Allergy & Pulmonary Medicine | Fellowship Program

Pediatric Pulmonology Fellowship Program

at the Washington University School of Medicine

The multidisciplinary Division of Pediatric Allergy and Pulmonary Medicine at St. Louis Children’s Hospital continues to flourish, supporting premier clinical and research programs in pulmonary and allergic diseases of children.  The Division provides exceptional care for children with various allergic and pulmonary diseases, and pursues its academic mission to advance knowledge of the molecular and immunological basis of these conditions and develop novel diagnostic and treatment approaches to improve outcomes of these diseases.  Its strong commitment to excellence in patient care, teaching, and basic and clinical investigation was recognized by the Division’s ranking as one of America’s best pulmonary services, according to CHILD magazine’s 2007 survey.

The ACGME-accredited pediatric pulmonology fellowship training program continues to attract promising pediatric candidates for subspecialty training and develop the next generation of academic pulmonologists, as evidenced by their recent grant and publication record (see below).  

In our Division you will find:

l a center that is participating in National Institutes of Health-funded childhood asthma research programs, including the Children’s Asthma Management Program (CAMP), Children’s Asthma Research and Education Program (CARE), and the Inner City Asthma Consortium (ICAC), that are helping us understand the benefits and long-term effects of asthma treatment in children,

l a cystic fibrosis center that cares for more than 400 patients that is a member of the CFFT Therapeutic Development Network,

l a pediatric lung transplantation program that cares for the largest cohort of lung and heart-lung transplant patients in North America.  The first pediatric lung transplant was performed here in 1990, and more than 300 children have now undergone lung or heart-lung transplant at our Center,

l a center for the Genetic Determinants of Mucociliary Clearance Consortium, part of the National Institutes of Health Rare Diseases Clinical Research Network, which was created to better define pathogenesis, natural history, and treatment of primary ciliary dyskinesia and atypical forms of cystic fibrosis,

l clinical investigators who are intimately involved in minority programs designed to impact asthma morbidity,

l National Institutes of Health-sponsored, multidisciplinary center examining pulmonary complications leading to morbidities and mortality of sickle cell disease,

l an evolving multispecialty clinic for chronically ill children who are technology-dependent,

l a bronchoscopy center where more a bronchoscopy center where more than five hundred procedures are performed annually,

l a busy and fully automated pediatric sleep diagnostics center,

l a state-of-the-art pulmonary function laboratory proficient in performing both pediatric and infant studies, and

l reknowned, well-funded basic and clinical research programs that are examining cellular and molecular mechanisms of asthma, cystic fibrosis, primary ciliary dyskinesia, bronchiolitis obliterans, emphysema, and respiratory infections.  Research opportunities are not limited to the Division, and numerous collaborations are ongoing throughout the medical center.

The Division of Pediatric Allergy and Pulmonary Medicine offers challenging medical goals and unparalleled research potential.  If you are interested in pursuing a career in pediatric pulmonary medicine here at Washington University in St. Louis, please contact us at:

Thomas Ferkol, MD
Associate Professor of Pediatrics, Cell Biology and Physiology
Director, Pediatric Pulmonology Fellowship Program
Division of Pediatric Allergy and Pulmonary Medicine
One Children’s Place
St Louis, Missouri 63110
Telephone: 314 286 2778
e-mail address: ferkol_t@kids.wustl.edu

Fellow Grant Support and Publications (past three years)

Fellow support and training

Anand Patel, M.D., T32 Training Grant, Mechanisms of Childhood Infection and Immunity

John Spivey, M.D., T32 Training Grant, Developmental Cardiology and Pulmonary Medicine

Jessica Boyd, M.D., T32 Training Grant, Developmental Cardiology and Pulmonary Medicine

Audrey Wells, M.D., Pediatric Scientist Development Award

Katherine Rivera-Spoljaric, M.D., K30 Award, Mentored Training Program in Clinical Investigation

Selected fellow publications

Boyd JH, Macklin EA, Strunk RC, DeBaun MR. Asthma is associated with acute chest syndrome and pain. Blood. 2006;108:2923-7.

