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:
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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.
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Develop a solid foundation in the principles of basic immunology fundamental to understanding and managing clinical disorders.
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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. Indeed, this year National Jewish Health was ranked the
#1 Pulmonary Hospital in the United States by U.S. News & World Report, for
the 14th year in a row. This reflects National Jewish Health’s 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 a
full-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 experience
with 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, 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 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 immune
disorder(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
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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.
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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.
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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 modalities
in 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 Hospital
Colorado (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. This
assignment for first year Fellows is supervised by Dan Atkins. Four other 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 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 previous 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 of
their 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.
