Pediatrics Allergy and Immunology Fellowship Program

The ACGME-accredited University of Colorado Denver Program A in Allergy & Immunology based at National Jewish Health

Goals of the Fellowship Program
Overview
1st Year Assignments
2nd Year Assignments
Application Process
Faculty

 

Goals of the Fellowship Program:

The primary goals are to:

  1. Provide state-of-the-art clinical training in allergy and immunology a sit pertains to the evaluation and management of associated medical disorders. Emphasis will be placed on atopic disorders, such as asthma, atopic dermatitis, food allergy, eosinophilic esophagitis, rhinitis, and sinusitis. Training in the management of primary immune deficiency and autoimmune disease is included.

  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.

 

Overview

Fellows in the University of Colorado Program A in Allergy & Immunology receive most of their experience through 4 different assignments. The Fellowship program is primarily based at National Jewish Health. National Jewish Health is a tertiary care medical and research facility that specializes in allergic, immune, and respiratory diseases. For 115 years, National Jewish Health has been the leading respiratory hospital in the nation. The insitution has been ranked a top respiratory hospital by U.S. News & World Report ever since pulmonology was included in the rankings. This reflects our expertise in medical care and research accomplishments in lung, allergic, and immune diseases.

Two Fellow assignments at National Jewish Health are the Pediatric Day Program and Medical Officer of the Day (MOD). Fellows also have 3rd level of experience with outpatient clinics and inpatient consults at Children’s Hospital Colorado.  Children’s Hospital Colorado is afull-spectrum academic pediatric institution, and most of the University of Colorado School of Medicine pediatric administration, faculty, residents, and academic programs are based at Children’s Hospital Colorado. National Jewish Health provides Children’s Hospital Colorado with their clinical allergy and immunology services, and Fellows rotate at Children’s Hospital Colorado under the supervision of National Jewish Health faculty based there, to further diversify and enrich their Fellowship experience. The 4th patient experience for this program’s Fellows is an Adult Allergy Consult Service, primarily based at the University of Colorado Hospital (UCH).  UCH is a full-spectrum academic medical institution, primarily oriented to clinical services for adults.  This assignment provides Fellows with consultative experiencewith adult inpatients, drug allergy, and drug desensitization procedures. All assignments are designed to provide pediatric and adult experience in diagnosis and management of allergic and immunologic disorders including the use of pharmacotherapy, allergen immunotherapy and immune regulation.


 

1st Year Assignments

Pediatric Day Program: National Jewish Health

Fellows are assigned to this rotation for 6 months of the first year. Pediatric patients, both local and out-of-state, with severe allergic, pulmonary,and immune disorders are admitted to this service for in-depth multi-disciplinary outpatient team evaluations. Fellows are 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 Health 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, nasalpolyposis, 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 also provides 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 complex disease management, patient education, home management strategies and interacting with the referring physicians and tertiary consultants, will be a focus of these months.  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. The basic application of rhinolaryngoscopy and bronchoscopy will also be addressed during this rotation.

MOD (Medical Officer of the Day): National Jewish Health

Fellows are assigned to this rotation for 6 months of the first year. Acutely ill pediatric patients with allergic, respiratory and immune disorders are seen by the Fellow as the provider in an urgent care setting, under faculty attending supervision. Most of the pediatric patients seen in this rotation have exacerbations of their asthmatic, respiratory, allergic and/or immunedisorder(s) that benefit from specialty care. Some of the patients evaluated in urgent care require hospitalization at National Jewish Health, and continue to be followed by the admitting Fellow and attending. MOD and Day Program Fellows sometimes cross-over in order to continue to learn through specialty patient care when the patient volume in their primary assignments may be low.
 

Outpatient Clinics 

  • Pediatric Allergy and Immunology Continuity Clinic: The objective for this rotation is to focus on the outpatient diagnosis and management of asthma and allergic disease similar to the profile described for the Day Hospital rotation. This will be accomplished through a Pediatric allergy continuity clinic, one-half day per week, for the first 2 years of the Fellowship, and through one-to-one mentoring with an allergist during this rotation. Skills in the interpretation of epicutaneous skin testing and spirometry will be developed within this time period.  Patient continuity allows for the development of expertise in the management of chronic disease processes over time, including implementation of step-up and step-down asthma guideline-based care, allergen immunotherapy and application of evidence-based management of atopic dermatitis and food allergy.

  • Adult Allergy Continuity Clinic: The major objective of this clinic is to provide experience with the diagnosis and management of adult allergic and asthmatic problems.  This experience is obtained one-half day per week for 6 months in the first year and 12 months in the second year, thus providing a thorough cross-training experience in adult allergic and asthmatic diseases.  Fellows will gain expertise in problems commonly encountered in older allergy/immunology patients, such as aspirin exacerbated respiratory disease, chronic urticaria, vocal cord dysfunction, and hymenoptera allergy.

  • Immunodeficiency Clinic:  Exposure and familiarization with all aspects of primary and secondary immunodeficiency as well as the use and interpretation of clinical immunologic laboratory testing are the major objectives of this clinic.  During this clinic, Fellows develop expertise in the long-term management of patients with immunodeficiency and immune-mediated diseases.  Fellows also acquire experience with the administration and complications of therapeutic modalitiesin treating these diseases, such as intravenous gamma globulin (IVIG).

  • Atopic Dermatitis, Pediatric Rheumatology, and ENT clinics: 

    Familiarization with these related specialty disciplines that may have an allergic or immunologic etiology can be obtained on an elective basis in the second year.

  • Children's HospitalColorado (CHC): The emphasis during this clinic rotation will be on outpatient and inpatient Allergy & Immunology consultation by the Fellow 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, eosinophilic esophagitis, and pediatric sinusitis.   Some faculty from National Jewish also have clinics at CHC.

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

2nd Year Assignments

Research and Scholarly Activity: 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 on request, and they therefore account for ~20% of the timespent during the 2-month period.

Pediatric Allergy and ImmunologyContinuity Clinic, and Adult Allergy Continuity Clinic: are continued throughout the 2nd year, as previously described in Year 1.


3rd Year Training Assignments

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

Teaching conferences: as part oftheir training, fellows regularly attend a city-wide conference in allergy and immunology, a patient care conference in pediatrics, a board review course, a clinical research conference, and an allergy journal club.

 

Learn about the application process.