The primary goal is to prepare fellows to provide high-quality, evidence-based care of patients with pulmonary conditions in the inpatient setting. When not participating in other required and elective activities, the first year pulmonary fellow spends weekdays and every 4th weekend on the general pediatric pulmonary service. In this role, the fellow responds to all requests for consultations on patients admitted to the general pediatric service, the pediatric and neonatal intensive care units, and the emergency department. The fellow also initiates the management of children admitted to the pulmonary service, designs and implements inpatient management plans, follows the daily progress of each patient, and performs outpatient discharge planning. These activities are all performed under the direction of our attending physicians.
The goal is to prepare fellows to provide high-quality, evidence-based care to pediatric pulmonary patients in the outpatient setting. Throughout all three years of training, fellows see patients in the outpatient setting on a weekly basis, becoming more independent as they progress through training. The first-year fellow sees patients under the mentorship of the program director, Ben Nelson. One clinic each month is dedicated to the care of cystic fibrosis patients, which is supervised by the CF directors Dr. Fracchia and Yonker. The second year fellow sees patients on Wednesday mornings under the mentorship of Dr. Shannon Fracchia, and the third-year fellow sees patients on Tuesdays under the mentorship of the division chief, Dr. Bernard Kinane. One clinic each month is dedicated to sleep-disordered breathing, neuromuscular diseases, or aerodigestive issues. Patients are scheduled in the fellow’s name in order to promote continuity of care.
Throughout their training, fellows care for patients with CF, both in the outpatient and the inpatient setting. During the first year, the fellow is the key member of the multidisciplinary CF care team, which includes physicians (pediatric and adult), physical therapists, nutritionists, social workers, and psychiatrists. Fellows are involved in genetic counseling of parents and families where appropriate and encouraged to attend the North American Cystic Fibrosis Conference.
Fellows participate in the interpretation of pulmonary function tests, cardiopulmonary exercise tests, sweat tests, and impulse oscillometry.
During the first year of the fellowship, fellows learn the art of bronchoscopy through interactive educational sessions and hands-on training in the simulation center. Trainees perform bronchoscopies on Monday mornings at the Massachusetts Eye and Ear Infirmary as part of the aerodigestive clinic, and at Mass General under the supervision of the program director. On average, trainees perform greater than 100 procedures in their first year. Fellows have the opportunity to collaborate with the adult interventional pulmonology group to learn the latest techniques including transbronchial biopsy, cryotherapy, and endobronchial ultrasound.
During the first year of fellowship, pediatric pulmonary fellows complete a pediatric sleep medicine elective which includes participation in our pediatric sleep clinic, interpretation of sleep studies, exposure to the pediatric sleep lab, and optional involvement in ongoing research and scholarly projects. The pediatric sleep lab at MGH is a best-in-class, AASM-accredited 4-bed facility that conducts over 100 sleep studies per month. Our patient population is complex and spans the breadth of child and adolescent sleep problems, including airway and pulmonary disorders, neuromuscular disease, hypersomnia disorders, insomnia, circadian issues, movement disorders, and parasomnias. Our pediatric sleep program is embedded in the broader Harvard Division of Sleep Medicine, and many pediatric fellows have chosen to pursue subsequent sleep fellowship training both here at Harvard and at other leading programs across the country.
First-year fellows have protected time for 6 - 8 weeks of electives. Incoming fellows help to shape their elective experience based on their interests and experience.
Lung Transplantation: The transplant elective is a 1-2-week clinical experience for fellows during their first year of training. During this time, fellows admit and follow patients both before and after single or double lung transplantation. They are carefully supervised by the Lung Transplantation Medical Director and the transplant surgeons. Trainees perform consultations on patients who have received heart, liver, bone marrow, and other solid organ transplantations.
Pediatric Respiratory Care: During the first year of the fellowship, trainees may spend one week with the respiratory therapy service, participating in the care of patients in the Pediatric Intensive Care Unit and the Neonatal Intensive Care Unit, including ventilator management. Fellows have the opportunity to become more familiar with ventilators, CPAP, BiPaP, cough assist devices, and HFNC.
Pediatric Radiology: During the first year of the fellowship, trainees may spend one week with the pediatric radiology service, reviewing imaging studies and attending all radiology rounds and teaching conferences.
Interventional Pulmonology: Trainees may spend one week with the adult IP group learning the latest interventional techniques, performing procedures including endobronchial ultrasound, and caring for patients.
Airway Clearance: Trainees may spend one week with physical therapists learning the most effective forms of airway clearance. Trainees will have the opportunity to test out the equipment on themselves.