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Pediatric Pulmonology, Allergy, and Sleep Medicine

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Fellowship in Pediatric Pulmonology
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Department of Pediatrics
Fellowship in Pediatric Pulmonology

• Introduction
• Program Eligibility
• Application Process and Requirements
• Duration Of Training
• Description - Clinical Training
• Facilities And Resources
• Summary

TRAINING PROGRAM IN PEDIATRIC PULMONOLOGY

Graduation Party

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Introduction

The field of Pediatric Pulmonology is a broad one and New York Medical College and its affiliated hospital, The Maria Fareri Children's Hospital at Westchester Medical Center, offer a vast panorama of clinical and research opportunities. To optimize the educational experience, each fellow is encouraged to take an active role in conjunction with the program director in designing his own program.

The Pediatric Pulmonary Fellowship adheres to the requirements for Pediatric Pulmonology certification by the Pulmonology Subboard of the American Board of Pediatrics, and is fully accredited by the Accreditation Council for Graduate Medical Education. The goals of our three year program are to provide:

  • A base of scientific skills and expertise that will ultimately allow fellows to become independently functioning and funded investigators
  • Skills to provide expert clinical care for infants, children and adolescents with disorders of the respiratory system
  • A solid knowledge base and skills to guide, instruct and teach others the fundamentals of lung function and clinical care
  • To build administrative and time management skills

Program Eligibility

Applicants are eligible for the program if they meet the following requirements:

  • Have completed (or will complete by July 1st of expected start year) an ACGME-accredited residency program
  • Have passed all components of the U.S. Medical Licensure Examination, including:
    • Step 1
    • Step 2 (Clinical Knowledge)
    • Step 2 (Clinical Skills)
    • Step 3
  • Have fulfilled the eligibility requirements for certification by the American Board of Pediatrics

International applicants must also provide evidence of the following:

  • Certification by the Educational Commission of Foreign Medical Graduates (ECFMG).  Information on ECFMG Certification may be obtained at http://www.ecfmg.org
  • Successful completion of the ECFMG English Examination

Application Process and Requirements

To apply to our fellowship program, please complete an application through the ERAS, the electronic residency application service offered by AAMC.  Their website is:

      http://www.aamc.org/programs/eras/applicants/start.htm

We accept one to two new fellows each year.  Applications are encouraged to be submitted 18 months prior to the start of training.

Please be sure to include the following items in your application:

  • ERAS Common Application Form
  • Current Curriculum Vitae
  • At least three letters of recommendation, including one from your pediatric residency  

  program director (More than 3 letters are encouraged.)

  • Medical School Dean’s letter (same as required for residency)
  • USMLE Scores Step 1, 2, 3 
  • Board scores 
  • Personal statement
    • We would appreciate a description of your clinical and research experience, your reason for an interest in Pediatric Pulmonology, and your career goals.
  • Research background/publications

A personal interview is required and will be granted to the most qualified applicants.  We expect each applicant invited to interview to devote an entire day with us, usually a Friday.  If Fridays are not possible, we can occasionally choose a different day.  Interviews are usually scheduled from January to the end of April.  Application deadlines are sometimes flexible.

 Application Timeline and Selection Procedure

November

ERAS opens for applications.

December

Programs download applications and determine interview invitations.

Dec-April

Selected applicants will be invited to interview.

January

Applicants and program register with NRMP.

April-May

Applicants are ranked on basis of prior performance, letters of recommendations, personal interviews, and academic promise.

June

Match Day

July 1

Fellowship start date one year after match

 

 

 

 

 

 

 

 

 

 


Duration Of Training

A minimum of three years is required. It is expected that there will be a progressive development of clinical, teaching and research skills during the program.


Description - Clinical Training

At least 15 of the 33 months will be spent primarily on clinical service. The Pediatric Pulmonology, Allergy and Sleep Medicine Division of New York Medical College cares for the entire spectrum of respiratory disorders in patients varying from 500-gram neonates to adolescents and beyond. The bulk of the clinical experience will be in the faculty practice of New York Medical College and the inpatient facilities of the Maria Fareri Children's Hospital at Westchester Medical Center.

