Pediatric Environmental Health | Clinical Fellowship 2020

1.Overall mission of the fellowship (goals, themes)

The overall goal of the PEH fellowship is to prepare trainees for a career in academic pediatric environmental health or in public health. The fellowship has two primary components: training in the management of children with a wide range of environmental health-related concerns and training in teaching and research related to pediatric environmental health.

Specific goals are: a) To train fellows in pediatric environmental health to be expert in the clinical care of pediatric patients with environment-associated diseases. b) To develop physician leaders through training in research methodologies and scholarly work in the field.

2. Brief history: when program began, number of fellows graduated

The national PEH fellowship training program was initiated by the APA in 2001. Boston Children‘s Hospital was the first site approved for such training. Other sites followed at Mt Sinai Hospital, U. of Washington in Seattle, and George Washington U./Children’s National Medical Center in Washington DC. Over the past 17 years, 8 trainees have completed the fellowship at Boston Children’s Hospital. Details of the fellowship training content and follow-up of its alumni have been previously published: Landrigan PJ, Woolf AD, Gitterman B, Lanphear B, Forman J, Karr C, Moshier EL, Godbold J, Crain E. The Ambulatory Pediatric Association Fellowship in Pediatric Environmental Health: a 5-Year assessment. Environ Heal Persp 2007; 115: 1383-7. Landrigan PJ, Braun J, Forman J, Galvez M, Karr C, Paulson J, Woolf AD, Lanphear B, Wright RO. The APA training programs in pediatric environmental health: a 15-Year assessment. Acad Pediatr. 2019; 19 (4) 421-7.

3. Program focus and/or special tracks (e.g., health services research, child abuse, hospital medicine, etc)

Program focus is on the sub-specialty of pediatric environmental health with 4 components: clinical service, research, teaching and community-level advocacy. There are no separate tracks.

4. Length of fellowship training program in years

This is a 2-year (optional 3rd research-oriented year) clinical training program.

5. The total percentage of clinical time per year

PEH fellows participate in 3 clinic sessions (half-day) per week (30%). They are on-call for the Region 1 Pediatric Environmental Health Specialty Unit (Region 1 New England PEHSU) 8 nights per month, with attending physician back-up (10%). They also participate in the weekly PEHC case conference and in writing case notes and making follow-up calls to patients and their families (10%).

6. Career plans of fellows targeted for recruitment

The goal of the fellowship training program is to increase nationally physician-level manpower training with expertise in pediatric environmental health. Our PEH fellowship is designed to produce well-trained academicians who can assume leadership positions in pediatrics departments in teaching hospitals. Career plans for prospective fellows are to become pediatric environmental health specialists and leaders within academic settings which include teaching, clinical service, community advocacy, and research. An alternative career pathway is in training physicians who can assume leadership positions in non-profit organizations or governmental agencies specializing in public health.

7. Integration with other fellowship programs in the institution (shared didactic experiences, clinical experiences, etc)

The PEH fellowship at Boston Children’s Hospital is integrated into the fellowship training program in Medical Toxicology and the Massachusetts/Rhode Island Poison Control System. PEH fellows also participate in additional training opportunities in pediatric primary care within the Division of General Pediatrics. Fellows have elective rotations at the Occupational & Environmental Medicine Clinic at Cambridge Hospital and with personnel in the Region 1 EPA/ATSDR agencies in located in Boston. Fellows also can audit environmental courses taught at the Harvard T.H. Chan School of Public Health.

8. Other information that will help to understand the overall purpose and plan for the program.

The fellowship training program in Pediatric Environmental Health is a 2 or 3-year fellowship designed to train pediatricians in the assessment and management of children whose health problems are related to the environment (for example, heavy metal poisoning, allergies and asthma, exposures to indoor and outdoor pollution, toxic waste dumps, etc.) and to provide them with the necessary public health and research background to be successful academicians and physician scientists. The goal is to produce pediatricians who excel in community-based and primary care research
addressing environmental health problems affecting children and who will be leaders in the emerging field of pediatric environmental health.

The program emphasizes teaching and research, the mastering of scientific and grant writing skills, and the development of effective advocacy skills and expertise in the critical review of the pediatric environmental health literature and risk assessment and risk communication. The training sites for each fellow are tailored to his or her interests. The curriculum covers: didactic curriculum, clinical practice, community activities, and research. By the conclusion of the training period, all fellows will meet competencies in environmental pediatrics, including those milestones around medical knowledge, patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Fellows undertake advanced training in biostatistics and epidemiology and will receive training in advocacy, linked to innovative clinical programs in that include environmental law and public policy. Fellows pursue an academic career trajectory. They have access to advanced computer facilities and technologies available at Boston Children’s Hospital, Harvard Medical School, and other affiliated institutions. Fellows will rotate through the Pediatric Environmental Health Clinic which sees about 250 patients each year plus 5-10 inpatient consultation/admissions at Boston Children’s Hospital annually.