Pulmonology Fellowship Program

Number of fellows taken per year: 2
Deadline for application to your program (if applicable): March 31, 2006
Duration of appointment: 3 years
Other sites of training: Childrens Hospital Los Angeles
Postgraduate training required (1,2,3 years): 3 years
US Citizenship required: NO

Application: Download

Director of training program: Thomas G. Keens, M.D.
Phone: (323) 361-2101
FAX: (323) 361-1363
E-mail: tkeens@chla.usc.edu
Address: Childrens Hospital Los Angeles,
Division of Pediatric Pulmonology
4650 Sunset Blvd., M/S #83
Los Angeles, CA 90027

Program Coordinator: Evelyn Hsu
Phone: (323) 361-4539
E-mail: ehsu@chla.usc.edu

Description of fellowship:
General: The CHLA Fellowship training program in Pediatric Pulmonology is designed to train physicians capable of assuming a leadership role in the development of the subspecialty. In addition to excellence in clinical care, our program provides training in the academic activities of research and teaching. The CHLA is 3-year ACGME accredited fellowship training program. Fellows who successfully complete our fellowship qualify for American Board of Pediatrics eligibility in Pediatric Pulmonology. We accept up to two fellows per year for a three-year program. Some fellows will stay for a fourth year, usually involved in research. Training occurs on an apprenticeship basis with our faculty. You will get to know our faculty and fellow colleagues quite well, and they will be your teachers.

Our Fellowship Training Program provides approximately 14-months of clinical training out of 3-years, and 19 months of research training. Clinical training is concentrated in the first year (9-months), with decreasing time in the second and third years. This schedule provides increasing time for research as the fellowship progresses. This allows the fellow to gain an idea about the subject matter of the subspecialty first, in order to decide what might interest him or her, and to decide which faculty he or she might want to work with for research.

Clinical Training: An important role of Fellowship Training is to provide comprehensive training in the diagnosis and management of infants, children, and adolescents with respiratory disorders. This includes both inpatient and outpatient experience. At CHLA, the unifying philosophy behind our fellowship training program is the understanding and application of respiratory physiology to the diagnosis and management of respiratory disorders. This is a program where fellows do not simply learn to interpret pulmonary function tests in isolation. Rather, they learn to use the laboratory and apply physiologic principles in their patients' daily care.

Inpatient Service: CHLA has a busy clinical pulmonary service. The inpatient service averages approximately 30 inpatients on any given day. Our program provides a broad clinical experience, which is ideal for the fellow who learns best by seeing and doing. CHLA has the only Pediatric Pulmonology program in the central Los Angeles metropolitan area. Thus, we see a large number of all types of respiratory disorders, even those considered to be rare in many programs. A fellow graduating from our program is unlikely to be surprised by anything they see in practice. If they have not seen a patient with the same disorder, they are likely to have seen one close enough that they can readily develop a diagnostic and therapeutic approach. During the inpatient rotation, fellows will gain experience in asthma, bronchopulmonary dysplasia, cystic fibrosis, pulmonary infections, respiratory disorders in systemic diseases and in immunocompromised hosts, neuromuscular diseases, disorders of ventilatory control, interstitial lung diseases, congenital malformations of the respiratory system, and acute and chronic respiratory failure. They will learn how to use supplemental oxygen, home mechanical ventilation, non-invasive mask ventilation, diaphragm pacing, and other technologies. Fellows function at a junior consultant level, providing consultation, guidance, and education to Pediatric house officers. In general, fellows round in the morning and write notes, and then round with their Pulmonary Attending in the afternoon for teaching. The Pediatric House Staff at CHLA are generally of high quality, so fellows are not expected to serve as intern or resident on Pulmonary patients. The fellow is also responsible for teaching any medical students or residents taking the Pulmonary Elective. Fellows are frequently asked to give mini-presentations on pulmonary problems to house staff ward teams (topics such as cystic fibrosis, home mechanical ventilation, BPD, infant apnea, etc.). Although there is no separate ICU rotation, approximately 20%-30% of Pulmonary inpatients are in the intensive care unit, which gives the fellow ample ICU experience and education.

Outpatient Service: Much of Pediatric Pulmonology involves the ongoing care of children with chronic disorders in the outpatient setting. In the outpatient rotation, the Fellow attends Pulmonary Clinic, which is supervised by a full-time Pulmonologist five-days per week. In addition, the other Attending Pulmonologists each have 1-2 days of clinic. Therefore, the fellow is exposed to the different styles and clinical expertise of several different faculty members. Fellows see new consultations, follow-up visits for interesting or unusual patients, and answer sick calls from patients who develop acute illnesses. Fellows also have a continuity clinic over their entire 3-years, where they follow a select number of patients with a variety of disorders to learn the long-term management of pediatric respiratory disorders. Each fellow's continuity clinic is ½ day per week, where the fellow schedules his or her own patients.

