National Jewish Department of Pediatrics Division of Allergy & Immunology Fellowships

The ACGME-accredited University of Colorado Program A in Allergy & Immunology based at the National Jewish Medical and Research Center

Goals of the Fellowship Program
Overview
1st Year Assignments
2nd Year Assignments
3rd Year Assignments

Goals of the Fellowship Program:

The primary goals are to:

1. Provide state-of-the-art clinical training in allergy and immunology as it pertains to the evaluation and management of associated medical disorders. Emphasis will be placed on atopic disorders, such as asthma, rhinitis, sinusitis, and dermatitis. This is balanced with experiences in immune deficiency and autoimmune disease.

2. Develop a solid foundation in the principles of basic immunology fundamental to understanding and managing clinical disorders.

3. Initiate a solid experience in the fundamentals of research, either basic or clinical. This is intended to provide the base for career development in academic medicine and subspecialty clinical practice.

Return to Top

Overview

Fellows in the University of Colorado Program A in Allergy & Immunology receive most of their inpatient experience through 4 different assignments. The Fellowship program is primarily based at the National Jewish Medical & Research Center (National Jewish). National Jewish is a tertiary care medical and research facility that specializes in allergic, immune, and respiratory diseases. Indeed, this year National Jewish was ranked the #1 Pulmonary Hospital in the United States by U.S. News & World Report, for the 7th year in a row. This reflects National Jewish’s expertise medical and research expertise in lung, allergic, and immune diseases.

Two Fellow inpatient assignments are at National Jewish: the Pediatric Day Program and Medical Officer of the Day (MOD). Fellows also have an inpatient assignment at The Children’s Hospital (Children’s) in Denver. Children’s is a full-spectrum academic pediatric institution, and most of UCHSC’s pediatric administration, faculty, residents, and academic programs are based at Children’s. National Jewish recently began to provide Children’s with their clinical allergy and immunology services, and Fellows rotate at Children’s under the supervision of National Jewish faculty based there, to further diversify and enrich their Fellowship experience. The 4th inpatient experience for this program’s Fellows is an Adult Allergy Consult Service, primarily based at the University of Colorado Health Sciences Center (UCHSC). UCHSC is a full-spectrum academic medical institution, with a central hospital primarily oriented to clinical services for adults. While UCHSC’s pediatric activities are primarily based at Children’s, and its allergy and immunology activities are primarily based at National Jewish, its general medicine, surgery and critical care inpatient services are mostly based on its own campus. Therefore, this assignment provides Fellows with consultative experience with adult inpatients at UCHSC, and further enriches their Fellowship experience.

Return to Top

1st Year Assignments

Pediatric Day Program: National Jewish

Fellows are assigned to this rotation for 4 months of the first year. Pediatric patients with severe allergic, pulmonary, and immune disorders are admitted to this service for in-depth multi-disciplinary team evaluations. Fellows are primary care providers for these patients, under faculty attending supervision. The disease severity and complexity of the patients admitted to this program are similar to patients seen in an inpatient setting, and essentially all patients require overnight hospitalization at National Jewish on some nights, although some do not sleep at the hospital on all nights of their admission.

This rotation provides a primary patient base for the understanding of the diagnosis, treatment, and pathophysiology of, but not limited to: 1) severe chronic refractory asthma, its detailed differential diagnosis, recognition and evaluation of the iatrogenic aspects of its management, and alternative treatments; 2) severe allergic disease including chronic rhinosinusitis, nasal polyposis, food allergy, including the use of double-blind, placebo-controlled food challenges, anaphylaxis, atopic dermatitis, urticaria, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, eosinophilia, and drug allergy; 3) immunodeficiency diseases with autoimmune features; and (4) pediatric pulmonary diseases, such as chronic pneumonias and pneumonitis, aspiration, bronchiolitis, bronchitis, congenital pulmonary anomalies, obstructive pulmonary disease, interstitial lung disease, bronchopulmonary dysplasia, cystic fibrosis, vocal cord dysfunction, bronchiectasis, and immotile cilia syndrome. This rotation should also provide a familiarization with the psychosocial effects of chronic disease on the child, adolescent, and family. The development of specific allergy & immunology specialist clinical skills, such as patient education, home management strategies and interacting with the referring physicians and tertiary consultants, will be a focus of these months.

MOD (Medical Officer of the Day): National Jewish

Fellows are assigned to this rotation for 4 months of the first year. Acutely ill pediatric patients with allergic, respiratory and immune disorders are seen by the Fellow as the primary care provider in an acute care unit, under faculty attending supervision. Most of the pediatric patients seen in triage and admitted have exacerbations of their asthmatic, respiratory, allergic and/or immune disorder(s) that benefit from specialty care. Many of the patients evaluated in triage require hospitalization at National Jewish, and continue to be followed by the admitting Fellow and attending. The basic application of rhinolaryngoscopy and bronchoscopy will also be addressed during this rotation. Expertise in methods and interpretation of pulmonary function testing, pH probe studies for gastroesophageal reflux, and various allergen, food and airway provocation challenges will be acquired. MOD / Triage and Day Program Fellows sometimes cross-over in order to continue to learn through specialty patient care even when the patient volume in their primary assignments may be low.

The Children's Hospital

This 4-month assignment for first year Fellows just began in July, 2000 with Dr. Dan Atkins serving as the attending faculty member responsible for this assignment (Dr. Atkins is the Director of Ambulatory Services and the Pediatric Care Unit at National Jewish, and the Director of Allergy and Asthma Services at The Children’s Hospital). The emphasis during this rotation will be on in-patient Allergy & Immunology consultation by the Fellow and under faculty attending supervision, within a large, full-service academic hospital for children. Also included will be specialty clinics based at Children’s in pediatric asthma, pediatric allergy, pediatric atopic dermatitis, and pediatric sinusitis. However, since the priority for Fellows is the inpatient consults, the clinics will be covered by the attending should the Fellow have consults requiring immediate attention.

Pediatric Allergy and Immunology Continuity Clinic: Outpatient pediatric experience, continued for all 24 months of the Fellowship.

Adult Allergy Continuity Clinic: Outpatient adult experience, for 20 of 24 months of the Fellowship.

* Other scholarly activities include attending one national specialty meeting in the first year.

Return to Top

2nd Year Assignments

Research: A high quality research experience takes the major portion of effort in the 2nd year.

Adult Allergy Consult Service: In-patient adult allergy consult experience, for 2 months in the second year. These consults are sporadic, and they therefore account for ~20% of the time spent during the 2-month period.

Pediatric Allergy and Immunology Continuity Clinic, and Adult Allergy Continuity Clinic: are continued throughout the 2nd year.

Return to Top

3rd Year Assignments

Fellows seeking a career in academic medicine may wish to continue their training and research at National Jewish. Some funding opportunities for further training at National Jewish exist. On approval of the faculty, a Fellow entering academic medicine may receive support to continue his research and also gain additional clinical and teaching experience for a third or more years.