Welcome to the Pediatric Pulmonary Fellowship Program
Meet Our Fellows
A Message from our Director
I have always been fascinated by the role of pediatric pulmonology. The combination of physiology, procedural skills, and both acute and chronic disease management creates a subspecialty that bridges between worlds: inpatient and outpatient, pulmonary floor and ICU, OR and medical floors. Each day brings something new. The wide variety of settings and disease processes involved in pulmonology make our fellowships unique and allow for significant diversity in interest areas within the field. Every one of our fellows enters this journey, and our goal is to help guide each one to find their own place, to build their own specific area of interest and expertise in pulmonary medicine that can be a career long pursuit.
Our goal in the pulmonary fellowship at the Medical College of Wisconsin is to build excellent clinicians who have built a research interest which will span their career. Research is a broad term including basic science, clinical, quality improvement, and education research and likely even more topics in the future. We start with a basic pulmonary training backdrop and then challenge our fellows to personalize their training to meet their interests and career goals. Our fellows have never stopped amazing me in all the unique opportunities they find and the amazing work that has enhanced our division because of their vision.
This year we topped new challenges, starting the year with the early cases of EVALI and ending it with telemedicine and COVID-19. Our fellows learned with us, and frequently led the way. The fellowship program and faculty at MCW provide tools, instruction, guide, and mentor; then sit back and smile as our fellows build into colleagues with great ideas and launch their own careers.
Julie Noe, MD
Fellowship Director, Pediatric Pulmonary and Sleep Medicine
Assistant Professor of Pediatrics
The Pediatric Pulmonary Fellowship program fulfills the requirements for training as stated by the American Board of Pediatrics and is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Graduates of the three-year program will be eligible to take the American Board of Pediatrics subspecialty examination in Pulmonology upon completion of the fellowship.
During our three-year training program, time is distributed among both clinical and research opportunities to ensure that fellow’s develop expertise in the field of pediatric pulmonary. The program provides approximately 5 months in the first year and 3 months in each of the second and third years for clinical work. Approximately 17 months of protected time dedicated to hypothesis driven research.
- To adequately educate and provide the necessary background for a trainee to diagnose and manage pediatric respiratory disorders.
- To prepare the trainee to conduct research in the area of pediatric respiratory diseases.
- To enable the trainee to become a competent teacher of pediatric pulmonary physiology and pediatric respiratory disease.
1st year fellows
- Will learn the role of a consultant
- Will begin to staff patients with residents and students with direct faculty supervision
- Will be involved in telehealth with supervision in video visits and participate in sick and urgent phone call medicine and triage with faculty supervision.
- Introduction to bronchoscopy and assist and begin to perform bronchoscopies
- Identify a research topic and mentor
2nd and 3rd year fellows
- Will work in a consultative role with graduated independence
- Increased teaching opportunities with the medical team in addition to students and residents
- Expand their outpatient practice with graduated independence in fellows’ clinic and with sick/urgent telephone calls
- Increased comfort with telehealth with graduated independence
- Continue to perform bronchoscopies with increasing independence and exposure to more complicated cases
- Further development of research goals including local and national presentations and manuscript writing.
- Determine sub-specialty interests in pulmonary medicine and build an area of expertise
Clinical training in Pediatric Pulmonary Fellowship centers on a multidisciplinary approach to the care of patients with respiratory diseases at Children’s Hospital of Wisconsin. Children’s Hospital is an award-winning health care system dedicated solely to the health and well-being of children. Multidisciplinary teams of physicians, nurses, and many other health care professionals specializing in pediatrics are available to meet the full range of patient-care needs.
A variety of essential lectures and conferences are included in the fellows’ weekly schedule which include, but are not limited to: 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, which reviews certain basic concepts, including development of research design, abstract and manuscript preparation, basic biostatistics, quality improvement, and professionalism and communication, among other topics.
The Pulmonology division is involved in various multidisciplinary clinics that provide care to patients with disorders requiring a multidisciplinary approach. The following clinics are currently active and will be included to enhance the fellows’ outpatient Pulmonology experience.
- Cystic Fibrosis
- Positive Airway Pressure Program
- Muscular Dystrophy
- Asthma Plus
During the 3-year training program, time is distributed to ensure that fellows develop clinical expertise. Clinical time will be split between outpatient clinics, inpatient service, procedures, and the corresponding service related conferences. Fellows will hold a one-half day per week of continuity clinic for the duration of their training.