The Pulmonology inpatient service at the Maria Fareri Children's Hospital is one of the major strengths of the training program. WMC serves as the only tertiary care referral center located within an area of seven counties with a population of over 3 million. As the only Pediatric Pulmonology Division in the area, essentially all children requiring subspecialty services are referred to the division. The hospital has a stated policy to never turn down patients who need tertiary care. Each trainee will spend at least 15 months "on-service" during the 3-year program. The daily inpatient census varies from 7 to 17 patients. In addition, we average 1 to 4 new consults daily, many of which require daily follow-up. This includes patients in both the Neonatal ICU and Pediatric ICU. Therefore, the pulmonary service follows between 8 and 20 patients daily.

Our service actively consults on many patients in the Pediatric Intensive Care Unit, and most patients with significant respiratory disease are transferred to the pulmonary service when they no longer require intensive care. In addition, trainees may elect to spend up to 8 weeks "on-service" In the PICU for a more intensive experience. During this time, Attending Physicians in Pediatric Critical Care Medicine will directly supervise the fellow.

Care of children with chronic respiratory diseases such as bronchopulmonary dysplasia is an important part of clinical pediatric pulmonology. All fellows in our program will spend an average of 6 weeks each year participating in the care of children at Blythedale Children's Hospital, a superb children's rehabilitation hospital less than 100 yards from our campus. During this time, our fellows will become quite experienced with the management of technology-dependent children including children on chronic mechanical ventilation, children with tracheostomies and the respiratory care of a vast array of children with genetic, metabolic and neuromuscular disorders. For more information, Blythedale’s website is: http://www.blythedale.org.

In addition to an active inpatient service at WMC, each fellow will have scheduled office hours in the faculty practice, where he or she will follow their "own" patients with chronic respiratory disorders throughout their fellowship. This continuity of care is an essential part of the training, and is held in the faculty practice suite of the Department of Pediatrics: http://www.cwpw.org.

The Pediatric Pulmonology, Allergy and Sleep Medicine Division has a huge outpatient program, with approximately 10,000 outpatients per year. This translates into, on average, 120 patients per week in our outpatient facilities, of which approximately 20 - 30 are new. Essentially all patients are referred from their primary care physicians, and our faculty cares for all children regardless of their health insurance status or their ability to pay.

1.  The clinical training will include experience in:

  • ASTHMA AND ALLERGIC RESPIRATORY DISORDERS
    • Our division is by far the largest center for both inpatient and outpatient care of children with asthma and related disorders in the region.
  • BRONCHOPULMONARY DYSPLASIA
    • Our fellows and faculty follow all children with chronic lung disease who graduate from our own NICU as well as the other units in the region. Because of our special relationship with Blythedale Children's Hospital, one of the premier children's rehabilitation hospitals in the nation, our graduates are very experienced in the management of chronic ventilator-dependent infants.
  • CYSTIC FIBROSIS
    • WMC is a designated Cystic Fibrosis Care Center of the National Cystic Fibrosis Foundation, with over 150 children and adults cared for by the Pediatric Pulmonary Division.
  • PEDIATRIC SLEEP DISORDERS
    • WMC has a beautiful state-of-the-art 4 bedded sleep center, and our division interprets hundreds of pediatric sleep studies each year.
  • INFANT APNEA AND DISORDERS OF RESPIRATORY CONTROL
    • WMC is a state-designated Infant Apnea referral center, with over 150 infants and children referred yearly for evaluation and management of apnea and central hypoventilation syndromes.
  • PEDIATRIC INTENSIVE CARE
    • The 18 bed Pediatric Intensive Care Unit of the Maria Fareri Children's Hospital is the only PICU in the 7 county Hudson Valley Region. We transport all critically ill children from the region for tertiary care. Our pulmonary fellows are very involved in the management of patients in the PICU, including management of postoperative respiratory complications in children following surgery of all kinds, including neurosurgery and open heart surgery.
  • NEONATAL RESPIRATORY DISORDERS
    • The NICU of the Maria Fareri Children's Hospital is the only quaternary level NICU in the region. With 50 beds, our NICU offers all services including extracorporeal membrane oxygenation (ECMO). The entire spectrum of congenital and acquired respiratory disorders of newborns is seen.
  • LOWER RESPIRATORY INFECTIONS
  • PULMONARY REACTIONS to chemical injury, multiple trauma and foreign bodies
    • WMC houses the only burn center in the region, and our fellows are regularly consulted in the management of children in the burn center.
  • ASPIRATION syndromes
  • ANOMALIES of the respiratory system
  • PULMONARY DISORDERS of infants with cancer, both primary, and secondary to treatment.
  • PULMONARY DISORDERS in children with the entire spectrum of complex congenital heart disease, including chronic illness and postoperative management.
  • INTERSTITIAL LUNG DISEASES, including disorders with infectious, immunological and collagen vascular etiologies.
  • TECHNOLOGICALLY DEPENDENT CHILDREN INCLUDING HOME VENTILATION.
    • Our division manages hundreds of children living at home in the region on mechanical ventilation, with tracheostomies, or using noninvasive ventilatory assist including CPAP and BiPaP.

