyxiating thoracic dystrophy)
2. CDH, eventration
3. Scoliosis
4. Neuromuscular disease

Others:

1. Pediatric Lung Transplant
2. Bronchiolitis obliterans
3. Immunosuppressive therapy in transplant patients (choices and how does it work)
4. Sleep

              a. Sleep disordered-breathing
              b. Excessive daytime sleepiness, “evaluation of sleepy teenager”
              c. Nightmares, night terrors, sleepwalking

3-4 Meetings/Year Lecture Topics
Pathology
The goal is to discuss cases and identify both normal and abnormal pathology involving the respiratory system

1. Upper airway
2. Lower airway
3. Lung
4. Interstitial and pulmonary vasculature

Radiology (review these topics in part of radiology conference)

1. Congenital malformation:

              a. CPAM
              b. Congenital lobar emphysema
              c. Bronchogenic cyst
              d. Pulmonary sequestration
              e. Eventration and congenital diaphragmatic hernia
              f. Lung hypoplasia
              g. TEF

2. BPD
3. Vascular rings and slings
4. CF
5. Asthma
6. Bronchiolitis
7. Swyer-James
8. ILD
9. Infections:

             a. Fungal
             b. TB
             c. Other atypical infections