Boyd JH, Strunk RC and Morgan WJ. The outcomes of sickle cell disease in adulthood are clear, but the origins and progression of sickle cell anemia-induced problems in the heart and lung in childhood are not. J Pediatr 2006;149:3-4.

Elizur A, Bacharier LB, Strunk RC. Pediatric asthma admissions: chronic severity and acute exacerbations. J Asthma 2007;44:285-9.

Elizur A, Kannai Y, Pollack N, Katz Y. Maternal positive skin prick test results and asthma prediction after early childhood wheezing. Ann Immunol 2007;98:540-45.

Elizur A, Orscheln RC, Ferkol TW, Dunne WM, Storch GA, Cannon CL. Transmission of Panton-Valentine Leukocidin-positive Staphylococcus aureus between cystic fibrosis patients. J Pediatr 2007;151:93-95.

Elizur A, Orscheln RC, Ferkol TW, Atkinson JJ, Dunne WM, Buller RS, Armstrong JR, Mardis ER, et al. Panton-Valentine Leukocidin-positive methicillin-resistant Staphylococcus aureus lung infections in patients with cystic fibrosis. Chest 2007;131:1718-25.

Elizur A, Sweet SC, Huddleston CB, Gandhi SK, Boslaugh SE, Kulinski CA, Faro A, Pre-transplant mechanical ventilation increases short term morbidity and mortality in pediatric patient with cystic fibrosis. J Heart Lung Transplant 2007;26:127-31.

Elizur A, Cannon C, Ferkol T.  Inflammation in the cystic fibrosis lung. Chest. 2007. In press.

Elizur A, Adair-Kirk TL, Kelley DG, Griffin GL, Demello DE, Senior RM.  TNF-a from macrophages enhances LPS-induced Clara cell expression of KC. Am J Respir Cell Mol Biol. 2007. In press.

Glassberg J, Spivey JF, Strunk R, Boslaugh S, DeBaun MR. Painful episodes in children with sickle cell disease and asthma are temporally associated with respiratory symptoms. J Pediatr Hematol Oncol 2006;28:481-5.

Holtzman MJ, Battaile JT, Patel AC. Immunogenetic programs for viral induction of mucous cell metaplasia. Am J Respir Cell Mol Biol 2006;35:29-39.

Holtzman MJ, Tyner JW, Kim EY, Lo MS, Patel AC, Shornick LP, Agapov E, Zhang Y. Acute and chronic airway responses to viral infection: implications for asthma and chronic obstructive pulmonary disease. Proc Am Thorac Soc 2005;2:132-40.

Lie H, Ferkol T. Primary ciliary dyskinesia: recent advances in pathogenesis, diagnosis and treatment. Drugs. 2007. In press.

Patel AC, Morton JD, Kim EY, Alevy Y, Swanson S, Tucker J, Huang G, Agapov E, et al. Genetic segregation of airway disease traits despite redundancy of chloride channel calcium-activated (CLCA) family members. Physiol Genomics 2006;25:502-13.

Price CL, Boyd JH, Watkins AR, Fleming F, DeBaun MR. Mailing of a sickle cell disease educational packet increases blood donors within an African-American Community. Transfusion 2006;46:1388-93.

Spivey JF, Singleton D, Sweet S, Storch GA, Hayashi RJ, Huddleston CB, Danziger-Isakov LA. Safety and efficacy of prolonged cytomegalovirus prophylaxis with intravenous ganciclovir in pediatric and young adult lung transplant recipients. Pediatr Transplant 2007;11:312-8.

Tyner JW, Kim EY, Ide K, Pelletier MR, Roswit WT, Morton JD, Battaile JT, Patel AC, et al. Blocking airway mucous cell metaplasia by inhibiting EGFR anti-apoptosis and IL-13 transdifferentiation signals. J Clin Invest 2006;116: 309-21.

