Professional Education

Fellowship Programs in Pediatric Pulmonary Medicine

The Pediatric Pulmonary Section of the Arizona Respiratory Center provides extensive training in clinical pulmonology, clinical and basic research techniques, and teaching methodologies. The goal is to train academic pediatric pulmonologists who will deliver state-of-the-art care to children with respiratory disorders, become independent investigators, and contribute to our understanding of the pathophysiology and treatment of pediatric respiratory disease.

Trainees' Time Commitment:

The distribution of time commitments in any given year of training can be adjusted to meet an individual trainee's needs.

Clinical Training: The first year trainee is exposed to a wide variety of acute and chronic pediatric pulmonary problems and learns applied pulmonary physiology and pulmonary function testing techniques. First-year trainees participate on the pulmonary service for 4 months. Attending physician rounds are made daily on the in-patient pulmonary service (1200 inpatient days/yr and 150-170 consults/yr). The first year trainee attends three half-day outpatient clinics per week in which approximately 2000 patients are seen per year. Second year trainees participate on the pulmonary service for 4 months, attend one half-day clinic per week and are responsible for two bronchoscopies per week. In addition, trainees spend one month on the Pediatric Critical Care service and a month on a combined Pediatric Allergy/Pediatric Sleep Disorders rotation during the first year. Third year trainees act as junior attendings for one month each on the inpatient and clinic services and attend 26 half-day clinics per year.

Research Training: First year begins with a one-month course covering basic statistics, experimental design, and respiratory physiology and pathophysiology. Formal course work in ethics and biostatistics is provided. The first year trainee also starts preliminary studies in their chosen area of research and continues this in the second and third years. The third year is devoted largely to the completion of a research project under the direction of an appropriate faculty mentor.

Preparation for Academics: Trainees learn to teach in both formal and small group sessions with faculty, residents and medical students. Second and third year trainees assist in teaching the Respiratory Physiology portion of the Physiology Course to the freshmen medical students. Trainees are also given a writing assignment in the first year (review article or case report). They are expected, with supervision from the faculty, to write research proposals and grant applications at each stage of their training. They are also expected to prepare a manuscript of publication quality describing their research results prior to completion of their training.

Facilities/Personnel: Our section has 3 secretaries and adequate office facilities (including microcomputers) for the trainees. The 400 sq ft pulmonary function lab is staffed by two technicians and is capable of measuring lung function from infancy through adulthood. Outpatients are seen in a dedicated pulmonary/allergy clinic with dedicated reception and nursing staff.

Weekly Schedule

Unscheduled time for rounds, consultations, reading, research, and clinical pulmonary function laboratory.

Patient Population

For years there has been considerable migration of patients with respiratory disorders to Tucson and other cities in Arizona. This has produced a sizable pediatric patient population with a variety of pulmonary illnesses. Therefore, pediatric patients for care, research and teaching purposes are readily available. In addition, over 40% of our CF population is over 20 years of age, thus offering learning opportunities into the complex social and medical problems presented by advancing cystic fibrosis.

The Pediatric Pulmonary Section has a half-day clinic four times a week in which patients with a variety of respiratory illnesses are seen. In addition to CF, the various disorders seen include asthma, bronchiolitis, idiopathic pulmonary hemosiderosis, bronchiectasis, congenital lung and airway anomalies, coccidioidomycosis, bronchopulmonary dysplasia, apnea, severe viral respiratory illnesses, and tuberculosis. There is also an active sleep medicine program directed by Dr. Morgan. In addition to these clinics, Outreach Clinics are held quarterly in Yuma, Fort Defiance and White River, Arizona.

Inpatient pulmonary service patients and consultations are seen at Arizona Health Sciences Center (University Hospital) and at Tucson Medical Center (a large private hospital closely affiliated with the University). The same pediatric house officers cover the pediatric services at both hospitals and the full-time faculty attend at both as well.

We perform approximately 75 flexible fiberoptic bronchoscopies per annum on outpatients and have a comprehensive training program in bronchoscopy. The University of Arizona has an active lung transplant program directed by Dr. J. Copeland. The trainees participate in patient assessment, referral and follow-up, working closely with the transplant team.