2.  Educational Program

Our division has four hours of conferences per week. Each fellow is expected to attend and participate in the following division conferences:

  • Respiratory Physiology and Biology, 3/Month
  • Inpatient Clinical Review, Weekly
  • Journal Club, Monthly
  • Research Seminar, Monthly
  • Sleep/Apnea Conference, Monthly
  • Cystic Fibrosis Team Conference, Monthly
  • Pediatric Allergy/Pulmonary Conference
  • Pediatric Critical Care Conference Quarterly
  • Pediatric Pulmonary Conference for House Staff Monthly

Seminars are also designed by the faculty on statistics, research design, ethics of clinical research, and operational aspects of a pediatric pulmonology facility including the proper selection, maintenance and calibration of pulmonary function instrumentation. Sessions are also scheduled on medical writing, oral presentation skills and teaching programs.

Senior fellows are also expected to attend our monthly Cystic Fibrosis Center Quality Improvement Committee meetings.

In addition, fellows are expected to attend the departmental weekly grand rounds.

The Pulmonary and Critical Care Division of the Department of Medicine has a full schedule of conferences, many of which are very applicable to Pediatric Pulmonology.

There is a steady schedule of basic science and research conferences in the many departments of the medical school participating in pulmonary research.

It is expected that each graduate of the training program will be skilled in teaching. Toward that aim, each fellow will be required to organize and deliver conferences to the division, the house staff and to the department with gradually increasing responsibility through the three years.

3.  Research Training

The research component of the program is given equal weight to the clinical program. A minimum of 15 months will be devoted to research during the three- year program. It is expected that the fellow will develop projects in both basic and clinical research, and follow these projects through until completion and publication. Since this is the main campus of the medical college, there is a wide spectrum of laboratory opportunities in lung biology. The amount of time protected for research will increase yearly, so that the bulk of the third year will be spent performing independent research. All of the division members are participating in research and there are many projects being pursued jointly with other divisions within the Department of Pediatrics and with other departments.

The fellow will meet with the program director frequently to help shape and focus the trainee’s research interests and design a program that is stimulating and productive. The goal is to have the research program tailored to the individual and organized so that the trainee can be productive as soon as the heavy clinical demands of the first year start to wane.

Fellows are encouraged to develop projects both at the bench in one of the many laboratories open to them, and at the bedside.

Each fellow is expected to develop at least one independent project, from inception all the way through to publication, with the fellow acting as first author (principal investigator.) In addition to intramural presentations of their work, fellows will be encouraged to present their data in abstract form in appropriate national and international scientific conferences in addition to submitting their data for publication in a peer-reviewed journal.

Our division has been designated as an American Lung Association Asthma Clinical Research Center since 1999.  As a member of that network, we perform large multicenter trials in asthma.  More information can be obtained about this network at: http://cctrials.org/alaacrc/.    

