Pediatrics Allergy and Immunology Fellowship Program
The ACGME-accredited University of Colorado Denver Program A in Allergy & Immunology based at National Jewish Health
Goals of the Fellowship Program
1st Year Assignments
2nd Year Assignments
Goals of the Fellowship Program:
The primary goals are to:
Provide state-of-the-art clinical training in allergy and immunology asit pertains to the evaluation and management of associated medical disorders.Emphasis will be placed on atopic disorders, such as asthma, atopic dermatitis,food allergy, eosinophilic esophagitis, rhinitis, and sinusitis. Training inthe management of primary immune deficiency and autoimmune disease is included.
Develop a solid foundation in the principles of basic immunology fundamental to understanding and managing clinical disorders.
Initiate a solid experience in the fundamentals of research, either basic or clinical. This is intended to provide the base for career development in academic medicine and subspecialty clinical practice.
Fellows in the University of Colorado Program A in Allergy &Immunology receive most of their experience through 4 different assignments.The Fellowship program is primarily based at National Jewish Health. National Jewish Health is a tertiary caremedical and research facility that specializes in allergic, immune, andrespiratory diseases. Indeed, this year National Jewish Health was ranked the#1 Pulmonary Hospital in the United States by U.S. News & World Report, forthe 14th year in a row. This reflects National Jewish Health’s expertise in medicalcare and research accomplishments in lung, allergic, and immune diseases.
Two Fellow assignments at National Jewish Health are the Pediatric Day Program and Medical Officer of the Day (MOD). Fellowsalso have 3rd level of experience with outpatient clinics and inpatientconsults at Children’s Hospital Colorado. Children’s Hospital Colorado is afull-spectrum academic pediatric institution, and most of the University ofColorado School of Medicine pediatric administration, faculty, residents, andacademic programs are based at Children’s Hospital Colorado. National JewishHealth provides Children’s Hospital Colorado with their clinical allergy andimmunology services, and Fellows rotate at Children’s Hospital Colorado underthe supervision of National Jewish Health faculty based there, to furtherdiversify and enrich their Fellowship experience. The 4th patient experiencefor this program’s Fellows is an AdultAllergy Consult Service, primarily based at the University of Colorado Hospital (UCH). UCH is a full-spectrum academic medical institution,primarily oriented to clinical services for adults. This assignment provides Fellows with consultative experiencewith adult inpatients, drug allergy, and drug desensitization procedures. Allassignments are designed to provide pediatric and adult experience in diagnosisand management of allergic and immunologic disorders including the use ofpharmacotherapy, allergen immunotherapy and immune regulation.
1st Year Assignments
Pediatric Day Program: National Jewish Health
Fellows are assigned to this rotation for 6 months of the first year.Pediatric patients, both local and out-of-state, with severe allergic, pulmonary,and immune disorders are admitted to this service for in-depthmulti-disciplinary outpatient team evaluations. Fellows are providers for thesepatients, under faculty attending supervision. The disease severity andcomplexity of the patients admitted to this program are similar to patientsseen in an inpatient setting, and essentially all patients require overnighthospitalization at National Jewish Health on some nights, although some do notsleep at the hospital on all nights of their admission.
This rotation provides a primary patient base for the understanding of thediagnosis, treatment, and pathophysiology of, but not limited to: 1) severechronic refractory asthma, its detailed differential diagnosis, recognition andevaluation of the iatrogenic aspects of its management, and alternativetreatments; 2) severe allergic disease including chronic rhinosinusitis, nasalpolyposis, food allergy, including the use of double-blind, placebo-controlledfood challenges, anaphylaxis, atopic dermatitis, urticaria, allergicbronchopulmonary aspergillosis, hypersensitivity pneumonitis, eosinophilia, anddrug allergy; 3) immunodeficiency diseases with autoimmune features; and (4)pediatric pulmonary diseases, such as chronic pneumonias and pneumonitis, aspiration,bronchiolitis, bronchitis, congenital pulmonary anomalies, obstructivepulmonary disease, interstitial lung disease, bronchopulmonary dysplasia,cystic fibrosis, vocal cord dysfunction, bronchiectasis, and immotile ciliasyndrome. This rotation also provides a familiarization with the psychosocialeffects of chronic disease on the child, adolescent, and family. Thedevelopment of specific allergy & immunology specialist clinical skills,such as complex disease management, patient education, home managementstrategies and interacting with the referring physicians and tertiaryconsultants, will be a focus of these months. Expertise in methods and interpretation of pulmonaryfunction testing, pH probe studies for gastroesophageal reflux, and variousallergen, food and airway provocation challenges will be acquired. The basicapplication of rhinolaryngoscopy and bronchoscopy will also be addressed duringthis rotation.