Tyner JW, Uchida O, Kajiwara N, Kim EY, Patel AC, O'Sullivan MP, Walter MJ, Schwendener RA, et al. CCL5/CCR5 interaction provides anti-apoptotic signals for macrophage survival during viral infection. Nat Med 2005;11:1180-7.

Uong EC, Boyd JH, DeBaun MR. Daytime pulse oximeter measurements do not predict incidence of pain and acute chest syndrome episodes in sickle cell anemia. J Pediatr 2006;149:707-9.

Wells A, Faro A. Special consideration in pediatric lung transplantation. Semin Respir Crit Care Med. 2006;27:552-60.

Description of the Pediatric Pulmonary Medicine Training Program

In our Pediatric Pulmonary Medicine Training Program, clinical training is emphasized during the first year of the fellowship, but some research training is intermingled so that the scholarly approach is incorporated into the fellow’s education early in the process.  Clinical training accounts for 12 months of the fellowship, with 9-10 months of service or elective time Year One, and 2-3 months total during Years Two and Three.  Research months are scheduled as long, uninterrupted blocks, usually 6 to 10 months in duration.  Pediatric-trained allergy fellows can share responsibility for this service with junior or senior pediatric pulmonology fellows at St. Louis Children’s Hospital.

On average, the pulmonary fellows are on call every 5 to 7 weeks and handle outpatient calls from home, including months covering the inpatient rotation service rotation.  In addition, the fellow will be on call to answer pages from parents and other caregivers of children and adolescents with chronic lug disease who receive care by the Division of Allergy and Pulmonary Medicine approximately one night every 2 weeks and distribute and electronic communication regarding these calls the following day.

By completion of their fellowship training, our fellows are eligible for the Pediatric Pulmonology Subboard Examination of the American Board of Pediatrics. The training program is fully accredited, and we can accommodate as many as 6 fellows (2 per year) in the program.

The clinical service consists of the fellow taking responsibility of Pediatric Pulmonary Service and Pediatric Lung Transplantation Service, consultations, bronchoscopies, and emergency outpatient visits.  The complexity and volume of the pediatric pulmonology service vary.  The service cares for children who have remarkable variety of lung diseases, like cystic fibrosis, asthma, bronchopulmonary dysplasia, acute and obliterative bronchiolitis, pneumonia, dyskinetic cilia syndrome, bronchiectasis, interstitial lung diseases, granulomatous diseases of the lung, lung tumors, surfactant deficiencies, sleep-disordered breathing, apnea, central hypoventilation, and congenital lung anomalies.  While on this service, the fellows interpret (with supervision) pulmonary function studies (including infant testing), and polysomnograms.  Because Washington University has an active lung transplantation service, fellows are exposed to the pre-operative evaluation and post-operative care of these patients.  During their time on the lung transplantation service, fellows have the opportunity to learn and perform a variety of bronchoscopic techniques, including bronchoalveolar lavage, endobronchial brush biopsy, and transbronchial biopsy.  The pediatric pulmonary fellow also has non-service rotations that are required parts of their clinical training, including (i) Pediatric Intensive Care Unit, (ii) Pediatric Pulmonary Function Laboratory, and (iii) Pediatric Sleep Laboratory, during Year One.

The Pediatric Pulmonary Continuity Clinic, which is supervised by the pulmonary faculty, begins at the onset of the fellowship.  All of the fellows are assigned one half-day weekly, and are regularly scheduled in Pediatric Ambulatory Clinic located in St. Louis Children’s Hospital.  Individual fellows, who have primary responsibility for their patients, attend the clinic with a full complement of nurses and ancillary staff.  Located in proximity to the clinic on the second floor, the Pulmonary Function Laboratory performs its large repertoire of tests including bronchoprovocation, exercise studies and infant pulmonary function measurements.  The Pediatric Clinical Laboratories are adjacent to the clinic, and Pediatric Radiology is located on the floor below.  Early in the fellow’s clinical training, the attending physician assumes much of the responsibility for the service and performance of procedures.  However, as their skill and confidence increases, the trainees assume most of the responsibility for patient care while still being supervised by faculty from the Division of Pediatric Allergy and Pulmonary Medicine.

