The fellowship program in pulmonary medicine at The Children's Hospital of Philadelphia encompasses three years of training, with two fellowship positions available each year. Applicants must have first successfully completed three years of training in general pediatrics in an accredited residency program.
The goals of the fellowship program are to provide the fellow with a comprehensive experience in the diagnosis and treatment of a wide variety of pediatric breathing disorders and to make the fellow familiar with the unique needs of children with chronic lung diseases. In addition, fellows are taught the scientific method of critical thought and analysis, and are trained for a career in academic pulmonary medicine.
Howard Panitch, MD
Director, Pediatric Pulmonary Medicine Fellowship
The Children's Hospital of Philadelphia
Division of Pulmonary Medicine
34th Street and Civic Center Boulevard
Philadelphia, PA 19104
Fellows evaluate and care for all patients admitted into the hospital on the pulmonary service under the direct supervision of an attending pulmonologist. Fellows also examine and treat outpatients with a variety of pulmonary disorders, also under the supervision of attending pulmonologists.
Fellows are taught the indications for and techniques to perform flexible bronchoscopy and learn how to administer and interpret standard and infant pulmonary function tests, bronchial challenges and sleep studies. Each fellow is expected to deliver several lectures in the weekly conferences designed for for the pulmonary fellows and to prepare lectures for the pediatric house staff in work rounds and noon conferences.
Each fellow is expected to complete a research project, in which he or she researches a topic and develops a hypothesis and the experimental method to test that hypothesis. The fellow is expected to conduct the appropriate experiments, present the results at a national meeting, and write a manuscript to be submitted to a peer-reviewed journal for publication.
Rotations during the fellowship consist of one month blocks divided into:
As a general guideline, the first year of fellowship consists 10-11 months of clinically related activities, while the second and third years are comprised of 9-10 months of research-related activities. Schedules may be individualized to suit the particular circumstances of the fellow. Throughout the fellowship training program, the fellow has an opportunity to serve as the primary pulmonologist to patients acquired during the inpatient and outpatient rotations by following them in the outpatient office during designated fellows' follow-up hours.
Each fellow is expected to complete a research project, in which he or she researches a topic, and develops a hypothesis and the experimental method to test that hypothesis. The research may be basic ("bench") research, or clinical, patient-oriented research. The fellow is expected to conduct the appropriate experiments, present the results at a national meeting, and write a manuscript to be submitted to a peer-reviewed journal for publication.
All full-time staff members of the Division of Pulmonary Medicine are actively engaged in basic and /or applied research. Current areas of investigation include neurohumoral, cellular and molecular mechanisms regulating airway contractility, airway smooth muscle growth and cell surface receptor expression; regulation of postnatal development and growth of the lung; developmental effects of pulmonary inflammation and oxidative lung injury on airway and pulmonary vascular reactivity; biochemical and molecular regulation of membrane ion channels in cystic fibrosis; maturational changes in chest wall and airway function; pulmonary manifestations of sickle cell disease; the physiological basis of ventilator dependence in children with chronic respiratory insufficiency; and developmental aspects of respiratory mechanics and ventilatory control.
Other areas of applied research includes studies on airway reactivity in infants, evaluation of mechanisms of airway hyper-responsiveness in asthma, assessment of mechanisms of the sleep-disordered breathing, pulmonary function abnormalities following radiation, control of ventilation in lung disease, and development of new tests of lung function in infants. Opportunities exist for involvement in research projects occurring elsewhere within the University of Pennsylvania, including the Sleep Disorders Center and the Gene Therapy Program.
To a limited extent, the curriculum can be adapted to the future goals of the trainee. A typical curriculum might be:
|Inpatient Service||Consults/Bronchoscopy||Outpatient/Sleep Disorders||Research|
The Division and hospital have many teaching conferences to augment the clinical education of our fellows. A complete monthly listing of these conferences can be found on the Pulmonary Medicine Teaching Conferences page.
The Division of Pulmonary Medicine and Cystic Fibrosis Center provides for the inpatient and outpatient care of infants and children referred to The Children's Hospital of Philadelphia from the entire Delaware Valley and beyond. In addition to the Cystic Fibrosis program, specific programs have been developed in the areas of Asthma Care, Bronchopulmonary Dysplasia, Chronic Respiratory Insufficiency and Technology Dependence, and Sleep Disorders. In addition, infants and children with a wide variety of pulmonary diseases and breathing disorders are followed in the Division.
An interdisciplinary team that includes personnel from Medicine, Nursing, Nutrition, Social Work and Physical Therapy provides comprehensive patient care. Patients admitted onto the Pulmonary service or seen in consultation are reviewed and discussed during a weekly interdisciplinary team meeting. While rotating on the inpatient service, the fellow is responsible for the care of all patients admitted onto the Pulmonary service on the general wards and in the intensive care units of the hospital. Rounds are made daily with a designated inpatient Attending Pulmonologist, at which time the plan of care is reviewed.
On the outpatient rotation, the fellow sees new patients referred to the office, technology-dependent infants and children, acutely ill pulmonary patients for sick visits, and those patients followed by the Fellow in continuity. All office visits are precepted by the Attending Physicians. Other available inpatient opportunities include rotations on the lung transplant service and a chronic mechanical ventilation unit.
Diagnostic evaluation of inpatients and outpatients is supported by a well-equipped flexible bronchoscopy facility, as well as state-of-the-art pulmonary function testing and sleep disorders laboratories which comprehensively serve to assess lung function and respiratory nocturnal disorders in infants and older children. The pulmonary function laboratories include tests of routine pulmonary function, infant pulmonary function, ventilatory control, exercise-related breathing disorders, and bronchial reactivity.