Rotations and Elective Descriptions

Rotation: Inpatient Service
Site: Connecticut Children’s Medical Center with consults at John Dempsey Hospital NICU and Saint Francis Hospital NICU
Site Director: Dr. Melanie Sue Collins
Hours: 8:00 am – 5:30 pm
While on the pediatric pulmonary clinical service, the fellow has primary responsibility for
running the inpatient service under the supervision of the pediatric pulmonary attending. S/he evaluates all patients admitted to service or seen in consultation and presents an assessment and plan for evaluation and treatment to the attending. The fellow performs flexible bronchoscopy with attending physician supervision. S/he interacts directly with and supervises the pediatric residents on the pediatric unit and any residents or medical students on pulmonary inpatient elective. The fellow may be responsible for teaching conferences for the pediatric residents. The fellow manages telephone calls from outpatients, and evaluates patients who need to be seen urgently in the pulmonary clinic or the Emergency Department; s/he also handles telephone consults from referring physicians under direct supervision of the attending physician on service. They also see sick follow-ups or urgent outpatient consults in clinic while on the inpatient service. Night call is taken daily during the week when on inpatient service. Call during outpatient, elective, and research months is limited to one weekend per month.
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Rotation: Outpatient Service
Site: Connecticut Children’s Medical Center
Site Director: Dr. Melanie Sue Collins
Hours: 8:00 am – 5:30 pm
Ambulatory patients are seen in the office suite of the Pediatric Pulmonary Division at CT
Children’s; patients are also seen in satellite offices by faculty and nurses. Patients >5 years of age and/able to perform pulmonary functions tests do so during an ambulatory visit. The
first-year fellow attends most of the clinics during outpatient rotations and sick follow-ups or urgent outpatient consults while on the inpatient service. Second and third-year fellows attend 1-3 half-day clinics per week and sick follow-ups or urgent outpatient consults clinics while on the inpatient service. By continuing subspecialty and general pediatric pulmonary clinic attendance through the second and third year, the fellow will assume primary responsibility for the management of selected patients on a continuing, longitudinal basis. The fellow sees patients with a supervisory attending(s) in the general and specialty clinics run each week. In the general clinics, there is a mix of new and follow-up patients. Specialty clinics are conducted for patients with cystic fibrosis, sickle cell pulmonary problems, and aero digestive problems; these clinics have additional staff (nurses, nutritionist, and social work) who also see patients. Starting in the second half of the first year, the fellow begins a half-day continuity clinic, which includes both new and follow-up patients. This clinic is slower paced and has no other learners assigned. The fellow attends all clinic sessions based at CT Children’s and documents clinical encounters in the ambulatory medical record. S/he is expected to include all pulmonary function tests and other laboratory data in his assessment and to follow through on any testing recommended at the time of the visit. When needed, s/he will coordinate care with other members of the team (i.e.: ordering home equipment, insurance or school issues).
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Rotation: PFT Lab
Site: Connecticut Children’s Medical Center
Site Director: Dr. Melanie Sue Collins
Hours: 8:00 am – 5:30 pm
This rotation is designed for the fellow to learn the fundamentals of pulmonary function testing, including the physiology of pulmonary function testing, how to perform and interpret tests, and how to select the appropriate test to order. The Pediatric Pulmonary Function and Exercise Laboratory provides testing for pediatric patients of all ages and for select adult patients, and for inpatients, outpatients and research subjects. The range of tests includes simple spirometry, lung volumes by plethysmography and nitrogen washout, static respiratory pressures, diffusion capacity, exercise testing using a treadmill or ergometer, metabolic testing (calorimetry, exercise), impulse oscillometry, and oximetry. The fellow attends all testing sessions done by the laboratory technicians and learns to do simple spirometry. Reading is directed at learning basic pulmonary mechanics and the pathophysiology of obstructive and restrictive lung disease and testing standards (American Thoracic Society and others).
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Rotation: Sleep
Site: Connecticut Children’s Medical Center
Site Director: Dr. Jay Kenkare
Hours: 8:00 am – 5:30 pm
During this rotation, the fellow learns the theory of sleep and sleep disordered breathing. They learn the indications for ordering sleep studies and to interpret/read sleep studies during this rotation as well under the supervision of Dr Kenkare, director of sleep center here at CT Children’s. Fellow will have the opportunity to watch sleep studies being setup in the sleep lab. The fellow will also learn indications for ordering apnea monitoring and to interpret apnea downloads.

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Rotation: Research
Site: Connecticut Children’s Medical Center
Site Director: The fellow and program director will coordinate to select a mentor.
Hours: 8:00 am – 5:30 pm
The fellow’s research program will results evidence of productive research participation, a
requirement for successful completion of the fellowship program and for eligibility to take the Pediatric Pulmonology board examination. (See the ABP requirements for the definition of productive research participation.) S/he will learn the scientific method and become proficient in selected basic and/or clinical research techniques. The fellow’s program will be developed and carried out with the mentorship of an established investigator and monitored by the fellow’s Scholarship Oversight Committee. Although most fellows have one major area of research, one or two small, additional research projects may also be performed during the fellowship. Clinical research is conducted at CT Children’s, as well as through the General Clinical Research Center of UCHC. Basic science laboratories for pediatric pulmonary research faculty and their collaborators are maintained at the UCHC campus in Farmington.
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Elective: Respiratory Therapy
Site: Connecticut Children’s Medical Center
Site Director: Dr. Melanie Sue Collins/Justin Rearick, RRT
Hours: 8:00 am – 5:30 pm
During this rotation, the fellow is exposed to the variety of therapies and interventions available to manage respiratory problems. S/he learns the theory of therapies (airway clearance), how to perform and how to teach patients to perform their own therapy (MDI, aerosols, airway clearance) and the practical application of various modalities. The fellow accompanies the hospital’s respiratory therapy staff on daily work rounds, in the ICUs and general wards, to observe and to deliver respiratory care to inpatients.
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Elective: Radiology
Site: Connecticut Children’s Medical Center
Site Director: Dr. Douglas Moote
Hours: 8:00 am – 5:30 pm
During this rotation, the fellow learns the theory of radiography. They learn about safety of
radiation dosing in Pediatrics. They learn the appropriate indications for studies/procedures and to interpret/read chest x-rays, chest CT scan, and airway fluoroscopy the most commonly used radiographic studies. The fellow is supervised by pediatric radiologists here at CT Children’s and participates in PICU and NICU as well resident radiology rounds.

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Elective: Allergy Immunology
Site: Connecticut Children’s Medical Center/ CT Asthma/Allergy West Hartford
Site Director: Dr. Hillary Hernandez
Hours: 8:00 am – 5:30 pm
The aim of this elective is to provide a broader exposure to pediatric allergy and immunology. It will give fellows the opportunity to develop skills in the prevention, evaluation and management of allergic and immunologic conditions. Several areas of focus include: general review and understanding of the adaptive and innate immune systems and cellular players, environmental and food allergies, pathophysiology, evaluation and management as well as diagnosis and management of children with primary immunodeficiencies. The fellow may also renew/learn new skills in allergy testing such as skin pricks/patch testing, pulmonary function testing, preparation of children and families for IVIG and SQIG use and physical exam findings in allergy and immunodeficiency patients. It is also expected that the fellow will provide expertise about pulmonary medicine to the allergy/immunology staff.