Several conferences are required parts of the clinical training, providing the fellows with a comprehensive understanding of pulmonary physiology, pathophysiology, and clinical care.  In addition to the clinical lecture series scheduled by the Department of Pediatrics (Case Management Conference, Pediatric Fellows Conference, Pediatric Research Seminar, and Pediatric Grand Rounds), which frequently cover pulmonary topics, and sessions held by the Division of Pulmonary and Critical Care Medicine at Barnes-Jewish Hospital (Lung Biology Conference and Division of Pulmonary and Critical Care Medicine Grand Rounds), the Division of Pediatric Allergy and Pulmonary Medicine has clinical conferences essential to our educational mission: (i) the Pediatric Pulmonary Physiology Conference, (ii) Pediatric Pulmonary Pathology Conference, and (iii) Pediatric Pulmonary Clinical Conference, (iv) Respiratory Physiology Review; and (v) Pediatric Allergy and Pulmonary Medicine Journal Club.. 

During Years Two and Three, Research Training is highlighted, and the fellows are provided with protected time during which they develop and hone skills necessary to be successful as a physician-scientist.  Indeed, an emphasis of fellowship training here at Washington University is supervised research experience. The fellow directly participate in their research, and with guidance, they are responsible for experimental design, organize and collect data, as well as analyze and interpret their results.  The fellow selects a research mentor who is responsible for assisting the trainee in the design and execution of a research project, and provides laboratory resources necessary for the completion of the project in a timely fashion.  This individual is involved in the day-to-day supervision of the laboratory, meets regularly with the fellow to review data and research progress.  The mentor also supervises other related aspects of research training, like the preparation and presentation of the results of the fellow’s work. 

Every trainee, in consultation with the mentor, fellowship program director, and the Director of the Division of Pediatric Allergy and Pulmonary Medicine, will constitute a research committee of four to six faculty members for his or her project to regularly evaluate research progress, discuss difficulties, and provide advice.  Written reports will be prepared by the committee, and submitted to the program director. Any concerns with the fellow’s progress are discussed at that time, and appropriate measures will be taken to ensure the fellow’s completion of the project.  It is expected that as he or she progresses through their project, the trainee will prepare and submit grant applications, scientific abstracts, and first-authored papers that pertain to their work.  With time, the fellow will become increasingly independent, and it is up to the mentor, program director and division chief, to assure that satisfactory progress toward independence is made.

It is expected that the fellow will present their work annually to the Division at the Pediatric Allergy and Pulmonary Medicine Research Conference.  With time, the trainee will become increasingly independent, and it is up to the mentor, program director and division chief, to assure that acceptable progress toward independence is made. 

In addition to our research conference, numerous research seminars are held throughout the Washington University School of Medicine, and are available for the fellows to attend.  Specifically, three research conferences are conducted within the Department of Pediatrics.  The Pediatric Research Seminar series is held weekly in the new McDonnell Pediatric Research Building, and investigators from the different research units within the department present their recent work.  The required Pediatric Fellows Conference is held weekly, again in the McDonnell Pediatric Research Building, during which trainees are exposed to research from outside the division as well as formal courses in clinical research, statistics and study design, and the responsible conduct of research.  In addition, fellows are encouraged to take a computer-based course on Clinical Experimentation, which teaches design, execution, and analysis of studies in humans, with the expressed purpose of understanding mechanisms underlying human physiology or pathophysiology as it applies to translational research.  Finally, fellows also have the opportunity to take additional graduate courses at the Washington University School of Medicine relevant to their research.