The focus of the first year of the fellowship is to develop the clinical skills and abilities to provide optimal patient care for children with respiratory diseases. The program provides approximately 10 months of clinical experience, including both inpatient and outpatient care during the first year. During their inpatient rotation the fellow will be on first call from 7:30 am-4:30 pm and will also take two weekends per month and two nights per week on the assigned inpatient service. Continuity clinic will focus on pulmonary patients one-half day per week throughout the first year. During the first year, the fellow will devote his/her effort to the following rotations:
The fellow will spend 5 months on the pulmonary service during the first year. At the end of the first year the fellow will have a diversity of experiences with children with respiratory diseases and develop the clinical skills needed to function as a clinician.
- Graduated responsibility for the care of pulmonary inpatients with increasing responsibility as training progresses.
- Graduated responsibility completing pulmonary inpatient consultations on general floors and the PICU. The fellow will be responsible for the initial contact and evaluation, staffing with a faculty member, and appropriate documentation and communication with the primary team.
- Graduated responsibility for resident education on the pulmonary inpatient team for residents and medical students.
- Graduated responsibility in the care of inpatients with tracheostomies and home ventilators.
Cystic Fibrosis (CF)
The fellow will spend 1 month observing pediatric and adult Cystic Fibrosis clinics.
- Attend weekly CF team meetings.
- Participating in CF multidisciplinary clinics.
- Independent study to gain familiarity with landmark CF research trials and scientific rationale behind current CF therapies.
- Gain a thorough understanding of current CF practice guidelines.
- Gain an appreciation of the team approach to CF care, and available team members and tools such as Port CF.
- Gain an appreciation of the role of multi-center trials in CF research and advancement of care.
- Develop knowledge to identify and manage CF nutritional needs.
- Gain familiarity with standard medications and airway clearance techniques used in CF care.
- Master the criteria for CF admission for pulmonary exacerbation.
The fellow will take one month during the first year to identify a research mentor and project with the guidance of the Scholarship Oversight Committee. This month will also give exposure to various potential basic and clinical research projects that are available within the Pulmonary Section, the Department of Pediatrics, and throughout the Medical College of Wisconsin.
- Identify a research interest area and select a mentor.
- Develop a research question and build a research plan.
- Present a poster at the MCW Pediatric Fellows’ poster session in April with an overview of research plan.
Years 2 and 3
The second and third years of the fellowship training provides ample protected time to pursue research endeavors while fostering improved clinical, administrative, and teaching skills.
The fellow will spend 7-8 months during the second and third year implementing their research project. This will involve building new skill sets within the scope of their project, including specific knowledge within the field of study and more general skills such as IRB submission, grant writing, abstract writing and manuscript preparation.
- Present at local, regional, and national meetings beginning in the second year.
- A peer-review publication, an in-depth manuscript, a thesis or dissertation written in connection with the pursuit of an advanced degree, an extramural grant application that has either been accepted or favorably reviewed.
- Building a skill set and academic focus/research area that can be maintained throughout the fellow’s career.
The fellow will spend 1 month attending sleep clinics during the second year.
During this rotation the fellow will:
- Attend all sleep clinics.
- Attend all Positive Airway Pressure clinics.
- Attend the Sleep Conference every Friday.
- Begin to learn to score and read sleep studies, gaining an appreciation for the information they contain.
- Learn the indications for sleep studies and additional sleep related testing.
Procedural Skills and Diagnostic Studies
Fellows in the program are expected to develop procedural skills which include but are not limited to, flexible bronchoscopy and bronchoalveolar lavage, transbronchial biopsies, intubation and airway management techniques. Each fellow will participate in a minimum of 100 flexible bronchoscopies his/her fellowship.
Fellows will become proficient in the interpretation of pulmonary function tests (PFTs), including methacholine challenges, cardiopulmonary exercise testing and infant PFTs. In addition, they will interpret overnight pulse oximetry studies and learn their indications and limitations. The fellowship also allows the fellows to become familiar with interpreting overnight polysomnographic studies.
Years 2 and 3 of the Pediatric Pulmonary Fellowship are primarily dedicated to hypothesis-driven research with decreased clinical responsibilities from the first year of training. Two distinct research pathways are offered, laboratory-based research and clinical research. Additional pathways are available if recognized by the ABP to qualify for sitting for pulmonary boards. A major goal of our training program is to provide fellows a focused environment in which they can develop research interests which will be integrated into their future careers. The Scholarship Oversight Committee (SOC) will guide the fellow along with their research mentor, meeting biannually during the 3 years of the fellowship training.
With a wide variety of research options available, fellows have the opportunity to participate in an ongoing research project or establish projects of their own under a faculty mentor. These mentors may be pulmonary faculty or faculty in other divisions and departments within MCW. Regardless of the research pathway the fellow selects, the ultimate goals include national presentations and publishing a manuscript in a peer-reviewed journal.
Scholarship Oversight Committee (SOC) Guidelines
To provide the Pediatric Pulmonary Fellows with guidance, leadership, and support throughout their fellowship.
All fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical, or translational biomedicine; health services; quality improvement; bioethics; education; and public policy. Fellows must gather and analyze data, derive and defend conclusions, place conclusions in the context of what is known or not known about a specific area of inquiry, and present their work in oral and written form.
A Scholarship Oversight Committee in conjunction with the trainee, the mentor, and the program director will determine whether a specific activity is appropriate to meet the ABP guidelines for scholarly activities. These activities require active participation by the fellow and must be mentored. The mentor(s) will be responsible for providing the ongoing feedback essential to the trainee’s development.
Involvement in scholarly activities must result in the generation of a specific written “work product.” Examples include, but are not limited to:
- A peer-reviewed publication in which a fellow played a substantial role
- An in-depth manuscript describing a completed project
- A thesis or dissertation written in connection with the pursuit of an advanced degree
- An extramural grant application that has either been accepted or favorably reviewed
- A progress report for projects of exceptional complexity, such as a multi-year clinical trial
Review of scholarly activity and the written work product will occur at the local level. Each fellow must have a Scholarship Oversight Committee. The Scholarship Oversight Committee should consist of three or more individuals, at least one of whom is based outside the subspecialty discipline; the fellowship program director may serve as a trainee’s mentor and participate in the activities of the oversight committee, but should not be a standing (i.e., voting) member. This committee will:
- Determine whether a specific activity is appropriate to meet the ABP guidelines for scholarly activity
- Determine a course of preparation beyond the core fellowship curriculum to ensure successful completion of the project
- Evaluate the fellow's progress as related to scholarly activity
- Meet with the fellow early in the training period and regularly thereafter
- Require the fellow to present/defend the project related to his/her scholarly activity
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.
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)
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)
- Chest physiotherapy devices
- Home ventilation and non-invasive ventilation
- Inhaler devices and spacers
- Exercise physiology and how to read cardiopulmonary physiology testing
- Respiratory mechanics: compliance (lung and chest wall), airway resistance
- Lung function test and correlation with physiology (what do they mean)
- Ventilation: Forced expiratory volumes, flow-volume, closing volume, measurement of alveolar ventilation (test of uneven ventilation)
- Gas Exchange:
- Acid – base balance
- Diffusion capacity
- Other tests:
- Lung volumes
- Lung elasticity
- Airway resistance
- Control of breathing
- Topographic differences of lung functions
- 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
- Congenital malformation: choanal atresia; micrognathia; laryngeal (malacia, web, atresia, cyst); laryngotracheoesophageal cleft; vocal cord paralysis, subglottic pathology (stenosis, hemangioma)
- Infectious causes of stridor: croup and tracheitis
Lower Airway Disease
- Congenital malformation: CDH, sequestration, TEF, bronchogenic cysts, lobar emphysema, agenesis
- Malacia: trachea, bronchi with relation to vascular rings
- Bronchiolitis: clinical picture, epidemiology, causes, treatment (role of steroid and bronchodilators), prognosis and long term consequences
- Chronic cough: evaluation and management
- Mechanism of disease (including inflammatory cells and cytokines)
- Acute and chronic management (including detailed ICS differences)
- Cystic Fibrosis:
- Genetics and disease mechanism (CFTR)
- Clinical manifestation, diagnosis (newborn screening) and prognosis
- Recurrent pneumonia: evaluation and management
- Chronic lung disease associated with prematurity: evaluation, management and long term outcome
- GERD and Aspiration syndrome: respiratory complications
- Pulmonary hemorrhage and hemoptysis
- Lung abscess: evaluation and management
- Cancer-related lung disease(opportunistic infections and post bone marrow transplant)
- Sickle cell patients: acute chest syndrome
- ARDS causes and management
- Hypersensitivity pneumonitis
- Alpha-1 antitrypsin deficiency and primary ciliary dyskinesia
- Sarcoidosis, sickle cell disease, chronic granulomatous disease
- Respiratory disease and infections:
- Mycobacterial infections
Interstitial Lung Disease: When to suspect and how to diagnose
- Air and fluid in the chest: how to evaluate and manage (chest tube, VATS)
- Jeune Syndrome (asphyxiating thoracic dystrophy)
- CDH, eventration
- Neuromuscular disease
- Pediatric Lung Transplant
- Bronchiolitis obliterans
