Fellowship Program Overview
The Division of Pediatric Pulmonology and Allergy & Immunology contains 23 faculty, 1 M.D.-Ph.D., 1 M.D.-M.H.S., 8 Ph.D., and 13 M.D. The training of MD and PhD scientists side by side has been shown to increase the probability that physicians will remain active in investigation after training.
The goal of this program is to train some of the next generation of investigators (graduate students, physician fellows, and Ph.D. postdoctoral fellows) in an integrated research environment in the principles and practice of research in pediatric pulmonology and Cystic Fibrosis (CF), ranging from bench research to clinical studies. A special goal is to train M.D. or Ph.D. scientists who can engage in translational research. Our program has produced many of the leaders in pediatric pulmonology and many of the CF experts in the U.S., including department chairs, division chiefs, cystic fibrosis Center Directors, and funded investigators.
Our program exists in the context of the Case Western Reserve University School of Medicine, which is in a phase of rapid expansion of its research effort and has reached the top dozen medical schools for NIH funding support in the last few years. Our program is based in the Department of Pediatrics, which has been numbered among the top ten such departments for NIH funding for the last decade. This Department has 110 faculty based at Rainbow Babies and Children's Hospital, which is among the top children's hospitals in the United States, as named by U.S. News and World Report. Thus, the institutional setting of the program is one of balanced clinical and research excellence.
We do not hire fellows solely to meet clinical needs, and the clinical responsibilities of the fellows do not expand and contract with the number of fellows in the program. The clinical time, like the research time, is viewed as a training experience. In its over 50 year history, our program has educated many of the current leaders in pediatric pulmonology in the U.S., including department chairs, division chiefs, cystic fibrosis center directors, and funded investigators.
Characteristics of our Fellows
We welcome applications from pediatricians who are committed to patient care, education, and scholarship and who have completed an accredited pediatric residency program and are eligible for the Pediatric Boards. Fellows who are board eligible must become board certified during their fellowship in order to be eligible for the Pediatric Pulmonology sub-board.
In general, our fellows are excellent clinicians and have been highly rated residents. All fellows commit to the serious research training inherent in our program, and all enter the program with some interest in pursuing a career in academic medicine. Some have had extensive research experience prior to entering the fellowship, but some have not.
Three years of fellowship training usually lead to Board eligibility in Pediatric Pulmonology. On rare occasions, fellows do not seek clinical training and concentrate only on the research aspects of training, or have received clinical training elsewhere. Such requests are reviewed individually.
We welcome applications from well-trained and committed pediatricians who are board-eligible and graduates of accredited pediatric residency programs. Fellows acquire the clinical skills needed to independently practice pediatric pulmonology at the end of the training program through a wide range of clinical experiences. Fellows spend 18 weeks each year of the fellowship in a variety of clinical rotations in addition to one half day per week in the outpatient setting. Fellows are trained by divisional faculty, comprised of 12 pulmonologists, 2 allergy-immunologists, and a specialist in sleep medicine.
Clinical training experiences include:
- Pediatric pulmonology inpatient and consultative service
- Outpatient general pulmonary continuity clinics
- Outpatient Cystic Fibrosis continuity clinics
- Technology Dependent Clinics
- Flexible bronchoscopy
- Pulmonary Function Testing
- Sleep medicine and polysomnography
- Rotations in a tuberculosis clinic, lung transplant clinic, and pulmonary vascular disease clinic
- Pulmonary Physiology and Mechanical Ventilation Rotation
Our physicians and staff care for ~400 cystic fibrosis patients in the Leroy Matthews Cystic Fibrosis Center, over 3500 patients with asthma in the Rainbow Asthma Center, and hundreds of patients with other lung diseases, including bronchopulmonary dysplasia, interstitial lung diseases, aspiration syndromes, chronic respiratory insufficiency or failure, congenital anomalies of the respiratory system, and acute and chronic respiratory infections. The division averages about 6000 inpatient bed days per year and about 4000 outpatient visits. Six of our faculty have been listed in "Best Doctors in the U.S."
We perform ~150 bronchoscopies per year, for a variety of indications including chronic cough, evaluation of infection in the immunocompromised host, evaluation of infection in cystic fibrosis, chronic wheeze, stridor, and pulmonary hemorrhage. Graduating fellows are excellent bronchoscopists able to independently perform flexible bronchoscopy, bronchoalveolar lavage, blind bronchoalveolar lavage, and mucosal brushings and biopsies.
Our pulmonary function laboratory is fully equipped and staffed to perform spirometry, lung volume testing, exercise and bronchoprovocation testing, infant pulmonary function testing,and measurement of exhaled gases.
Our fellows receive excellent comprehensive research training during protected and call-free research rotations that make up the remaining 28 weeks of each year. Although some fellows enter the program with prior research experience, most do not, and each fellow is trained in a training program tailored to their interests, and needs. Fellows select a research mentor early in the course of the fellowship and develop a project, which they pursue throughout their fellowship. Mentors may be talented investigators in the division or outside of it, including basic science departments. However, the project must be relevant to pediatric pulmonology in the broadest sense, and it must represent an important research question, which can be pursued with rigor and in depth. The fellowship takes its research training responsibilities seriously, and regular follow up of progress occurs not only from the mentor but from the division chief as well. Fellowship projects range from quite molecular basic science to clinical, patient-based research. All are acceptable as long as they meet high standards of rigor and excellence. Part of the research training includes preparation of a grant, of which 89% have been funded. Our fellows present their findings at several national meetings each year, including the North American Cystic Fibrosis Conference and the American Thoracic Society International Conference.
Underlying our research training program is an integrated research program in CF and related pulmonary disorders, which is supported by three Center grants from the NIH and the CF Foundation, as well as a pool of R01 and other grants to participating investigators which total over $8 million of direct research support each year. This research training program includes 26 potential mentors from 6 departments, most of them experienced and federally-funded. Our division is also the site of a CF Foundation funded Therapeutics Development Center network Center, which conducts multi-center clinical research projects in CF. Our division also participates in AsthmaNet, a federally funded network of asthma clinical research sites.
In addition to hands on learning centered on our broad patient base, we offer structured didactic courses that cover pulmonary physiology, pathophysiology, and cell and molecular biology relevant to the lung. The materials from these courses provide an excellent board preparation source. All fellows take a month long introductory course on clinical research and study design offered through the medical school during the first year of fellowship. Monthly journal clubs foster evidence based practice and critical appraisal of the literature. Weekly case based conferences allow us to learn from each other about interesting and challenging patients, and weekly research seminars allow us to stay up to date on the latest research being conducted in our division and related fields.
Since its inception, the RB&C/CWRU Pediatric Pulmonology Training Program has graduated over 50 fellows, accounting for 6.5% of all practicing pulmonologists in the U.S. Graduates of our training program include 4 Department Chairs, 21 Division Chiefs, 21 CF Center Directors, and many funded physician-scientists and excellent academic clinician educators across the country.
We accept applications through ERAS and participate in the NRMP match for pediatric pulmonology. Candidates may apply beginning November of their second year of residency (or approximately1 ½ years prior to anticipated start date). Application materials include a CV, personal statement, and at least 3 letters of recommendation. After initial review, some candidates are invited for a personal interview. Interviews take place on Thursdays from January to April. In order to participate in the match, applications must be received by March 30th. We have two to three positions open most years.
Kristie Ross, MD
Co-Director, Pediatric Pulmonology Training Program
Division of Pediatric Pulmonology
UH Rainbow Babies and Children's Hospital, Rm 3001
11100 Euclid Avenue
Cleveland, OH 44106
11100 Euclid Avenue
Cleveland, OH 44106