Pediatric Allergy & Immunology Fellowship

The ACGME-accredited University of Colorado School of Medicine/National Jewish Health Pediatric Allergy & Immunology Program

Goals of the Fellowship Program
Overview
Rotations at NJH, RMHC and UCH
Research and Other Academic Assignments
Application Process
Faculty
Current and Former Fellows

Overall Educational Program Goals

Provide state-of-the-art clinical training in pediatric allergic and immunologic diseases including primary immunodeficiency, with an emphasis on severe and comorbid asthma, atopic dermatitis, food allergy and anaphylaxis. Although focused primarily on pediatrics, fellows are also cross-trained in the treatment of adult allergy and clinical immunology.
Train physicians who (a) demonstrate a comprehensive and in-depth understanding of the biological and physiological basis of allergy and immunology and (b) demonstrate expertise in the management of complex clinical disorders. This training is designed to serve as a foundation for a career in academic medicine or clinical practice.
Provide the opportunity for research in clinical and/or basic science related to allergic and immunological diseases.
Train expert allergists as manifested by competency in six domains outlined by the Accreditation Council for Graduate Medical Education (ACGME), and in our specialty Milestones v2.0. Progress throughout the training program is evaluated as outlined in the program manual. The evaluation process is based on the six core competencies and the evaluation process outlined by the American Board of Allergy and Immunology.

Overview

Fellows in the University of Colorado/National Jewish Health Pediatric Allergy & Immunology program receive most of their experience at National Jewish Health through four different assignments. National Jewish Health is a tertiary care medical and research facility that specializes in allergic, immune, and respiratory diseases. Since 1899, National Jewish Health has been recognized as the leading respiratory hospital in the nation. Fellows spend half of their two-year fellowship program in the clinical rotations described below spread out over the two years.

Clinical assignments include:

Pediatric Day Program and Care Unit at National Jewish Health
Inpatient Consultation at Rocky Mountain Hospital for Children (RMHC)
Pediatric and Adult Outpatient Allergy & Immunology Clinics at National Jewish Health
Adult Allergy Consult service (for one month during second year) at the University of Colorado Hospital (UCH).

Rotations at National Jewish Health

Pediatric Day Program

Pediatric patients, both local and out-of-state, with severe allergic, pulmonary, and immune disorders are admitted to this service for in-depth multi-disciplinary outpatient team evaluations. Fellows are the primary providers for these patients, under attending faculty supervision. The disease severity and complexity of the patients admitted to this program are comparable to patients seen in an inpatient setting.

This rotation provides a primary patient base for the understanding of the diagnosis, treatment, and pathophysiology of, but not limited to:

Severe chronic refractory asthma, its detailed differential diagnosis, recognition and evaluation of the iatrogenic aspects of its management, and alternative treatments
Severe allergic disease including chronic rhinosinusitis, nasal polyposis, food allergy, anaphylaxis, atopic dermatitis, urticaria, allergic bronchopulmonary aspergillosis, eosinophilia, and drug allergy
Immunodeficiency diseases
Pediatric pulmonary diseases, such as aspiration, hypersensitivity pneumonitis, bronchiolitis, interstitial lung disease, vocal cord dysfunction, and other pediatric disorders such as sleep apnea, sinus disease, GERD, EoE, FPIEs and more

This rotation also has a strong focus on understanding and helping to manage the psychosocial aspects of chronic disease together with behavioral therapists that are seen by every patient and their families.

The development of specific allergy and immunology clinical skills, such as complex disease management, patient education, home management strategies, and interacting with the referring physicians and tertiary consultants, will be a focus of these months.

Expertise also will be acquired in:

Skin testing
Oral food challenges and drug challenges
Methacholine and exercise challenges
Methods and interpretation of pulmonary function testing and impulse oscillometry
pH and impedance probe studies for gastroesophageal reflux
Various allergen, food and airway provocation challenges
Managing patients with severe atopic dermatitis through administering daily baths, wet wraps and topical therapies

During this rotation, fellows also see acutely ill pediatric patients with allergic, respiratory, and immune disorders in an urgent care setting, under attending faculty supervision. Most of the pediatric patients seen in this rotation have exacerbations of their asthmatic, respiratory, allergic, and/or immune disorder(s) that benefit from specialty care. Some of the patients evaluated in urgent care require hospitalization at National Jewish Health, and continue to be followed by the admitting fellow and attending.

