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 as it 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 (NJH). NJH is a tertiary care medical and research facility that specializes in allergic, immune, and respiratory diseases. For more than 115 years, NJH has been recognized as the leading respiratory hospital in the nation. This reflects our expertise in medical care and research accomplishments in lung, allergic, and immune diseases.

Two fellow assignments at NJH are the Pediatric Day Program and Medical Officer of the Day (MOD). The 3rd patient experience 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 experience with adult inpatients, drug allergy, and drug desensitization procedures. Finally, fellows will spend time performing inpatient pediatric consultations, as well as outpatient clinics at Rocky Mountain Hospital for Children (RMHC). RMHC is a full-spectrum, family-focused children’s hospital serving the community of Denver. Under the supervision of NJH allergists and immunologists, the fellows will provide care for patients in this community setting. 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 4 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 primary 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.

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, eosinophilia, and drug allergy; 3) immunodeficiency diseases; and (4) pediatric pulmonary diseases, such as chronic pneumonias and pneumonitis, aspiration, hypersensitivity pneumonitis, 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 has a strong focus on understanding and helping to manage the psychosocial aspects of chronic disease together with behavioral therapists that are seen by every patient and their families. The development of specific allergy and 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 and impedance 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 4 months of the first year. Acutely ill pediatric patients with allergic, respiratory, and immune disorders are seen by the fellow 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 immune disorder(s) that benefit from specialty care. Some of the patients evaluated in urgent care require hospitalization at NJH, and continue to be followed by the admitting fellow and attending. During these 4 months, the fellow will also continue to care for patients in the Pediatric Day Program, but will not attend the adult allergy continuity clinic.

Rocky Mountain Hospital for Children
Fellows are assigned to this rotation for 4 months of the first year. The emphasis during this rotation will be on outpatient and inpatient Allergy & Immunology, within a dedicated children’s hospital. The fellow will participate in pediatric allergy clinics at RMHC and staff inpatient consultations at RMHC with supervision by NJH attending physicians. During this rotation, fellows will continue to participate in their adult and pediatric continuity clinics and the immunology clinic at NJH. Time will also be reserved during this rotation to begin preparing a research project to be undertaken in the second year.

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. These clinics will facilitate development of a number of required skills for allergists including the interpretation of epicutaneous skin testing and spirometry. 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 allergy and asthma. This experience is obtained one-half day per week for 8 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 managing conditions more commonly encountered in adult patients, such as aspirin exacerbated respiratory disease fixed airway obstruction, mixed COPD/asthma phenotypes.

  • 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 therapeutic modalities, such as administration of intravenous gamma globulin (IVIG) and pulse steroids. Fellows participate in this clinic one-half day per week during both years of their fellowship.

*Fellows generally attend one national specialty meeting during the first year and the ACAAI Board Review Course, which is offered every other year.

 

2nd Year Assignments

Research and Scholarly Activity: A high quality research experience takes the major portion of effort in the 2nd year. Fellows routinely present at several national meetings each year.

Adult Allergy Consult Service: In-patient adult allergy consult experience, for 1 month in the second year. These consults are upon request, 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, as previously described in Year 1.

Dermatology, Rheumatology, GI, Pulmonology, and ENT clinics: Familiarization with these related specialty disciplines can be obtained on an elective basis during the second year of fellowship.

 

3rd Year Training Assignments

For fellows seeking a career in academic medicine, funding opportunities for continued training are available subject to approval by the faculty.

Teaching Conferences

As part of their training, fellows regularly attend the following conferences held at NJH (most conferences run from September to May):

  • Denver Allergy Rounds, a weekly, city-wide conference in allergy and immunology
  • A weekly board review course that is shared with the adult fellows
  • A weekly Pediatric Department Noon Conference consisting of case presentations, formal clinical and research presentations, and a pediatric journal club
  • A weekly Pediatric Allergy and Immunology lecture series focusing on skills needed to conduct and understand clinical research methods, including a biostatistics course
  • A monthly allergy journal club that is shared with the adult faculty and fellows
  • An optional, weekly Adult Allergy Case Conference
  • There is also an introductory “boot camp” lecture series held in July and August to provide a broad overview of basic adult and pediatric allergy and immunology topics

Learn about the application process.

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