Division of Pulmonary Medicine | Fellowship Structure

The Fellowship program in Pediatric Pulmonology is a three-year program designed to provide a balanced clinical and research experience. In addition, the fellowship is designed to ensure that fellows meet criteria for certification in Pediatric Pulmonology by the American Board of Pediatrics at the end of their fellowship. Dual fellowships performed in conjunction with other pediatric and adult subspecialties may be arranged. In general, four new fellows are accepted into the program each year. The first year of training is dominated by clinical experience on the inpatient hospital services and in the outpatient clinics while the second and third years have their focus on research activities.

The inpatient hospital services of the Division are divided between the Subspecialty Pulmonary Inpatient Service, the Pulmonary Consult Service, the Lung Transplant Service, and the Bronchoscopy Service. The Subspecialty Pulmonary Inpatient Service serves as the admitting service for patients with acute and chronic respiratory diseases including asthma, Cystic Fibrosis, chronic lung disease of prematurity, interstitial lung disease, pneumonia, pleural effusions, pneumothoraces, congenital malformations, lung transplant patients, electronic cigarette and vaping associated lung injury and many other pediatric respiratory conditions. The Subspecialty Pulmonary Inpatient Service is generally composed of an attending physician, a pulmonary fellow, a nurse practitioner, two medical students, an intern, and a supervising resident. The average daily census on the pulmonary inpatient service is around 11-14 patients. The fellow is responsible for leading the team under the direction of the attending. The Subspecialty Pulmonary Inpatient Service is combined with other subspecialty services including Allergy/Immunology.

The Pulmonary Consult Service provides consultative services to all programs and services within Boston Children’s Hospital. The Pulmonary Consult Service consists of an attending physician working one on one with a pulmonary fellow. Occasionally a resident or medical student will spend time on the Consult service as well.

We are one of the busiest pediatric lung transplant centers in the country and generally perform 5-8 lung transplants each year. The Lung Transplant fellow will care for our lung transplant patients pre and post-transplant both in the ICUs and the regular inpatient transplant unit.

We have a Neonatal Intensive Care Unit consult service providing consultation to neonates at Brigham & Women’s Hospital and Beth Israel Deaconess Hospital with respiratory issues including bronchopulmonary dysplasia, interstitial lung disease, sleep disordered breathing, and other causes of neonatal lung disease.  The fellow covering the lung transplant service also covers the outside NICU consults with a group of pulmonary attendings with expertise in neonatal lung disease.   

As mentioned, the Bronchoscopy Service performs greater than 700 bronchoscopic procedures each year. Each first-year fellow will generally perform over 100 bronchoscopies in their first year of training with additional experience in the second and third years. While on the Bronchoscopy service, the fellows will also be responsible for interpreting pulmonary function tests performed in our laboratory under the direction of an attending physician.

The Ambulatory service is a new service this academic year designed to give fellows more exposure to urgent outpatient pulmonary issues (November-March). Fellows attend 2 half-day pulmonary clinics per week, with the focus on urgent visits (urgent new patients or sick patients) staffed with the ambulatory attending. Additionally, fellows choose 2 half-day subspecialty clinics to attend each week. Fellows continue to have one fellow’s clinic per week, as scheduled.

The subspecialty clinics available to choose from are:

  1. Adult CF
  2. Aerodigestive Disease
  3. Bronchopulmonary Dysplasia
  4. Chronic Vent
  5. Congenital Diaphragmatic Hernia
  6. Esophageal Atresia
  7. Exercise Challenge w/ Laryngoscopy
  8. Exercise Consult
  9. Interstitial Lung Disease
  10. Neuromuscular disease
  11. Post-ICU Clinic
  12. Primary Ciliary Dyskinesia
  13. Pulmonary Hypertension
  14. Pulmonary Complications of Oncologic Therapies
  15. Severe Asthma
  16. Sleep
  17. Transplant
  18. Trach Clinic (with ORL or CAPE)
  19. Vaping

When not on one of the five services described above, the first-year fellow will choose among a variety of electives as well as take one month of vacation.

Night call for the Pulmonary Service from Monday through Thursday is directed to one of the fellows on Service and is taken from home. Weekend coverage is rotated among all of the fellows with a supervising attending.

Fellows follow their own template of ambulatory patients in the outpatient clinic under the supervision of an attending physician and the fellow is considered the primary clinician for their patients. All fellows attend clinic longitudinally throughout their three years of training. In addition to our general clinics, the Cystic Fibrosis Center, the Interstitial Lung Disease Program, the Lung Transplant Program, the Chronic Ventilation Program, the Severe Asthma Program, and the Center for Healthy Infant Lung Development Program conduct multidisciplinary clinic sessions where nutrition, physical therapy, social work, nursing, respiratory therapy and physician services are provided. In addition to their continuity clinic, second and third year fellows rotate through our sub-sub-specialty clinics to gain further clinical exposure to these patients. These clinics include: Asthma, Pulmonary Hypertension, Chronic Lung Disease of Prematurity, Interstitial Lung Disease, Sleep Disordered Breathing, Congenital Diaphragmatic Hernia, Chronic Ventilation, Lung Transplant, Exercise evaluation, Vocal Cord Dysfunction, Pulmonary Complications of Vaping and Aerodigestive Clinic amongst others.

Near the end of the first year, the emphasis shifts to research, and this focus continues throughout the second and third years of training. While the majority of their time is spent pursuing their research projects, second and third year fellows will spend approximately 6-8 weeks on a combination of the Inpatient, Consult, Lung Transplant, Bronchoscopy, and Ambulatory and attend their continuity and sub-specialty elective clinics.

Dr. Chiel and Dr. Casey host a Pediatric Pulmonary Fellowship Boot Camp that all fellows in the program will participate in. This involves simulation activities to allow exposure to a variety of clinical situations.

Example Rotation Schedule

Pulmonary Inpatient Service9-10 weeks
Pulmonary Consult Service9-10 weeks
Lung Transplant Service9-10 weeks
Bronchoscopy/PFT service9-10 weeks
Ambulatory service (Nov-Mar)2-3 weeks
Elective time9 weeks
Vacation4 weeks
Pulmonary Inpatient service1-2 weeks
Pulmonary Consult service1-2 weeks
Lung Transplant service1-2 weeks
Bronchoscopy/PFT service1-2 weeks
Ambulatory service (Nov-Mar)1 week
Elective time4 weeks
Research time36 weeks
Vacation4 weeks
Pulmonary Inpatient service1-2 weeks
Pulmonary Consult service1-2 weeks
Lung Transplant service1-2 weeks
Bronchoscopy/PFT service1-2 weeks
Ambulatory service (Nov-Mar)1 week
Elective time4 weeks
Research39 weeks
Vacation4 weeks