In addition, we are designated as a Therapeutics Development Center by the Cystic Fibrosis Foundation.  This extra level of accreditation assures that we have the opportunity to participate in all of the clinical trials in the CF Foundation pipeline. This network’s website is:  http://www.cff.org/research/TDN/.

4.  Pediatric Pulmonary Function and Exercise Laboratory

We have a complete state-of-the-art pediatric pulmonary function and exercise laboratory. Each graduate of the training program will be able to set up a pulmonary lab, understand and maintain the equipment, perform all tests and interpret all results. This includes state-of-the-art testing of infants and young children.

5.  Flexible Bronchoscopy

We perform all pediatric flexible bronchoscopy services at the Maria Fareri Children's Hospital at Westchester Medical Center. Each graduate of the training program will be able to independently develop a pediatric bronchoscopy service.

6.  Childhood Sleep Disorders

Our division serves as a referral center for children with a wide range of sleep-related disorders. Each graduate of the training program will be accomplished in the evaluation of these disorders, including the design and interpretation of a wide range of sleep studies, including complete polysomnography.

7.  Children's Environmental Health Center of the Hudson Valley

Our division is home to the only Children's Environmental Health Center in the lower Hudson Valley, http://www.childrensenvironment.org. Recognized and supported by the New York State Department of Health, our center has three missions:

  • Consultations for children with suspected or known exposures to environmental toxins.
  • Educational programs for physicians and other health care professionals, as well as for the community, dedicated to raising awareness of the importance of minimizing exposure of our children to environmental toxins and pollutants.
  • Research, which is vital to understanding the role of the environment in the health of children.

Facilities And Resources

The Pediatric Pulmonology, Allergy and Sleep Medicine division has a 13 physician faculty with a very wide range of clinical and research interests. This assures each trainee of the opportunity to be exposed to all facets of our field. Our faculty is currently involved in dozens of research projects, ranging from cell and molecular biology, clinical trials, and epidemiological research. Fellows may choose any of the faculty as mentors in research.

New York Medical College, which has been training physicians since 1860, is one of the largest medical schools in the United States. The main campus moved to Westchester from New York City over 15 years ago, and this move has sparked an extraordinary growth in both the research and patient care roles of the medical school. The Department of Pediatrics has likewise grown at a fantastic rate, with all subspecialists very well represented. There are huge opportunities for each fellow to interact with basic scientists and clinical scientists in all fields of medicine.

The School of Health Sciences and Practice of New York Medical College is a vital resource for our training program. In addition to strong statistical and epidemiological support, the faculty of the Institute for Public Health Health and our division faculty collaborate closely in our newly developed Children's Environmental Health Center of the Hudson Valley. Trainees are strongly urged to consider obtaining and MPH while they are completing their fellowship in pediatric Pulmonology.

The Maria Fareri Fareri Children’s Hospital at Westchester Medical Center is a major teaching hospital of New York Medical College. It serves as the only major referral center for the seven counties in the lower Hudson Valley, and has the highest “case-mix index,” which is a measure of acuity, in the state. Our helicopters bring children in daily from a very expansive geographic region. The focus is on tertiary and critical care. We are always at or above 100% census with transports of critically ill children occurring daily. In 2004, the magnificent Maria Fareri Children's Hospital at Westchester Medical Center opened, and continues to expand in size and scope of programs offered. MFCH is dedicated to family-centered care and is a truly beautiful facility. All patients have private rooms and parents are encouraged to stay 24 hours a day. More information about our new Children’s Hospital can be obtained by visiting our web site: http://www.worldclassmedicine.com/home_mfch.cfm?id=65.


Summary

The Training Program in Pediatric Pulmonology is a highly selective, rigorous and demanding 3-year program designed to prepare pediatricians for an academic and clinical career in Pediatric Pulmonology. As a result, our fellows are very well prepared for the entire spectrum of professional positions available for board certified Pediatric pulmonologists.


 


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