Dual fellowships performed in conjunction with other pediatric subspecialties may be arranged. In general, two to three new fellows are accepted into the program each year. The first year of training is dominated by clinical experience on the Pulmonary Inpatient and Consult services and the outpatient Pulmonary/Cystic Fibrosis Clinic.

The inpatient hospital services of the Division are divided between the Pulmonary Inpatient Service and the Pulmonary Consult Service.

The Inpatient Service serves as the attending service for patients with acute and chronic respiratory diseases including asthma and Cystic Fibrosis. The Inpatient Service is generally comprised of an Attending, a Pulmonary Fellow, three Junior Residents and a Nurse Practitioner. The fellow is responsible for supervisory duties under the direction of the Attending. The Inpatient Service averages 85-100 pulmonary admissions with an average length of stay of 7 days, and 350-400 Cystic fibrosis admissions with and average length of stay of 13 days each year.

During months in which the first year fellow is assigned to neither the Inpatient not the Consult Services, the fellow is assigned to the Pulmonary Function Laboratory. In the Laboratory, duties of the fellow include management of patients during special testing such as exercise testing, drawing difficult arterial blood gases, and interpretation of pulmonary function tests.

Fellows see and follow ambulatory patients in the outpatient pulmonary clinic under the supervision of staff Attending physicians. Fellows participate in clinic throughout their years of training. The Pulmonary/Cystic Fibrosis Program conducts multidisciplinary clinic sessions where nutritional, physical and respiratory therapy, social service, nursing, and physician services collaborate for patient care. There are approximately 7,500-8,000 outpatient visits to the Pulmonary and Cystic Fibrosis Clinics per year. Interesting and/or difficult patients are reviewed during the weekly clinical conference.

Each fellow becomes involved in a research project during the second year of training. A wide variety of projects including bench research in pulmonary molecular and cell biology, pulmonary physiology, and clinical and epidemiological studies are available. Collaborative research arrangements within the Harvard Medical area are extensive and include the Divisions of Newborn Medicine, Immunology, Allergy, and others within Children's Hospital; the Respiratory Division of Brigham & Woman's Hospital; the Physiology Department of the Harvard School of Public Health; and the Channing Laboratories outside of Children's Hospital. The research progress of the fellow is monitored and facilitated through biannual presentations before the Scholarship Oversight Committee.

In addition to their clinical duties and hands-on research experience, fellows participate in several conferences each week. The Division sponsors a weekly clinical and research conference series; a weekly fellowship curriculum conference, which covers a two-year curriculum in Pediatric Pulmonology; and a weekly clinical case conference. Clinical case conferences are also held weekly at the New England Pediatric Pulmonary Consortium, which has a typical attendance of 15-25 pediatric pulmologists from throughout the New England Region. Fellows also attend biweekly conferences conjunction with the adult Pulmonary Fellowship Program at Brigham & Women's Hospital and Beth Israel Deaconess Hospital. All trainees and staff members in the Division are encouraged to attend these conferences. Finally, there are a wide variety of conferences held within the Longwood Medical Area, centered on Harvard Medical School, which are of interest.

The Pulmonary Function Laboratory performs 4,000 tests each year, including arterial blood gas drawing and analysis, exercise studies, and lung function studies. Some of the lung function studies performed include spirometry, measurements of total lung capacity, and its subdivisions by body plethysmography and helium dilution, diffusing capacity, airway challenge studies, infant pulmonary function studies, assessment of respiratory strength, graded cardiopulmonary exercise testing, and ventilatory response to carbon dioxide. Seventy-five percent of these studies are carried out on outpatients. The Division's Sweat Test Laboratory performs 1,200 studies each year.

The Division also maintains an active clinical research effort led by David Waltz, M.D. The Cystic Fibrosis Center at Children's Hospital has been named a Therapeutic Development center by the Cystic Fibrosis Foundation. As such we are currently engaged in a variety of early clinical trials involving novel therapeutics for CF. Other areas of focus in clinical research by members of the Division include antibody responses in CF, epidemiological studies of CF and asthma, novel therapeutics in asthma, respiratory sequelae of premature birth, sleep disturbance in children, and ethical issues of chronic lung disease.

In addition to selecting a research project, several fellows in the Division have completed the Masters Program in Public Health offered by the Harvard school of Public Health, or other additional courses of study during their fellowship years

Fourth year medical students may participate in a four-week elective on the Mary Ellen Avery Pulmonary Service. During this elective students evaluate and follow children and young adults with pulmonary diseases and Cystic Fibrosis on the inpatient service, attend bronchoscopy procedures, and participate in the ambulatory clinic. These students come from medical schools in both the United States and foreign countries. The clerkship is sponsored through the Registrars Office at Harvard Medical School (617-432-1515). Fourth-year medical students may also rotate through the Pulmonary/Cystic Fibrosis clinic as part of an ambulatory pediatrics rotation.

Pediatric residents in the Boston Combined Residency Program rotate through the Mary Ellen Avery Pulmonary Service as one of their core rotations. They have the same educational experience as the medical students plus approximately 30 hours each month of attending/fellow instruction related to patient care. Two or more members of the Division attend Senior Rounds.

• Eman Al-Khadra, MD