Pediatric Pulmonology Fellowship Program at the Washington University School of Medicine

Introduction

Our Accreditation Council for Graduate Medical Education (ACGME)-approved pediatric pulmonology fellowship-training program attracts promising pediatric candidates for subspecialty training and develops the next generation of academic pulmonologists.

In the Pediatric Pulmonology Fellowship Training Program, clinical training is emphasized during the first year of the fellowship, with research training intermingled so that the scholarly approach is incorporated into the fellow’s education early in the process. Clinical training accounts for twelve months of the fellowship, with six to eight months of service or elective time the first year of training, and the remaining four-to-six months total during the final two years. The pediatric pulmonary fellow has non-service rotations that are required parts of their clinical training, including Pediatric Pulmonary Function Laboratory and Pediatric Sleep Laboratory, during the first year.

Our fellows care for children with wide-ranging lung diseases and breathing disorders, such as asthma, sleep-disordered breathing, apnea, central hypoventilation, cystic fibrosis, ciliopathies, bronchiectasis, interstitial lung diseases, bronchopulmonary dysplasia, bronchiolitis, pneumonia, chronic respiratory insufficiency, thoracic tumors, and congenital lung anomalies during their clinical rotations. Because Washington University has an active pediatric lung transplantation service, fellows are exposed to the pre-operative evaluation and post-operative care of these patients. Fellows have regular, half-day outpatient clinics that are held in the Pediatric Pulmonary Center at St Louis Children’s Hospital, supervised by divisional faculty. Fellows also acquire the procedural skills and techniques needed for a pulmonary subspecialist, including flexible fiberoptic bronchoscopy, bronchoalveolar lavage, and transbronchial biopsies. They receive extensive training in the interpretation of pulmonary function studies, allergy tests, and overnight polysomnograms.

On average, the pulmonary fellows are on call every three to five weeks and handle outpatient calls from home, including months covering the inpatient service. In addition, the fellow will be on call for parents and other caregivers of children and adolescents with chronic lung disease who receive care from the Division of Allergy, Immunology, and Pulmonary Medicine approximately one night every two weeks. Pediatric-trained allergy fellows share clinical responsibilities with pediatric pulmonology fellows.

Beginning the first year, research training is highlighted, and the fellows are provided with protected time during which they develop and hone skills necessary to be successful as a physician-scientist. Indeed, an emphasis of fellowship training at Washington University is supervised research experience. Research activity is scheduled in long, uninterrupted blocks. As evidenced by their recent grant and publication record, our pulmonology fellows participate in clinical and translational research programs, which include:

  • National Institutes of Health (NIH)-funded childhood asthma research programs, including the Children’s Asthma Management Program (CAMP), Children’s Asthma Research and Education Program (CARE), and Network Clinical Center (AsthmaNet) that are helping us understand the benefits and long-term effects of asthma treatment in children,
  • Minority programs designed to impact asthma morbidity,
  • NIH-sponsored, multidisciplinary center examining pulmonary complications leading to morbidities and mortality of sickle cell disease,
  • Interdisciplinary NIH-funded project examining the role of respiratory viruses and associated immune response on graft dysfunction, supported by the pediatric lung transplantation program
  • Therapeutic Development Network, a Cystic Fibrosis Foundation (CFF)-supported program designed to rapidly bring new therapies to cystic fibrosis patients,
  • Center for the Genetic Determinants of Mucociliary Clearance Consortium, part of the NIH Rare Diseases Clinical Research Network, which was created to better define pathogenesis, natural history, and treatment of primary ciliary dyskinesia and atypical forms of cystic fibrosis,
  • Clinical research program studying the prevention of sudden infant death syndrome, funded by the Gates Foundation,
  • NIH-supported research program examining early determinants of chronic lung disease of infancy.

Research opportunities are not limited to the Division, and numerous collaborations exist throughout the medical center. Fellows have joined renowned, well-established basic research programs that are examining the genetics, molecular mechanisms, cellular pathophysiology, and disease processes of asthma, cystic fibrosis, surfactant deficiencies, ciliopathies, emphysema, immunodeficiencies, and respiratory infections. It is expected that as the fellow progresses through their project, he or she will prepare and submit grant applications, scientific abstracts, and first-authored papers that pertain to their work. With time, the trainee will become increasingly independent, and the mentor, scholarship oversight committee, and program director will assure that satisfactory progress toward independence has been made.

Several conferences are required parts of the training, providing the fellows with a comprehensive understanding of pulmonary physiology, pathophysiology, and clinical care. In addition to the clinical and research lecture series scheduled by the Department of Pediatrics and sessions held by the Division of Pulmonary and Critical Care Medicine at Barnes-Jewish Hospital, the Division of Pediatric Allergy, Immunology, and Pulmonary Medicine has clinical conferences essential to our educational mission: the Pediatric Pulmonary Physiology Conference, Pediatric Pulmonary Pathology Conference, Pediatric Pulmonary Clinical Conference, Respiratory Physiology Review; and Journal Club.

The Division of Pediatric Allergy, Immunology, and Pulmonary Medicine offers challenging medical goals and unparalleled research potential. If you are interested in pursuing a career in pediatric pulmonary medicine at Washington University in St. Louis, please contact us at:

Ferdinand Coste III, D.O.
Assistant Professor of Pediatrics
Director, Pediatric Pulmonology Fellowship Program
One Children’s Place
St Louis, Missouri 63110
Telephone: 314 747-5752
E-mail address: coste_f@kids.wustl.edu

Wash U School of Medicine
Children's Hospital St. Louis
Children's Discovery Institute
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