Introduction

The goal of this program is to train some of the next generation of pediatric pulmonologist physician/scientists in an integrated research environment in the principles and practice of clinical pediatric pulmonology, coupled with research in pediatric pulmonology and CF, ranging from bench research to clinical studies. We do not hire fellows solely to meet clinical needs, and the clinical responsibilities of the fellows do not expand and contract with the number of fellows in the program. The clinical time, like the research time, is viewed as a training experience. We are committed to turning out the next generation of academic pediatric pulmonologists. Our program has produced many of the leaders in pediatric pulmonology and many of the CF experts in the U.S., including department chairs, division chiefs, cystic fibrosis Center Directors, and funded investigators.

Clinical Training

Fellows entering this program are expected to be well-trained and excellent pediatricians who are board-eligible and graduated from accredited programs. Building upon their clinical excellence, our faculty trains these fellows in the principles and practice of pulmonology, by engaging in a rigorous program of inpatient/consultative care, outpatient continuity clinic, training in bronchoscopy, pulmonary function testing, and sleep medicine including polysomnography, and didactic training in pulmonary physiology, pathophysiology, and cell and molecular biology of the lung. Ordinarily fellows spend 11-14 months of the 36-month fellowship engaged in clinical service activities, including inpatient/consultation rotation (supervisory responsibility for pulmonary inpatients, direct performance under supervision of pulmonary consultations, bronchoscopy service, and pulmonary function testing), one month ICU rotation with emphasis on pulmonary physiology rather than direct patient care, one month sleep rotation with emphasis on sleep monitoring and interpretation of tests, and optional rotations in adult pulmonology with bronchoscopy or surgical rotations. In addition, early in the fellowship they acquire patients who are followed in half-day-weekly continuity clinic under the supervision of division faculty.

The division maintains a Cystic Fibrosis Center which follows ~400 patients, the Children's Asthma Center which follows 3200 patients directly and provides consultation to many more, as well as managing an asthma inpatient unit, a Bronchoscopy service which performs 150-200 procedures per year, a Pulmonary Function Laboratory with exercise and challenge capabilities, Infant Pulmonary Function Laboratory, a Tracheostomy/Ventilator Dependent patient clinic, a clinic for infants with chronic lung disease of prematurity, and a Sleep Program. The division averages about 6000 inpatient bed days per year and about 4000 outpatient visits. Six of our faculty have been listed in "Best Doctors in the U.S."

Research Training

The remaining months of fellowship (minimum 19) are spent in the supervised research experience. Many fellows enter the program with some prior research experience, but this is by no means required. Fellows select a research mentor early in the course of the fellowship and develop a project, which they pursue throughout their fellowship. Mentors may be talented investigators in the division or outside of it, including basic science departments. However, the project must be relevant to pediatric pulmonology in the broadest sense, and it must represent an important research question, which can be pursued with rigor and in depth. The fellowship takes its research training responsibilities seriously, and regular follow up of progress occurs not only from the mentor but from the division chief as well. Fellowship projects range from quite molecular basic science to clinical, patient-based research. All are acceptable as long as they meet high standards of rigor and excellence.

Our research training program is in its 25th year of support from the National Heart Lung and Blood Institute. This grant requires that trainees be U.S. citizens or permanent residents, so we cannot consider applications from physicians not meeting this requirement. Underlying our research training program is an integrated research program in CF and related pulmonary disorders, which is supported by three Center grants from the NIH and the CF Foundation, as well as a pool of R01 grants to participating investigators which total over $8 million of direct research support each year. This research training program includes 26 potential mentors from 6 departments, most of them experienced and federally-funded. Our division is also the site of a CF Foundation funded Therapeutics Development Center network Center, which conducts multi-center clinical research projects in CF.

Didactic Teaching

Some didactic training is required, including a three-year course given weekly. One year the focus in pulmonary physiology, one year, pulmonary pathophysiology, one year, the molecular and cellular biology of the lung. A course in epidemiology and biostatistics is also required, as is training in the responsible conduct of research. Attendance is required at a monthly clinical journal club, weekly research seminar, and weekly clinical conference, as well as a weekly CF team meeting. The option is available for other didactic coursework and journal clubs. Most labs also have regular meetings for discussion and presentation of data.

The Division and the Institution

The Division of Pediatric Pulmonology contains 23 faculty: 2 MD-PhD, 9 PhD, and 12 MD. Of these faculty, five are predominantly engaged in clinical medicine, and the others have strong research components to their programs, which bring in a total of about $6 million in direct costs each year. In the 2004-2005 year, the division will have 4 MD fellows, 3 PhD postdoctoral fellows, 4 postdoctoral Research Associates, and 7 graduate students. The training of MD and PhD scientists side by side has been shown to increase the probability that physicians will remain active in investigation after training.

Our program exists in the context of the Case Western Reserve University School of Medicine, which is in a phase of rapid expansion of its research effort and has reached the top dozen medical schools for NIH funding support in the last few years. Our program is based in the Department of Pediatrics, which has been numbered among the top ten such departments for NIH funding for the last decade. This Department has 110 faculty based at Rainbow Babies and Children's Hospital, which is among the "top 5 children's hospitals in the United States" as named by U.S. News and World Report. Thus, the institutional setting of the program is one of balanced clinical and research excellence.