MOD (Medical Officer of the Day): National Jewish Health
Fellows are assigned to this rotation for 6 months of the first year.Acutely ill pediatric patients with allergic, respiratory and immune disordersare seen by the Fellow as the provider in an urgent care setting, under facultyattending supervision. Most of the pediatric patients seen in this rotation haveexacerbations of their asthmatic, respiratory, allergic and/or immunedisorder(s) that benefit from specialty care. Some of the patients evaluated inurgent care require hospitalization at National Jewish Health, and continue to befollowed by the admitting Fellow and attending. MOD and Day Program Fellowssometimes cross-over in order to continue to learn through specialty patientcare when the patient volume in their primary assignments may be low.
Pediatric Allergy and Immunology Continuity Clinic: The objective for this rotation is to focus on the outpatient diagnosisand management of asthma and allergic disease similar to the profile describedfor the Day Hospital rotation. This will be accomplished through a Pediatricallergy continuity clinic, one-half day per week, for the first 2 years of theFellowship, and through one-to-one mentoring with an allergist during thisrotation. Skills in the interpretation of epicutaneous skin testing andspirometry will be developed within this time period. Patient continuity allows for the development of expertisein the management of chronic disease processes over time, includingimplementation of step-up and step-down asthma guideline-based care, allergenimmunotherapy and application of evidence-based management of atopic dermatitisand food allergy.
Adult Allergy Continuity Clinic: The major objective of this clinic is to provide experience with thediagnosis and management of adult allergic and asthmatic problems. Thisexperience is obtained one-half day per week for 6 months in the first year and12 months in the second year, thus providing a thorough cross-trainingexperience in adult allergic and asthmatic diseases. Fellows will gain expertise in problems commonly encounteredin older allergy/immunology patients, such as aspirin exacerbated respiratorydisease, chronic urticaria, vocal cord dysfunction, and hymenoptera allergy.
Immunodeficiency Clinic: Exposure and familiarization with all aspects of primary and secondaryimmunodeficiency as well as the use and interpretation of clinical immunologiclaboratory testing are the major objectives of this clinic. During thisclinic, Fellows develop expertise in the long-term management of patients withimmunodeficiency and immune-mediated diseases. Fellows also acquireexperience with the administration and complications of therapeutic modalitiesin treating these diseases, such as intravenous gamma globulin (IVIG).
Atopic Dermatitis,Pediatric Rheumatology, and ENT clinics:
Familiarization with these related specialty disciplinesthat may have an allergic or immunologic etiology can be obtained on anelective basis in the second year.
Children's HospitalColorado (CHC): The emphasis during this clinic rotation will be on outpatient and inpatientAllergy & Immunology consultation by the Fellow under faculty attendingsupervision, within a large, full-service academic hospital for children. Alsoincluded will be specialty clinics based at Children’s in pediatric asthma,pediatric allergy, pediatric atopic dermatitis, eosinophilic esophagitis, andpediatric sinusitis. Thisassignment for first year Fellows is supervised by Dan Atkins. Four other faculty from National Jewishalso have clinics at CHC.
* Other scholarly activities include attending one national specialty meetingin the first year.
2nd Year Assignments
Research and ScholarlyActivity: A high quality research experience takes the major portion of effort inthe 2nd year.
Adult Allergy Consult Service:In-patient adult allergy consult experience, for 2 months in the second year.These consults are on request, and they therefore account for ~20% of the timespent during the 2-month period.
Pediatric Allergy and ImmunologyContinuity Clinic, and Adult Allergy Continuity Clinic: are continuedthroughout the 2nd year, as previous described in Year 1.
3rd Year Training Assignments
Fellows seeking a career in academic medicine may wish to continue theirtraining and research at National Jewish Health. Funding opportunities forfurther training at National Jewish Health exist. On approval of the faculty, aFellow entering academic medicine may receive support to continue their researchand also gain additional clinical and teaching experience for a third or moreyears in their career development plan.
Teaching conferences: as part oftheir training, fellows regularly attend a city-wide conference in allergy andimmunology, a patient care conference in pediatrics, a board review course, aclinical research conference, and an allergy journal club
Learn about the application process.