Selection of Pediatric Pulmonology Fellows

Washington University School of Medicine, Department of Pediatrics, and Division of Pediatric Allergy and Pulmonary Medicine all strive to provide excellence in graduate medical education. Many factors contribute to the realization of this goal.  Residency and fellowship programs at this campus have traditionally attracted very strong applicant pools, and we are committed to the practice of carefully screening and selecting those applicants who are best qualified to participate and succeed in the programs based on their academic achievements and personal and professional characteristics. The process used by the Division of Pediatric Allergy and Pulmonary Medicine at St. Louis Children’s Hospital and Washington University School of Medicine is as follows:

All applicants must provide the review committee following:

l Completed application.

l Curriculum vitae.

l Three letters of recommendation or completed verification of qualification forms.

l Academic credentials, which include transcripts from medical school, documentation of participation in any other graduate medical education experiences, or clinical work as a physician.

l Evidence of progress toward American Board of Pediatrics board eligibility or certification, documentation of credentials similar to board certification or board eligibility in another country, but only if the position is non-ACGME-accredited.

The Washington University School of Medicine Division of Pediatric Allergy and Pulmonary Medicine Fellowship Training Program is a three-year program offered for advanced, subspecialty training beyond the residency level.  The program is designed to provide pediatricians with extensive training and experience in basic research, clinical investigation, and diagnostic procedures, leading to board certification in pediatric pulmonology.  It provides an extraordinary environment for the development of pulmonary clinicians and physician-scientists.  Our program is supported by National Institutes of Health training grants (T32), which have strict citizenship requirements.  Thus, individuals applying to the Pediatric Pulmonology Fellowship Training Program should be a citizen or a non-citizen national of the United States, or have been lawfully admitted for permanent residence.  The following categories of applicants are eligible for consideration for appointment to the pediatric pulmonology fellowship program:

l Graduates of medical school in the United States or Canada accredited by the LCME or AOA, and who have successfully completed or are in the process of completing residency training in pediatrics.

l Graduates of medical schools and residency outside the the United States and Canada who have completed Steps 1, 2, and 3 of the USMLE, recently received a currently valid certificate from the ECFMG, or possess a full and unrestricted license to practice medicine in a United States licensing jurisdiction, and who have completed or are in the process of completing pediatric residency training.

l American citizen graduates from medical schools outside the United States and Canada who have successfully completed the licensure examination in a United States jurisdiction in which the laws and regulations provide that a full and unrestricted license to practice will be granted without further examination after successful completion of a specified period of graduate medical education.

All candidates who are not citizens of the United States, including Canadian medical school graduates, must meet the requirements of the INS for training in this country.

Applicants are selected for interviews by faculty members based on their preparedness, ability, aptitude, academic credentials, communication skills, and personal qualities such as motivation and integrity.  The pediatric pulmonology fellowship training program does not discriminate with regard to sex, race, age, religion, color, national origin, disability, or veteran status.  The division chief and program director, after consultation with faculty members who have interviewed the applicants, will review the qualifications of each applicant and determine the individual’s suitability for the program.  If after review the applicant is deemed qualified, a fellowship position will be offered in writing.

Clinical Responsibilities of Pediatric Pulmonology Fellows

It is our goal to develop the next generation of academic pediatric pulmonologists, who are superior clinicians as well as physician-scientists or clinical researchers that strive to understand the biological basis for the disorders they treat.  The pediatric pulmonology fellow will:

l Obey and adhere to the applicable policies, procedures, rules, bylaws, and regulations of the Washington University School of Medicine, St Louis Children’s Hospital, and Department of Pediatrics

l Obey and adhere to all applicable state, federal, and local laws, as well as the standards required to maintain accreditation by the ACGME, RRC, JCAHO and any other relevant accrediting, certifying, or licensing organizations. 

l Participate fully in the educational and scholarly activities of the Program, including the performance of scholarly and research activities as assigned by the Program Director, attend all required educational conferences, assume responsibility for teaching and supervising other residents and students, fulfill the educational requirements of the program, and participate in assigned Hospital and University committee activities.

l Use his or her best efforts to provide safe, effective, and compassionate patient care and present at all times a courteous and respectful attitude toward all patients, colleagues, employees and visitors at the School of Medicine, Hospitals and other facilities and rotation sites to which the resident is assigned.