Pulmonary and Sleep Laboratories: An important part of the Pediatric Pulmonology Fellowship training is an understanding of respiratory physiology and the use of the physiology laboratory in the diagnosis and management of patients. In the outpatient rotation, the fellow interprets all pulmonary function tests, exercise stress tests, and sleep studies, which are performed. The Fellow also participates in the performance of less common studies, such as measurement of transdiaphragmatic pressure or CO2 ventilatory response, so that he or she will be able to perform them after fellowship. Thus, fellowship training provides extensive exposure to the performance and interpretation of routine pulmonary function tests, sleep studies, infant pulmonary function tests, exercise stress tests, tests of ventilatory muscle strength, and tests of ventilatory control. A challenge of this subspecialty is the adaptation of these physiologic tests to children of different ages, sizes, and abilities to cooperate, which our fellows learn.

Flexible Fiberoptic Bronchoscopy: Fellows will be able to master procedures required for subspecialists, notably flexible fiberoptic bronchoscopy. Fellows generally learn bronchoscopy during their 2nd and 3rd years. Each fellow usually takes bronchoscopy call for a week at a time, performing any procedures requested during that period of time.

Academic Training: A goal of fellowship training is to produce academic leaders in the subspecialty. The traditional route for most fellows is to engage in either basic or clinical research. CHLA provides a course for all fellows each year in July, which provides training in biostatistics, research design, protocol writing, grant writing, and the ethics of research. Fellows are expected to initiate, conduct, and publish the results of one or more research studies performed during fellowship. The faculty of the training program serves as the research mentors for fellows, and research training is usually learned by an apprenticeship system. Additional research mentors, outside the Division faculty, may also perform basic and/or clinical research mentoring for fellows. Historically, most CHLA fellows have performed human physiological research studies or clinical research. Areas of research where fellows have completed projects include:

• Respiratory Control, Sleep Disordered Breathing, and SIDS
• Cystic Fibrosis
• Infant Pulmonary Mechanics
• Lung Transplantation
• Lung Involvement in Systemic Disorders
• Ventilatory Muscle Function
• Clinical Lung Disorders

CHLA Pediatric Pulmonology Faculty:
All Division faculty are involved in teaching in our Fellowship Training program. Each has unique interests and areas of expertise. This diversity enriches the training program and benefits each trainee.

Thomas G. Keens, M.D. Professor of Pediatrics, Physiology and Biophysics, USC. Director, CHLA Pulmonary Fellowship Training Program. Chair, CHLA Institutional Review Board. Academic interests include cardiorespiratory control, CCHS, SIDS, home mechanical ventilation, exercise physiology in chronic lung disease, developmental respiratory physiology, and ventilatory muscle fatigue.

Cheryl D. Lew, M.D. Associate Professor of Pediatrics, USC. Currently pursing an M.S. in Medical Education at USC. Chair, CHLA Ethics Resource Committee. Academic interests include infant chronic lung disease, lung growth and development, biomedical ethics, respiratory aspects of neuromuscular disease, chronic respiratory failure, and adult learning in biomedical ethics and postgraduate medical education.

Eithne F. MacLaughlin, M.D. Associate Professor of Pediatrics, USC. Medical Director, CHLA Respiratory Care Department. Transplant Pulmonologist, CHLA Cardiothoracic Transplantation Program. Academic interests include lung transplantation, clinical pulmonary disorders, and respiratory care for children.

Monique F. Margetis, M.D. Assistant Professor of Pediatrics, USC. Director, CHLA Pulmonary Clinic. Academic interests include outpatient management of respiratory disorders in infants, children, and adolescents.

Iris A. Perez, M.D. Assistant Professor of Pediatrics, USC. Director, CHLA Flexible Fiberoptic Bronchoscopy Program. Associate Director, Sleep Physiology Laboratory and Sleep Disorders Program. Academic interests include sleep disordered breathing, sleep disorders, obstructive sleep apnea syndrome, and sleep architecture in ventilator dependent children.

Arnold C.G. Platzker, M.D. Professor of Pediatrics, USC. Division Head, Division of Pediatric Pulmonology. Director, CHLA Cystic Fibrosis Center. Academic interests include infant lung mechanics, aspiration, pulmonary function in HIV exposed infants, environmental tobacco smoke and asthma in infants and small children, and cystic fibrosis.

Sally L. Davidson Ward, M.D. Associate Professor of Pediatrics, USC. Director, Sleep Physiology Laboratory and Sleep Disorders Program. Academic interests include respiratory control, sleep disorders, sleep disordered breathing, obstructive sleep apnea syndrome, respiratory and sleep disorders in children with craniofacial anomalies, SIDS, and noninvasive home mechanical ventilation.

Marlyn S. Woo, M.D. Assistant Professor of Pediatrics, USC. Medical Director and Director of Medical Research, CHLA Cardiothoracic Transplantation Program. Academic interests in lung transplantation, lung growth following lung transplantation, and cystic fibrosis.

In addition to the Pediatric Pulmonology Faculty, the Division has a number of other professionals who support patient care and help teach fellows. These include nurse coordinators for the home mechanical ventilation program and tracheostomy patients, and for cystic fibrosis; dietitians; social workers; research nurse coordinator; pulmonary physiology technicians; and respiratory therapist. Many of these health professionals are also involved in research activities.

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