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Respiratory Medicine
Respiratory Medicine

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:
Beverley Nutt - 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 http://www.carms.ca/eng/index.shtml
CaRMS - Pediatric Subspecialty Match - About the Match  http://www.carms.ca/eng/peds_about_intro_e.shtml

International government funded / internationally trained: 
Applications must be submitted online before March 1, 2016 for applicants who intend to start training July 1, 2017. Please click the following link to apply: 
https://surveys.sickkids.ca/surveys/?s=EPX4MHH9Y3
Successful candidates will be contacted for an interview in mid September 2016.

Please understand that we annually receive many applicants and the process is quite competitive since we have limited number of positions that can be filled.

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:

  1. Normal lung growth, development and anatomy at both the macroscopic and microscopic level.
  2. Normal lung physiologic functions at the organ, tissue, cellular and molecular levels.
  3. Clinical assessment of lung function.
  4. Clinically relevant laboratory assessment of lung structure and function: pulmonary function (infant and childhood) gas exchange, oxygen transport, diagnostic imagng  assessments  (routine  radiology, CT, MRI and nuclear medicine scans
  5. 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.
  6. Impact of lung disease on the function of other body organs.
  7. 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:

  1. Cellular and molecular basis of pulmonary disease.
  2. Laboratory diagnosis and therapeutic monitoring of  lung diseases.
  3. Pathologic (gross and histologic) diagnosis of congenital and acquired lung disorders.
  4. Clinical management of underlying malignant disorders involving the lung (chemotherapy, radiotherapy, and 
        surgical excision).
  5. Diagnosis and therapy of adult respiratory disorders that are rarely seen in the paediatric population
       (e.g. emphysema, sarcoidosis).
  6. Ethical, legal and economic considerations in the provision of care for paediatric respiratory disorders.
  7. 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.

  1. Quality control of laboratory measurements.
  2. Measurement of lung volumes (inert gas dilution and plethysmographic).
  3. Measurement of inspiratory and expiratory flow rates (by spirometer and pneumotachograph).
  4. Carbon monoxide uptake by the lung (including correction for changes in hemoglobin concentration).
  5. Bronchial provocation test (methacholine).
  6. Blood gas tension and acid-base status.
  7. Assessment of oxygen requirements (pulse oximetry) for chronic oxygen therapy.
  8. Assessment of inspiratory and expiratory muscle strength.
  9. Jones' Stage I exercise test.
  10. 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

  1. Assessment of lung mechanics (compliance, resistance).
  2. Infant pulmonary function testing.
  3. Ventilatory control and drive (response to hypoxia and hypercarbia).
  4. 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

  1. 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)
  2.  Management of acute and chronic tracheostomies.
  3. Management of pulmonary airleaks.
  4. Role of flexible bronchoscopy in the ICU .
  5. Invasive and non-invasive cardio-respiratory monitoring to enable measurement of cardiac output, pulmonary and systemic vascular pressures, and gas exchange (shunt).
  6. Medical management of post-thoracotomy patient (including lung transplantation.
  7. Diagnosis and management of primary and secondary pulmonary hypertension within the ICU setting (monitoring, therapeutic drug trials).
  8. Cardiopulmonary interactions and management of right and left heart failure.
  9. Cardiogenic and non-cardiogenic (increased permeability) pulmonary edema.
  10. Trauma related disorders of the lungs, airways, and chest wall
  11. 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

  1. 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).
  2. 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:

  1. Asthma, and allergic rhinitis/sinusitis
  2. Chronic interstitial pneumonitis
        -  idiopathic (eg. LIP, DIP, UIP)
        -  associated to systemic diseases (eg. SLE, arthritides)
  3. Granulomatous and non-granulomatous inflammatory lung disorders (eg. Wegener's syndrome, Goodpasture's syndrome, pulmonary vasculitides)
  4. Hypersensitivity lung diseases (eg. extrinsic allergic alveolitis, allergic bronchopulmonary aspergillosis).
  5. Cystic fibrosis
  6. 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:

  1. General Respiratory Medicine
  2. Asthma
  3. Complex Respiratory Care
  4. Congenital Diaphragmatic Hernia
  5. Cystic fibrosis
  6. Hereditary Hemorrhagic Telangiectasia
  7. Interstitial Lung Disease
  8. Lung Transplantation
  9. Primary Ciliary Dyskinesia
  10. Sleep Clinics 
  11. 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)

  1. Congenital lung disease involving abnormal development of the airways, parenchyma or vasculature
  2. Infectious lung disease bacterial, viral, rickettsial, protozoal, parasitic in the ambulatory, hospitalized (nosocomial), and immune 
         compromised  patient.
  3. Allergic and immunologic lung disease
  4. Obstructive lung disease (large and small airway)
  5. Non-obstructive lung disease (chest wall, neuromuscular, interstitial)
  6. Acute and chronic respiratory failure.
  7. Sleep disorders
  8. Lung injury (traumatic, radiation, and chemotherapeutic)
  9. Pulmonary vascular disease
  10. Cardiogenic and non-cardiogenic pulmonary edema.
  11. Pleural and mediastinal disorders
  12. Neoplastic (primary and metastatic) lung disease
  13. 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
  -  Routine (Volumes, Flows, Bronchial   provocations)
  -  Exercise Testing
  -  Sleep Studies

2 months

The Hospital for Sick Children

B. Sleep

2 months

The Hospital for Sick Children

C. Ambulatory Clinics
 - General respiratory medicine, cystic fibrosis, primary ciliary dyskinesia, asthma, interstitial lung diseases, sleep, complex care, lung transplant

3 - 4 months

The Hospital for Sick Children

D. Immunology

1 month

The Hospital for Sick Children

E. Pediatric Critical Care
(Neonatal ICU is not mandatory as all Paediatric Residents have extensive experience prior to their training program in the Respiratory Medicine Division)

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 choice

1. Pediatric Radiology
2. Complex Respiratory Care
3. Infectious Diseases
4. Pediatric Lung Pathology
5. Community Pediatric Respiratory Medicine
6. Adult Lung Transplant
7. Anaesthesia
8. E.N.T.
9. Neonatal ICU
10. Adult ambulatory clinics/bronchoscopy

3 - 4 months
over duration
of Program

The Hospital for Sick Children
Bloorview
The Hospital for Sick Children
Physicians’ Offices
University Health Network (Toronto General)
Mt. Sinai
University Health Network (Toronto General) 
St. Michael’s Hospital

For more information on Subspecialty Fellowship information please visit:  University of Toronto Subspecialty Fellowship