Fellows in the Pediatric Pulmonary Fellowship of the Icahn School of Medicine at Mount Sinai are involved with clinical care throughout the entire three-year experience. In the first year, you will focus on inpatient and outpatient clinical care, while closely supervised by members of the Division of Pediatric Pulmonology and Cystic Fibrosis. During the second and third years, you will continue to engage in clinical training primarily in the outpatient setting, but will focus on the initiation and completion of a research project with close oversight from both divisional and departmental investigators.
The staff of the Medical School will serve as role models for ethical research and clinical care. By the end of the fellowship, you will be able to:
- Diagnose and manage pediatric patients with acute and chronic respiratory disorders
- Understand the pathophysiology of acute and chronic respiratory disorders in pediatric patients
- Select, perform, and evaluate procedures necessary for morphologic and physiologic assessment of respiratory diseases in children
- Interpret diagnostic tests and assess the effectiveness of therapeutic procedures
- Understand the basic and fundamental disciplines related to the lung including embryology, physiology, pharmacology, pathology, allergy and immunology, and genetics
- Appreciate the psychosocial aspects of chronic respiratory disease in pediatric patients
- Counsel chronically ill patients and their families
- Perform preventive measures related to respiratory disease in pediatric patients
- Conduct research in respiratory disorders in pediatric patients
- Perform medical writing, oral presentations, and development of teaching programs
- Understand the operational aspects of a pediatric pulmonary facility, including quality improvement, unit management; grant proposals and planning for program development
Requirements for Graduation
To graduate from the Pediatric Pulmonary Fellowship, you must demonstrate professional and ethical behavior throughout the course of training, as evidenced by supervisor reports and evaluations. You must also satisfactorily complete:
- The three-year program, as required for Pediatric Pulmonary Fellowship by the American Board of Pediatrics
- All Pediatric Pulmonary Fellowship competencies
- All clinical training assignments and competencies as listed in this manual and as evidenced by supervisor reports and evaluations that substantiate proficient performance.
- All curricular activities as evidenced by acceptable levels of course work and in-service examinations
- Scholarly presentations, including local and/or national conferences
- A scholarly project that results in a publication in a peer-reviewed journal or that is acceptable when reviewed by your scholarly oversight committee (SOC)
Clinical and Educational Experience:
The fellowship training involves:
Inpatient Consultation/Rounding. You will spend most ofthe first year on the inpatient service, providing consultation for patients admitted to the general pediatric floors, pediatric intensive care unit, pediatric cardiac intensive care unit, and neonatal intensive care unit. You will also perform inpatient and outpatient bronchoscopies at the discretion of the attending physician.
Outpatient Clinics. During thefellowship, you will gain extensive experience in outpatient pediatric pulmonary care. You will have your own patients in the fellow-run chest clinic, with a variety of general pulmonary conditions, and will also work in several specialized/multi-disciplinary clinics. These clinics may serve patients with severe/refractory asthma, cystic fibrosis, complex airway disease, pulmonary hypertension, bronchopulmonary dysplasia and sleep disorders. During the second and third year, you may also be able to work in select areas of interest.
Bronchoscopy. You will perform inpatient and outpatient bronchoscopies at the discretion of the attending physician. In addition, you will do advanced diagnostic and interventional procedures such as endo- and transbronchial biopsy, navigational bronchoscopy (i.e., endobronchial ultrasound), foreign body retrieval, and cryotherapy. If you are interested, you can do additional training with pediatric otolaryngology staff and adult interventional staff.
Our fellows participate in didactic training, which has several components: monthly core curriculum sessions; monthly physiology reviews; and additional clinical case presentations and required conferences. You must attend at least 75 percent of these offerings each year to graduate.
The core curriculum includes monthly didactic sessions designed to teach patient care with performance-based learning. We address these topics:
- Congenital lung disease
- Respiratory disorders in the newborn
- Bronchopulmonary dysplasia
- Disorders of the upper airway
- Sleep disordered breathing
- Tuberculosis and non-tuberculosis mycobacterial disease
- Fungal lung disease
- Bronchiectasis and suppurative lung disease
- Acute respiratory distress syndrome
- Chest wall and respiratory muscle disorders
- Tumors of the chest
- Immunopathogenesis of asthma
- Outpatient asthma management
- Acute asthma management/severe asthma evaluation and management
- Cystic fibrosis – genetics and pathophysiology
- Cystic fibrosis – pulmonary disease
- Cystic fibrosis – non-pulmonary disease
- Cystic fibrosis – medical emergencies
- chILD – overview
- chILD – pulmonary involvement in systemic inflammatory disorders
- chILD – diffuse alveolar hemorrhage
- Primary immunodeficiencies and the lung
- Pediatric lung transplantation
- Feeding, swallowing and aspiration disorders
- Primary ciliary dyskinesia
- Childhood pulmonary arterial hypertension
- Lung in sickle cell disease
- Mechanical ventilation – acute
- Mechanical ventilation – chronic
- Technology dependence
Physiology Lecture Series
This monthly conference series focuses on the physiology and pathophysiology involved in breathing and lung disease. We encourage you to attend these sessions and expect that you will lead discussions on three physiology topics each academic year. There will always be at least one pulmonary faculty member in attendance. We also invite fellows/faculty from intensive care, cardiology, and neonatology when appropriate.. The sessions address patient care and systems-based learning. We address these topics:
- Structure and function
- Blood flow and metabolism
- Ventilation-perfusion relationships
- Gas transport by the blood
- Mechanics of breathing
- Control of nentilation
- Pulmonary lung function testing
- Respiratory physiology during exercise
Additional Conferences and Sessions
Fellows also gain didactic experience through the following:
- Journal Club: Pediatric Pulmonary Journal Club occurs bi-monthly. The program director and faculty of the section oversee journal club and work with the fellows to select and present appropriate manuscripts. These sessions address how to review a paper and critically analyze the literature. You will critically review at least one paper annually.
- Metropolitan Thoracic Airway Conference: This interdisciplinary conference takes place on the first Thursday of every month. We discuss complex patient cases. In addition to Mount Sinai staff, pediatric pulmonary colleagues from the NYC metropolitan area may also attend. You will present at least one case per year, making a concise case presentation, followed by a brief discussion regarding disease management, pathophysiology, recent discoveries or up-to-date clinical reviews of the underlying disease.
- Complex Care Conference: The Visiting Doctors and Complex Care Program for the Department of Pediatrics provides home services for many patients with special needs, including those requiring invasive ventilator support (i.e., dependent on trach/vent). At this monthly conference, we discuss ongoing patient care issues and facilitate multi-disciplinary decision making.
- Cystic Fibrosis Conference: The cystic fibrosis team (including doctors, social workers, genetic counselors, and others) attends this monthly conference. We review patient management and facilitate multi-disciplinary decision-making. The conference also provides a format for state-of-the-art reviews, updates on research studies (including those conducted as part of the Therapeutic Development Network), and invited speakers.
- Radiology Conference: This conference occurs every Thursday. We discuss inpatient and outpatient imaging studies, with an emphasis on interesting or curious findings. We anticipate that you will present a brief clinical synopsis and participate in discussions about your patients. This conference teaches patient care, performance-based learning, and systems-based learning.