The pediatric pulmonology fellow will provide clinical services:

l Commensurate with his/her level of advancement and responsibilities.

l Under appropriate supervision.

l At sites specifically approved by the program.

l Under circumstances and at locations covered by the professional liability insurance maintained for the resident by the Hospital or School of Medicine as appropriate.

l Develop and follow a personal program of self-study and professional growth under guidance of the Program's teaching faculty.

l Fully cooperate in coordinating and completing documentation required by the ACGME, Residency Review Committee (RRC), Washington University School of Medicine, St Louis Children’s Hospital, Department of Pediatrics, and fellowship program, including but not limited to the legible and timely completion of patient medical records, charts, reports, time cards, operative and procedure logs, and faculty and Program evaluations.

Failure of the clinical fellow to comply with any of the responsibilities set forth above shall constitute grounds for disciplinary action, up to and including suspension or termination from the Program.

Evaluation and Promotion of Residents and Clinical Fellows

a.  Evaluation

The program director and faculty meet biannually to evaluate the educational and professional progress and achievement of each clinical fellow. The program director also meets with each clinical fellow individually to discuss a written summary of the evaluations every six-months or more frequently as dictated by the individual fellow’s performance.

The evaluations are based on achieving competency in the following elements:

l Fund of knowledge concerning cell and molecular biology of the lung, pulmonary physiology and lung mechanics, lung pathophysiology, and clinical topics, and the application of that knowledge to patient care and diagnostic testing.

l Clinical and technical skills, including expertise in fiberoptic bronchoscopy, bronchoalveolar lavage, and transbronchial biopsy.

l Clinical and scientific judgment.

l Personal character traits displayed, interpersonal skills.

l Teaching skills.

l Ability to assume increased responsibility for patient care.

An evaluation file shall be maintained by the program director for each clinical fellow and treated as confidential. The file may be reviewed by the resident and by divisional/departmental faculty and staff with legitimate educational and administrative purposes.  The Standing Committee on Graduate Medical Education (GME) Program Evaluation will review the evaluation plan of a program at the time of the Internal Review. The reviewer who meets with program faculty may ask to review a representative set of trainee files.

Finally, using a computer-based system, the fellows anonymously evaluate the performance of supervising attending physicians during the course of the academic year.  These faculty evaluations are forwarded to the Chief of the Division of Pediatric Allergy and Pulmonary Medicine and considered in their annual evaluations.

b. Promotion

Promotion of clinical pulmonology fellows to the next level of the program depends upon the fellow's performance and qualifications.  The fellow should achieve at least average overall scores in their clinical and research evaluations.  Decisions about promotion or reappointment of clinical fellows by the program director are communicated to the trainee as soon as reasonably practicable under the circumstances. In cases where reappointment letters or contracts are issued, communication between program directors and the Graduate Medical Education (GME) office will occur at least three months in advance of a new appointment year.

Disciplinary Action, Suspension, or Termination

a.  Informal Procedures

The program director will use informal efforts to resolve minor instances of poor performance or misconduct. In any case in which a pattern of deficient performance has emerged, informal efforts by the Program Director shall include notifying the fellow in writing of the nature of the pattern of deficient performance and remediation steps, if appropriate, to be taken by the fellow to address it.  If these informal efforts are unsuccessful or where performance or misconduct is of a serious nature, the division chief or fellowship program director may impose formal disciplinary action.

b. Formal Disciplinary Action

Disciplinary action may be taken for due cause, including but not limited to any of the following:

l Failure to satisfy the academic or clinical requirements of the training program.

