Fellowship Training Program
There has been steady increase in the number of trainees within the Division from Canada and around the world.
The Royal College of Physicians of Canada has consistently given its full approval to the Division’s training program.
Contact:
Training Program Coordinator
Paediatric Respiratory Medicine
The Hospital for Sick Children
555 University Avenue
Toronto, Ontario
M5G1X8
Telephone: 416-813-6248
email: respmed.trainingprogram@sickkids.ca
Dr. Melinda Solomon - Training Program Director
Paediatric Respiratory Medicine
The Hospital for Sick Children
555 University Avenue
Toronto, Ontario
M5G1X8
Telephone: 416-813-6248
email: respmed.trainingprogram@sickkids.ca
Application Submission:
If you are a PGY-2 or PGY-3 year in Pediatrics at a Canadian University or in an RCPSC-accredited U.S. Pediatrics program - submit your application/documentation through:
CaRMS - About CaRMS https://www.carms.ca/en/
CaRMS - Pediatric Subspecialty Match - About the Match https://phx.e-carms.ca/phoenix-web/pd/main?mitid=1350
International government funded / internationally trained:
Application dates:
The online application is open between January 1st and May 28th.
Successful candidates will be contacted (emailed) in September to discuss possible interview (Skype) dates.
Final decisions will be made and contacted in October for a start date (the following year) of July 1st.
Please click the following link to apply:
https://surveys.sickkids.ca/surveys/?s=EPX4MHH9Y3
**Please understand that we annually receive many applications and the process is quite competitive since we have a limited number of positions that can be filled. Only the successful candidates who will be granted an interview will be contacted**
Resources: The Hospital for Sick Children is the primary teaching hospital.
Length of Program: 2 years
Educational Objectives
General
The overall objective of this training program is to provide an educational opportunity that enables the resident with previous experience in General Paediatrics to obtain the theoretical, clinical, and laboratory knowledge, skills and attitudes to function as a clinical consultant in Paediatric Respiratory Medicine. At completion of the two year training period the candidate should be capable of functioning independently as a consultant with a thorough understanding of the fundamental principles of pulmonary physiology and pathophysiology, and a detailed knowledge and experience in the management of paediatric respiratory disorders. The trainee should be capable of supervising a clinical paediatric pulmonary function laboratory, demonstrate scholarship, and have a defined approach toward continuing medical education.
Trainees who wish to pursue an academic career as a clinician-scientist in Paediatric Respiratory Medicine will require an additional two and preferably three years of training where research constitutes 100 per cent of their effort. Such opportunities are available within the Division of Paediatric Respiratory Medicine (Lung Biology or other programmes of the Research Institute of The Hospital for Sick Children).
Specific Aims Of The Training Program
The trainee must acquire an in-depth understanding of:
- Normal lung growth, development and anatomy at both the macroscopic and microscopic level.
- Normal lung physiologic functions at the organ, tissue, cellular and molecular levels.
- Clinical assessment of lung function.
- Clinically relevant laboratory assessment of lung structure and function: pulmonary function (infant and childhood) gas exchange, oxygen transport, diagnostic imaging assessments (routine radiology, CT, MRI and nuclear medicine scans
- Epidemiologic, clinical, and laboratory approach to the diagnosis of (congenital, and acquired, infective and non-
infective disorders) pulmonary diseases that are seen in the paediatric age group. - Impact of lung disease on the function of other body organs.
- Medical and surgical therapeutic management and complications of the pulmonary disorders seen in the
paediatric age group.
The trainee must acquire sufficient understanding of the following areas to enable themselves to function now and in the future as a competent consultant in Paediatric Lung Disorders:
- Cellular and molecular basis of pulmonary disease.
- Laboratory diagnosis and therapeutic monitoring of lung diseases.
- Pathologic (gross and histologic) diagnosis of congenital and acquired lung disorders.
- Clinical management of underlying malignant disorders involving the lung (chemotherapy, radiotherapy, and
surgical excision). - Diagnosis and therapy of adult respiratory disorders that are rarely seen in the paediatric population
(e.g. emphysema, sarcoidosis). - Ethical, legal and economic considerations in the provision of care for paediatric respiratory disorders.
- Design, measurement, and evaluation of clinical trials.
Objectives Of Individual Rotations In The Paediatric Respiratory Medicine Residency
Each trainee must have a thorough understanding of the underlying physiologic principles, and pathophysiologic implications of the following pulmonary function tests. In addition, numbers 1-10 must have been personally performed and interpreted by the trainee to the satisfaction of their supervisor in the pulmonary function laboratory and in the sleep lab.
- Quality control of laboratory measurements.
- Measurement of lung volumes (inert gas dilution and plethysmographic).
- Measurement of inspiratory and expiratory flow rates (by spirometer and pneumotachograph).
- Carbon monoxide uptake by the lung (including correction for changes in hemoglobin concentration).
- Bronchial provocation test (methacholine).
- Blood gas tension and acid-base status.
- Assessment of oxygen requirements (pulse oximetry) for chronic oxygen therapy.
- Assessment of inspiratory and expiratory muscle strength.
- Jones' Stage I exercise test.
- Sleep study (set-up & interpretation).
The trainee must have an in-depth understanding of and pursue the opportunity to perform the following tests during their residency
- Assessment of lung mechanics (compliance, resistance).
- Infant pulmonary function testing.
- Ventilatory control and drive (response to hypoxia and hypercarbia).
- Inductive plethysmography.