The People

The Chairpersons of the Department of Pediatrics are: Michael W. Konstan, MD, Anne Lyren, MD, and Brian Berman, MD

The Pediatric Pulmonology Division Faculty are as follows:

• James F. Chmiel, MD, MPH – Director, Education; Director, Fellowship Training Program; Associate Director, LeRoy W. Matthews Cystic Fibrosis Center (airway inflammation in cystic fibrosis and asthma and anti-inflammatory agents)
• Daniel I. Craven, MD – Director, Fellows Course (asthma, multiply handicapped children, lung disease associated with sickle cell anemia)
• Elliott Dasenbrook, MD – (cystic fibrosis, translational research)
• Pamela B. Davis, MD, PhD – Chief, Pediatric Pulmonary Division; Director, Cystic Fibrosis Research Center; Senior Associate Dean for Research, Case Western Reserve University School of Medicine (cystic fibrosis, gene therapy)
• Dorr G. Dearborn, MD, PhD – Director and Chair, Svetland Institute of Environmental Health (mycologic toxicology)
• Meeghan A. Hart, MD – Director, Infant Pulmonary Function Laboratory; Assistant Director, education (infant pulmonary function testing, chronic lung disease of prematurity, cystic fibrosis, patient based research)
• Leigh A. Kerns, MD – (Pediatric Allergy & Immunology, immune deficiencies, asthma, food and insect allergies, allergic rhinitis and conjunctivitis ("hay fever"))
• Michael W. Konstan, MD – Director, LeRoy W. Matthews Cystic Fibrosis Center; Director, Pulmonary Function Laboratory (cystic fibrosis, clinical research)
• Laura Milgram, MD – (cystic fibrosis, clinical research)
• Carol L. Rosen, MD – Medical Director, Pediatric Sleep Center, UHC (trained as a pediatric pulmonologist, interested in sleep disordered breathing)
• Kristie Ross, MD – (asthma, childhood obesity, clinical research)
• Eli Silver, MD – (Allergy & Immunology, food hypersensitivity/food challenges, pediatric asthma, atopic dermatitis)
• Robert C. Stern, MD – (cystic fibrosis, clinical research)
• Steven Strausbaugh, MD – Director, Adult Cystic Fibrosis Program (cystic fibrosis, clinical research)

• Tracey L. Bonfield, PhD – (cystic fibrosis, asthma, acute lung injury, and pulmonary alveolar proteinosis)
• Calvin U. Cotton, PhD – (bicarbonate transport, ion transport in epithelia)
• Mitchell L. Drumm, PhD – (Cystic Fibrosis, genetics and therapeutics)
• Thomas Gerkin, PhD – (structure of biologically important molecules, mucin)
• Craig Hodges, PhD – (Mouse models of Cystic Fibrosis)
• Thomas Kelley, PhD – (signaling in cystic fibrosis)
• Carol Liedtke, PhD – (regulation of epithelial cotransporters)
• Aura Perez, PhD – (inflammation in cystic fibrosis, genomics)
• Assem Ziady, PhD – (cystic fibrosis, epithelial cell redox reactions, proteomics, cystic fibrosis)

Other faculty with parallel interests and collaborations with the division:
Division of Clinical Epidemiology (Department of Pediatrics)

• Susan Redline, MD – trained as adult pulmonologist, interested in sleep disordered breathing, asthma, and genetic epidemiology
• Mark Schluchter, PhD – epidemiologist/statistician, clinical trials, pulmonary databases, new methods of analyzing pulmonary outcomes data

Division of Infectious Diseases, Allergy, Immunology, and Rheumatology (Department of Pediatrics)

• Melvin Berger, MD, PhD – lung inflammation in cystic fibrosis

Characteristics of our Fellows

All of our fellows are U.S. citizens or permanent residents, because of the requirements of our grant. All of our physician fellows are board-eligible or certified in General Pediatrics, and all have completed a pediatric residency. In general, they are considered excellent clinicians and have been highly rated residents. All fellows commit to the serious research training inherent in our program, and all enter the program with some interest in pursuing a career in academic medicine. Some have had extensive research experience prior to entering the fellowship, but some have not.

Three years of fellowship training usually lead to Board eligibility in Pediatric Pulmonology. On rare occasions, fellows do not seek clinical training and concentrate only on the research aspects of training, or have received clinical training elsewhere. Such requests are reviewed individually.

Application Process

Fellows usually apply during their second year of residency training, and are accepted on a rolling admissions basis. Usually offers and acceptances are complete by July 1 of the year preceding enrollment, though occasionally later applicants can be accommodated. Written applications must include the application form, three letters of reference, and a medical school transcript. After initial review, applicants may be invited for a personal interview, which is required.

Contact
James F. Chmiel, MD
Director of Training
Division of Pediatric Pulmonology
UH Rainbow Babies and Children's Hospital, Rm 3001
11100 Euclid Avenue
Cleveland, OH 44106