l Professional incompetence, misconduct, or conduct that might be inconsistent with or harmful to patient care or safety.

l Conduct that is detrimental to the professional reputation of the Hospital or School of Medicine.

l Conduct that calls into question the professional qualifications, ethics, or judgment of the resident/clinical fellow, or that could prove detrimental to the Hospital's or School of Medicine's patients, staff, employees, volunteers, or operations.

l Violation of the bylaws, rules, regulations, policies, or procedures of the Washington University School of Medicine, St. Louis Children’s Hospital, Department of Pediatrics, Division of Pediatric Allergy and Pulmonary Medicine, including violation of the Responsibilities of Clinical Fellows set forth by the Department of Pediatrics.

l Scientific misconduct.

c. Specific Procedures

Formal disciplinary action includes:

l Suspension, termination, or non-reappointment.

l Reduction, limitation, or restriction of the resident's clinical responsibilities.

l Extension of the pulmonology fellowship or denial of academic credit that has the effect of increasing the number of clinical service months or extending the fellowship.

l Denial of certification of satisfactory completion of the residency program.

The division chief or the fellowship training program director shall notify the clinical fellow in writing of the action taken and the specific reasons.  The fellow will be notified in writing of any disciplinary action that would require extension of training or delays in promotion no later than four months before the end of the fellow’s current contract.  A copy of the notification shall be furnished to the Associate Dean for Medical Education.  The notification should advise the clinical fellow of his or her right to request a review of the action in accordance with the grievance procedure set forth below. 

In the case of a suspension, the written notification will precede the effective date of the suspension unless the division chief or program director determines in good faith that continued appointment of the clinical fellow places safety or well-being of patients or personnel in jeopardy, or immediate suspension is required by law or necessary in order to prevent imminent or further disruption of activities at the Washington University School of Medicine, St. Louis Children’s Hospital, or Department of Pediatrics, in which case the notice will be provided at the time of suspension.

Division of Pediatric Allergy and Pulmonary Medicine Policy on Duty Hours

The pediatric pulmonology fellowship program has adopted the following policy on duty hours. Graduate medical education in many specialties requires a commitment to continuity of patient care. At the same time as such continuity of care must take precedence (without regard to time of day, hours already worked, predefined call schedules etc), patients have the right to expect their care is being delivered by alert, healthy, responsible and responsive physicians.  The program respects that the necessary balance between patient care and education is delicate and has endorsed the following minimal requirement.

We follow the recommendations of the Graduate Medical Education (GME) Consortium, which states that excluding exceptional patient care needs, clinical fellows should have, on average, at least one day out of seven free from routine responsibilities, and be on call in-house no more frequently than every third night.  The latter does not apply to fellows in the pediatric pulmonology training program at Washington University, since we do not have required in-house call.  Specifically,

l The inpatient fellow is responsible for calls regarding current pulmonary inpatients on weeknights.

l Calls from outpatients are rotated among pediatric pulmonology and allergy fellows on a daily basis.  Outpatient call coverage begins at 4:30 PM and runs through 8:00 AM.

l All outpatient calls handled by a fellow are reviewed by divisional faculty and staff the following morning.

l The pulmonology fellows rotate their weekend coverage responsibilities, typically every 3 to 6 weekends.  Coverage during the weekends and holidays includes both the lung transplantation and pulmonary services.

Division of Pediatric Allergy and Pulmonary Medicine Policy on Moonlighting

Moonlighting is not required, but is permitted provided that such activities do not interfere with the pediatric pulmonology fellow’s clinical responsibilities or hinder their research performance.  Authorization for the fellow to moonlight, however, must be approved by the Program Director of the Pediatric Pulmonology Fellowship Program in writing and retained on file.

Division of Pediatric Allergy and Pulmonary Medicine Policy on Vacations

A total of 15 days vacation time is allotted according to Washington University School of Medicine and Department of Pediatrics guidelines for post-graduate clinical fellows.