Intensive Care Unit:
At the completion of this rotation the trainee should have a thorough understanding of the underlying pathophysiologic principles and the demonstrated ability to utilize the following critical care approaches to acute cardiorespiratory disorders
- Assisted mechanical ventilation
- airway management and intubation
- pressure vs volume cycled ventilators
- controlled vs intermittent mandatory ventilation
- weaning from assisted ventilation
- optimization of oxygen uptake, and carbon dioxide excretion by alteration of ventilator settings
- complications of assisted ventilation (airleak, humidification, oxygen toxicity, barotrauma, fluid balance), and artificial airways
- monitoring of gas exchange and respiratory mechanics during assisted ventilation quality control of ventilator performance and minimization of nosocomial infections
- indication for and provision of long term home assisted ventilation.
- novel forms of assisted ventilation (eg. high frequency ventilation) - Management of acute and chronic tracheostomies.
- Management of pulmonary airleaks.
- Role of flexible bronchoscopy in the ICU .
- Invasive and non-invasive cardio-respiratory monitoring to enable measurement of cardiac output, pulmonary and systemic vascular pressures, and gas exchange (shunt).
- Medical management of post-thoracotomy patient (including lung transplantation.
- Diagnosis and management of primary and secondary pulmonary hypertension within the ICU setting (monitoring, therapeutic drug trials).
- Cardiopulmonary interactions and management of right and left heart failure.
- Cardiogenic and non-cardiogenic (increased permeability) pulmonary edema.
- Trauma related disorders of the lungs, airways, and chest wall
- Ethical, legal, and economic considerations in the provision of care in the ICU.
Immunology:
At the completion of this rotation the trainee should have a sufficient understanding of the underlying basic pathophysiologic abnormalities and therapy of the following disorders to enable them to function as a consultant in the diagnosis and treatment of their associated pulmonary complications
- Inherited immunodeficiency disorders including severe combined immunodeficiency syndrome
- ß-lymphocyte disorders (eg. agammaglobulinemias)
- T-lymphocyte disorders (eg. DiGeorge syndrome)
- leukocyte disorders (eg. chronic granulomatous disease)
- complement dysfunction
- disorders associated with immunologic and pulmonary complications (eg. ataxia telangiectasia). - Acquired immunodeficiency disorders
- organ transplantation
- bone marrow transplantation for malignancy or genetic disorders
The trainee should acquire an in-depth understanding of the known or potential role of the immunologic system in primary respiratory disorders such as:
- Asthma, and allergic rhinitis/sinusitis
- Chronic interstitial pneumonitis
- idiopathic (eg. LIP, DIP, UIP)
- associated to systemic diseases (eg. SLE, arthritides) - Granulomatous and non-granulomatous inflammatory lung disorders (eg. Wegener's syndrome, Goodpasture's syndrome, pulmonary vasculitides)
- Hypersensitivity lung diseases (eg. extrinsic allergic alveolitis, allergic bronchopulmonary aspergillosis).
- Cystic fibrosis
- Pulmonary infiltrates with eosinophilia syndromes.
Ambulatory Clinics:
This clinic rotation will enable the trainee to have a comprehensive exposure to paediatric pulmonary disorders. Trainees are expected to attend the following ambulatory clinics during this rotation:
- General Respiratory Medicine
- Asthma
- Complex Respiratory Care
- Congenital Diaphragmatic Hernia
- Cystic fibrosis
- Hereditary Hemorrhagic Telangiectasia
- Interstitial Lung Disease
- Lung Transplantation
- Primary Ciliary Dyskinesia
- Sleep Clinics
- Tuberculosis Clinic
The above clinics combined with the in-patient consultation service will enable the trainee, at the completion of their residency in paediatric respiratory medicine, to possess an in-depth knowledge of the pathophysiology, diagnosis, and treatment of the following groups of respiratory disorders (not inclusive)
- Congenital lung disease involving abnormal development of the airways, parenchyma or vasculature
- Infectious lung disease bacterial, viral, rickettsial, protozoal, parasitic in the ambulatory, hospitalized (nosocomial), and immune
compromised patient. - Allergic and immunologic lung disease
- Obstructive lung disease (large and small airway)
- Non-obstructive lung disease (chest wall, neuromuscular, interstitial)
- Acute and chronic respiratory failure.
- Sleep disorders
- Lung injury (traumatic, radiation, and chemotherapeutic)
- Pulmonary vascular disease
- Cardiogenic and non-cardiogenic pulmonary edema.
- Pleural and mediastinal disorders
- Neoplastic (primary and metastatic) lung disease
- Environmental lung diseases
Paediatric Respiratory Medicine Fellowship Training Program
Faculty of Medicine, University of Toronto
The Hospital for Sick Children
Program Year | Content and Sequence of Rotations, Numbers of Months (or 4 week blocks) | |||||||||||
Months | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
First | PFT | Clinics | Respiratory Medicine Consult or Ward Service | off | Immunology | Elective | Research | Sleep | Clinics | |||
Second | PFT | Sleep | Clinics | Critical Care Unit |
Respiratory Medicine Consult or Ward Service |
Research | Elective | |||||
Third |
NOT APPLICABLE |
|||||||||||
Fourth | ||||||||||||
Fifth | ||||||||||||
Sixth |
Mandatory Content of Training
Description |
Duration |
Hospitals or other Institutions in which this training may be taken |
A. Pulmonary Function Laboratory
|
2 months |
The Hospital for Sick Children |
B. Sleep |
2 months |
The Hospital for Sick Children |
C. Ambulatory Clinics
|
3 - 4 months |
The Hospital for Sick Children |
D. Immunology |
1 month |
The Hospital for Sick Children |
E. Pediatric Critical Care
|
2 months |
The Hospital for Sick Children |
F. Respiratory Medicine Consult and/or Ward Service |
8 - 10 months |
The Hospital for Sick Children |
Elective Content of Training
Description |
Duration |
Hospitals or other Institutions in which this training may be taken |
Dependent upon the candidate's choice1. Pediatric Radiology
|
3 - 4 months
|
The Hospital for Sick Children
|