Pulmonary and Sleep Medicine

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Fellowship Program Details

 

Mission

The Pediatric Pulmonology Fellowship Program at Duke University Medical Center (DUMC) is a fully accredited three-year post-graduate program designed to train future leaders in academic pediatric pulmonary care, teaching and research. The fellowship provides a mentored program of progressive clinical responsibility, a structured basic and clinical science program, and a mentored research experience that provides a thorough experience in research from hypothesis formation to presentation of results. Teaching skills are developed through increasing responsibilities while teaching medical students and residents in clinical diagnosis and therapeutics, and preparing seminars and teaching materials. 

Goals

The goal of the Pediatric Pulmonology Fellowship Program at DUMC is to provide outstanding clinical and academic training so trainees can pursue academic careers as clinicians, educators, and scientists. The program emphasizes integrated care, teaching and research for childhood respiratory disorders, including asthma, chronic lung disease of infancy, cystic fibrosis, chronic suppurative lung diseases, obstructive sleep apnea and sleep disordered breathing, reactive airway disease, lower respiratory tract infections, restrictive lung disease caused by chest wall maldevelopment and neuromuscular disorders, pulmonary hypertension, collagen vascular diseases involving the lung, diseases related to immunodeficiency or immunosuppression, pulmonary intensive care, airway appliances and chronic ventilatory assistance, aspiration syndromes, and a variety of developmental disorders.

Training Objectives 

The main objectives of the fellowship program are to:

  • Gain experience coordinating the overall care of pediatric pulmonary patients and develop expertise in providing high-quality, cost-effective diagnostic and therapeutic management. 
  • Gain experience in teaching pulmonary medicine to house staff and medical students.
  • Gain skills in performing fiberoptic bronchoscopy and bronchoalveolar lavage.
  • Understand pulmonary function mechanics and principles of ventilation.
  • Learn to interpret pulmonary function tests, polysomnography studies, pH probe tests, sweat chloride tests, and radiologic studies of the chest.
  • Learn to interpret bronchial provocation testing.Understand principles of cardio-pulmonary rehabilitation.
  • Learn to evaluate and treat ventilator-dependent children.Learn to administer and monitor non-invasive ventilation.
  • Understand operation and maintenance of pulmonary function testing equipment including quality control and troubleshooting.
  • Learn research skills including critical reading, research design, statistical analysis, data reduction, scientific writing, and presentation.

The fellowship program has a graded experience in both clinical service and research. The first year, the trainee gains primary clinical experience with inpatient and outpatient activities under the supervision of attending physicians. On the inpatient service, the trainee directs day-to-day management of patients admitted to the hospital, answers inpatient consultations, and performs indicated procedures. In the outpatient setting, the trainee sees new and follow-up patients, and reviews and interprets results from the Pediatric Pulmonary Function Laboratory and Pediatric Sleep Laboratory. The trainee also participates in indicated procedures  with faculty supervision on patients that s/he has evaluated. During the first year, a clinical, translational, or basic science research project should be formulated with the assistance of an assigned faculty supervisor. 

The second and third years focus on research. Clinical responsibilities are limited to the continuity outpatient clinic one-half day per week, and on-call duties for the inpatient and consultation services one weekend per month.  Opportunities for basic, translational, or clinical research are available. Trainees may pursue a master’s degree in clinical research at the Duke Clinical Research Institute.  Trainees are expected to present their research results at a national meeting and publish these results. 

Clinical Training

The first year of the fellowship program is an intensive experience in the diagnosis and therapy of a broad range of pediatric pulmonary diseases. Along with clinical immersion, we provide an intensive didactic experience in pulmonary science. The first year includes:

  • Eight months of inpatient clinical service
  • One month of critical care
  • One month of outpatient clinics
  • One month of sleep medicine
  • One month of elective

During the second and third years, the trainee maintains a continuity clinic for longitudinal experience in patient care, and covers the in-patient service one wekend per month. During the third year, the fellow serves one month as a "junior attending" on the inpatient service to prepare to become an attending physician.

