Overview

Our program aims to cultivate exceptional clinicians and physician-scientists adept at addressing the distinctive challenges within pediatric pulmonology. Whether embarking on careers in clinical practice, translational research or basic science exploration, our fellows are equipped with the requisite skills and knowledge to make significant contributions to the field.

We prepare our fellows to confront both national and global health concerns, ranging from respiratory diseases to broader public health threats. Rooted in a culture of excellence, we prioritize honesty, integrity and fairness across all facets of clinical care and research.

Above all, we cherish compassion and diversity, urging our fellows to deliver empathetic care to patients and honor the diverse backgrounds and perspectives within our patient community.

Clinical training is emphasized during the first year of fellowship. Overall, clinical training accounts for a total of twelve months of the fellowship, with six to seven months of clinical service or elective time the first year of training, and the remaining five to six months total during the final two years. Additionally, there are non-service rotations that are required parts of clinical training, including the pediatric pulmonary function testing and pediatric sleep laboratories.

Fellows participate in regular, half-day outpatient clinics at the Pediatric Pulmonary Center in St. Louis Children’s Hospital, where they gain direct experience in managing a diverse range pediatric respiratory conditions under faculty supervision. They also receive training in crucial procedural skills like flexible fiberoptic bronchoscopy, bronchoalveolar lavage and transbronchial biopsies.

Our program prioritizes hands-on education, empowering fellows to take leadership roles during rounds and service in the pulmonary unit. Fellows learn the necessary skills and confidence to lead patient discussions and decision-making processes alongside attending physicians. Additionally, fellows participate in subspecialty clinics like the SACK (Severe Asthma Clinic for Kids), Aerodigestive and Sleep Clinics, exposing them to unique patient populations and diagnostic challenges. They also receive comprehensive training in interpreting pulmonary function studies, allergy tests, and overnight polysomnograms, further enhancing their clinical expertise in pediatric pulmonology.

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. On average, the pulmonary fellows are on call every three to five weekends and handle overnight calls from home, including when covering the inpatient service. Fellows also share in overnight outpatient call responsibilities, taking calls from parents and caregivers of children followed by the Division of Allergy and Pulmonary Medicine, about once or twice a month.

Training in research and its methodology is an essential component of our fellowship program. Starting in the first year of fellowship, research training is intermingled so that the scholarly approach is incorporated into the fellow’s education early in the process.

During the second and third years of fellowship, research training is highlighted, and the fellows are provided with significant protected time during which they develop and hone skills necessary to be successful as physicians and investigators who can succeed in academia.

Research activity and scholarly pursuits are scheduled in long, uninterrupted blocks. As evidenced by their recent grant and publication record, our pulmonology fellows have participated in basic, translational and clinical research programs, which include:

• National Institutes of Health (NIH) funded childhood asthma research programs that are helping us understand the benefits and long-term effects of asthma treatment in children, including the:
  • Children’s Asthma Management Program (CAMP)
  • Children’s Asthma Research and Education Program (CARE)
  • Network Clinical Center (AsthmaNet)
  • Inner City Asthma Consortium (ICAC)
• Mobile outreach Asthma Van program designed to help address disparities in local asthma care.
• 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.
• NIH supported research program examining early determinants of chronic lung disease of infancy, and the mechanistic underpinnings of Cystic Fibrosis and Asthma.
• A Pediatric Pulmonary Diseases & Asthma Center of Excellence in the Children’s Discovery Institute of the St. Louis Children’s Hospital.

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 didactic conferences are required parts of fellowship 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, the Division of Pediatric Allergy and Pulmonary Medicine has clinical conferences essential to our educational mission:

• Pediatric Pulmonary Physiology Conference
• Pediatric Pulmonary Pathology Conference
• Pediatric Pulmonary Clinical Conference
• Respiratory Physiology Review
• Journal Club