- Immunosuppressive therapy in transplant patients (choices and how does it work)
- Sleep disordered-breathing
- Excessive daytime sleepiness, “evaluation of sleepy teenager”
- Nightmares, night terrors, sleepwalking
3/4 Meeting/Year Lecture Topics
The goal is to discuss cases and identify both normal and abnormal pathology involving the respiratory system
- Upper airway
- Lower airway
- Interstitial and pulmonary vasculature
Radiology (review these topics in part of radiology conference)
- Congenital malformation:
- Congenital lobar emphysema
- Bronchogenic cyst
- Pulmonary sequestration
- Eventration and congenital diaphragmatic hernia
- Lung hypoplasia
- Vascular rings and slings
- Other atypical infections
Juan Ruiz, MD
- 2009 American Thoracic Society Internal Conference, Travel Scholarship Recipient
- 2009 Children’s Hospital of Wisconsin, Outstanding Teacher Among the Pediatric Fellows
Louella Amos, MD
- 2010 MCWAH Research & Quality Awards, “Treatment and Outcomes of Pediatric Restless Leg Syndrome (RLS)”
Julie Baughn, MD
- 2010 Medical College of Wisconsin, 4th Annual Fellows’ Research Poster Session, Honorable Mention Award Recipient, “Genetic Variation in the CFTR Gene in Children with Community-Acquired Pneumonia”
- 2011 Abstract Excellence Award – American Thoracic Society, Respiratory Structure and Function Assembly “Genetic Variation in The Cystic Fibrosis Transmembrane Conductance Regulator Gene (CFTR) is Associated with the Need for Mechanical Ventilation in Pediatric Patients with Community Acquired Pneumonia”
Nisreen Rumman, MD
- 2010 Best Abstract by a Trainee at the 34th Annual Midwest Pediatric Cardiology Society Scientific Session
Lauren Camarda, MD
- 2012 Fellow in Training Abstract Award, American Academy of Allergy Asthma and Immunology, “Impact of the Intestinal Microbiome on Severe Paramyxoviral Respiratory Infection”
Nick Antos, MD
- 2013 Medical College of Wisconsin Fellow Research Day, “Drawing a Cystic fibrosis (CF) Road Map: Improving CF Inpatient Care with an Admission Plan”
Ahsan Bashir, MD
- 2018 MCWAH Research & Quality Awards, "Polysomnography Provides Useful Clinical Information in the Liberation from Respiratory Technology"
Santiago Encalada, MD
- 2015 American Thoracic Society (ATS), Minority Trainee Development Scholarship (MTDS)
Brian Carroll, MD
- 2018 NACFC Pediatric Fellows Session
- 2019 MCW DOP Fellow Research Day Finalist
- 2020 MCWAH Research and Quality Award
“Impaired Lung Function Following E-Cigarette or Vaping Product Use Associated Lung Injury (EVALI) in the First Cohort of Hospitalized Adolescents”
Sara Dawson, MD
- 2019 American Thoracic Abstract Scholarship
“High pCO2 Levels at 36 Weeks is Associated with Longer Duration of Home Oxygen in Infants with BPD”
- 2019 MCWAH Research and Quality Award
“High pCO2 Levels at 36 Weeks is Associated with Longer Duration of Home Oxygen in Infants with BPD”
- 2019 NACFC Pediatric Fellows Session
- 2020 American Thoracic Society Abstract Scholarship
“Active Weaning of Diuretics in Preterm Infants with BPD does not Increase Duration of Supplemental Oxygen”
The Pulmonary (& Sleep Medicine) Division is comprised of nine clinical faculty members and six advanced practice nurses who provide treatment for infants, children, teens, and young adults with respiratory diseases. Our fellowship program offers innumerable clinical opportunities in collaboration with Children’s Wisconsin’s state of the art health care facilities and numerous sub-specialty focused clinics.
Our experienced, engaging faculty members are eager to help and support you throughout your time in our fellowship program.
The Medical College of Wisconsin Affiliated Hospitals, Inc. (MCWAH) offers an excellent comprehensive benefits package.
View MCWAH Benefits, Conditions & Terms of Employment for information regarding vacations, leaves, insurance, stipends and professional liability.
Our 3-year fellowship program is ACGME accredited and begins on July 1 each year. We accept one or two fellows each academic year through the National Resident Matching Program (NRMP). Applications from prospective applicants are accepted from November through March via the Electronic Residency Application Service (ERAS). All applicants are required to have completed a 3-year residency in an accredited residency program either in the United States or Canada and be either American Board of Pediatrics certified or board eligible.
Completed applications should include the following:
- ERAS application form
- At least 3 letters of recommendation including Program Director letter
- Curriculum Vitae
- Personal statement
- USMLE scores – Steps 1, 2, and 3
- ECFMG certificate for foreign medical school graduates
Selected applications will be invited for interviews in September-November.
Our program currently accepts the following Visas:
- Permanent Resident Visa
- Visitor Exchange Visa sponsored by ECFMG (J-1)
- Temporary Professional Worker's Visa (H-1B)
For additional Visa information, please visit Graduate Medical Education.
Julie Noe, MD
Assistant Professor of Pediatrics