Outpatient Clinics

Pediatric Allergy Continuity Clinic: These clinics focus on the outpatient diagnosis and management of asthma and allergic disease. Each fellow has their Pediatric Allergy Continuity Clinic one-half day per week. These clinics facilitate the development of required clinic skills for allergists. Patient continuity allows for the development of expertise in the management of chronic disease processes over time, including implementation of step-up and step-down asthma guideline-based care, allergen immunotherapy, application of evidence-based management of atopic dermatitis, and food allergy.
Adult Allergy & Immunology Continuity Clinic: Fellows have their adult clinic one-half day per week providing a thorough cross-training experience in adult allergy and immunology.
Pediatric Immunodeficiency Clinic: The major objectives of this clinic are to expose and familiarize fellows with all aspects of primary and secondary immunodeficiency as well as the use and interpretation of clinical immunologic laboratory testing. During this clinic, fellows develop expertise in the long-term management of patients with immunodeficiency and immune-mediated diseases. Fellows participate in this clinic one-half day every other week during both years of their fellowship.
Rocky Mountain Hospital for Children (RMHC): Inpatient allergy and immunology consultation is provided at RMHC with supervision from National Jewish Health attending physicians. Fellows are on-call Monday through Friday, 8 a.m. to 5 p.m.. Fellows do not cover call on nights or weekends. Fellows have additional time in the Pediatric and Adult Allergy and Immunology Clinics at National Jewish Health, and time also is reserved during this rotation for research and academic endeavors.
Adult Allergy Consult Service: This rotation takes place for one month in the second year of fellowship. Consults are performed at UCH and are staffed by faculty from the adult allergy division. Fellows are on-call at night and on the weekends during this rotation only. This month is concurrent with a research or outpatient month.

*Fellows generally attend one national specialty meeting during the first year and both AAAAI and ACAAI as well as the Aspen Allergy Conference during their 2nd year."

Research and Other Academic Assignments

Research and Scholarly Activity: Each fellow works with a faculty research mentor for a high quality research experience. Fellows routinely present at national meetings each year. Past fellows have conducted research in the following areas:

Anaphylaxis
Asthma and the environment
Asthma and steroid responsiveness
Environmental factors and risk of atopy
Food allergy and atopic dermatitis
Food allergy diagnosis
MRSA and atopic dermatitis
Molecular mechanisms of primary immunodeficiency
Oral food challenge outcomes

Elective Experience

During this one-month rotation during the second half of year two, fellows design the month to meet their specific learning goals to best prepare them for life after fellowship. Some available options include:

Additional time in adult or pediatric outpatient clinics at National Jewish Health main campus or Highlands Ranch
Other related specialty clinics, occupational medicine clinic, private practice allergy clinic, research, advocacy, QI, diagnostic laboratory, procedure time (food and drug challenges, pulmonary function testing, laryngoscopy, patch testing, skin biopsies)
Other activities based on interest and availability

Dermatology, GI, Pulmonology and ENT clinics: Familiarization with these related specialty disciplines can be obtained on an elective basis during the second year of fellowship.

Procedural Electives: Fellows can elect to spend additional time focused on specific procedures including performing and reading PFTs, rhinolaryngoscopy, patch testing, skin biopsies, and lab experiences.

Teaching Conferences
As part of their training, fellows regularly attend the following conferences held at National Jewish Health (most conferences run from September to May):

Denver Allergy Rounds – a weekly city-wide grand rounds in allergy and immunology
Board Review – a weekly review shared with the adult fellows
Pediatric Department Noon Conference – a weekly conference consisting of case presentations, formal clinical and research presentations and journal clubs
Pediatric Allergy and Immunology Lecture Series – every other week didactic lecture time
Journal Club – a monthly allergy journal club shared with the adult faculty and fellows
Adult Allergy Case Conference – an optional, weekly conference that focuses on adult allergy and immunology cases
Boot Camp Lecture Series – an introductory lecture series held in July and August that provides a broad overview of basic adult and pediatric allergy and immunology topics

3rd Year Training (Optional)

For fellows seeking a career in academic medicine, funding opportunities for continued training and research are available.

Learn about the application process.