The trainee will achieve clinical competence in all aspects of pediatric pulmonary medicine through:

  1. Direct precepting and mentoring by the clinical faculty in the Division of Pediatric Pulmonary and Sleep Medicine in the setting of the Pediatric Pulmonary inpatient and consultation services, the Pediatric Pulmonary clinics, the Pediatric Pulmonary Function, Exercise, and Sleep Laboratories as well as in the pediatric bronchoscopy suite.
  2. An introduction to bronchoscopy skills for first-year trainees in a pediatric flexible bronchoscopy suite.
  3. Opportunities for an elective rotation in a specialty like pulmonary pathology, radiology, or allergy and immunology.
  4. Didactic sessions and conferences directed at clinical and physiological topics covered on the American Board of Pediatrics Pediatric Pulmonology Sub-board examination, including weekly Pulmonary Science and Journal Club meetings; weekly Pediatric Grand Round conferences; and monthly Department of Pediatric subspecialty fellowship conferences.
  5. Familiarity with the most recent standard texts on pulmonary physiology, lung development/embryology, pediatric pulmonary medicine, and cell and molecular biology of the lung; and with other literature related to clinical topics arising during patient evaluations and management.
     

Intensive training is provided in pulmonary mechanics; pulmonary function testing including spirometry; lung volumes; inhalational challenges; infant pulmonary function testing; flow-integrated vital capacities; diffusion capacity; impulse oscillometry, fiberoptic bronchoscopy; and polysomnography.

Pediatric pulmonary outpatients receive care on the second floor of the state-of-the-art Duke Children's Health Center, which includes the Pediatric Pulmonary Function Laboratory and Pediatric Sleep Laboratory. Duke Children's Hospital is located on the fifth floor of Duke Hospital. It has 165 pediatric beds including a pediatric intensive care unit, neonatal ICU, full-term nursery, inpatient wards and a step-down unit.

Research Training

The fellowship program prepares graduates to assume leadership positions in academic pediatric pulmonology. Along with clinical and teaching skills, the program provides intense training in research methodology through immersion in a mentored research project. During the first year, the trainee selects a research mentor and completes a research proposal for review by the Fellowship Program Director. Trainees select their research program from tracks that promote either basic laboratory research or clinical/translational research career paths. For the clinical/translational track, we utilize programs at the Duke Clinical Research Institute. We draw mentors from Duke's investigators in the Departments of Pediatrics, Cell Biology, Medicine, Pathology, Pharmacology and Cancer Biology, Psychiatry, and the Institute of Genome and Science Policy. We also offer research opportunities with investigators at the University of North Carolina at Chapel Hill; the Environmental Health Sciences, and North Carolina State University.

Research training is closely mentored by the primary research mentor, who meets frequently with the trainee, and by a Scholarship Oversight Committee, which convenes twice per year to review the trainee's research progress and advise the trainee and his/her mentor. The research project should:

  • Lead to acquisition of research skills
  • Lead to presentation of an abstract by the trainee at a national meeting
  • Lead to publication of a paper in a peer-reviewed journal, with the trainee as first author

Trainees who successfully complete this fellowship program are eligible for certification by the American Board of Pediatrics Sub-board of Pulmonology. the fellowship training program is accredited by the Accreditation Council for Graduate Medical Education.

Program Faculty

Follow this link for a complete list of Fellowship Program faculty.

Duke and the Triangle

Duke University Medical Center (DUMC) has earned its reputation as a center of excellence in patient care, research, and medical education. For 2010-11, U.S. News & World Report ranked DUMC tenth in the nation and the Department of Pediatrics sixth.

The Duke University School of Medicine, one of the best in the country, graduates roughly 100 students per year. The Pediatric Residency Program is accredited by the American Council on graduate Medical Education. Fourteen pediatric residents, including the pediatric pulmonology fellow, and six medicine-pediatric residents enter the program annually. the Department of Pediatrics has fellowship programs in 12 subspecialties including Pediatric Pulmonology.

DUMC is located in the city of Durham, nicknamed the City of Medicine, where 22,000 of 190,000 residents work in healthcare-related fields. Durham, Chapel Hill, and Raleigh form the Triangle, where Research Triangle Park is located. RTP is one of the oldest established high technology centers in the country and a nationally-recognized center of pulmonary research. In addition to world-class pulmonary research programs at Duke, outstanding programs are located at NC State College of Veterinary Medicine, UNC-Chapel Hill, the EPA, and the NIEHS.

Read more about Duke and Durham and Living in the Triangle. More>>

Contact Information

 
 
Deanna Green, MD
Director, Fellowship Training Program
Co-Director, Cystic Fibrosis Center 
Assistant Professor of Pediatrics
deanna.green@duke.edu 

Deborah Lasater
Pediatric Pulmonary Fellowship Coordinator
DUMC, Box 102382
Durham, NC 27710
919-684-3829
919-668-4455 fax