We regularly follow over 120 CF patients with approximately 500-600 CF patient clinic visits per year. Trainees take an active role in the management of our CF patients. Complex patients are commonly assigned a 'primary fellow' in order to maintain continuity of care. All CF inpatients, both adult and pediatric, are managed or followed closely by the first year trainee. Finally, trainees are encouraged to participate in patient counseling, education, and activities such as Patient and Family Education Nights.

Patient Summary

Financial Support

To learn about the funding needed to support this fellowship program and the vital role you can play in developing the next generation of skilled pediatric pulmonolgists, please visit How to Make a Gift: Pediatric Pulmonary Fellowship.

Faculty

Wayne J. Morgan, M.D., Professor of Pediatrics and Physiology
Dr. Morgan's research field is the systems physiology of the growing lung. He directs the Pulmonary Section, the Cystic Fibrosis Center, and the Pulmonary Physiology Laboratory. He played a significant role in the development of forced expiratory flow measurement techniques in infancy and conducts the physiologic component of the Tucson Children's Respiratory Study (CRS), a longitudinal study of respiratory health in childhood. Dr. Morgan is the chair of the NASAG for the Epidemiology Study of Cystic Fibrosis. He is also the local Principal Investigator for the Tucson Field Center, National Cooperative Inner City Asthma and Chair of the Cystic Fibrosis Foundation Data Safety Monitoring Board. He is Head of the Pulmonary Section and Associate Head of the Department of Pediatrics.

Fernando D. Martinez, M.D., Professor of Pediatrics
Dr. Martinez is a pulmonologist and epidemiologist whose current work centers around genetic determinants of atopic disease. He is a member of the NIH Expert Panel on the Diagnosis and Treatment of Asthma. In May, 1996 he was appointed Director of the Arizona Respiratory Center.

Mark A. Brown, M.D., Associate Professor of Clinical Pediatrics
Dr. Brown is a pulmonologist and Director of the Pediatric Pulmonary Training Program. His research interest is in the role of the immune system in the development and modulation of lung diseases. He is working closely with Dr. Halonen in this regard, specifically investigating the influence of the maternal/in utero environment on the development of the fetal/neonatal immune system as it relates to the subsequent development of childhood asthma and atopic disease.

Theresa Guilbert, M.D., Assistant Professor of Pediatrics
Dr. Guilbert is a pulmonolgist with a keen interest in childhood asthma. Her research interest is in the epidemiology of asthma. She is a co-investigator with Drs. Morgan and Martinez in the national Pediatric Asthma Clinical Research Network. She is also interested in the use of multimedia technology in education.

John Mark, M.D., Assistant Professor of Pediatrics
Dr. Mark is a formerly community-based pulmonologist who completed a fellowship in Integrative Medicine at the UA in June 2001. He joined our faculty in July 2001 and provides expertise in alternative therapies as well as conventional medicine. Additional clinical interests include sleep disorders and non-invasive ventilation. He also conducts research on the application of alternative therapies to childhood pulmonary disease.

Anne L. Wright, Ph.D., Research Professor of Pediatrics
Dr. Wright is a clinical anthropologist who brings critical insight to our understanding of the social and perceptual factors involved in the care of our cystic fibrosis patients. Her research encompasses three main areas: 1) the epidemiology of lower respiratory tract illnesses and their sequelae in children; 2) the impact of infant feeding behaviors and the promotion of breastfeeding; 3) the influence of social factors in physician/patient interactions. As a researcher, she advises trainees in designing their research, including appropriate data management and analysis methods, strategy of analysis, and proposal preparation. She is very involved in the Tucson Children's Respiratory Study and is currently involved in a study with Dr. Halonen on the imunologic mechanisms behind the protective effects of breast feeding on childhood respiratory diseases.

Marilyn Halonen, Ph.D., Professor of Pharmacology
Dr. Halonen collaborates closely with our epidemiologic study group and is now beginning to investigate immune determinants of the development of the wheezing phenotypes of childhood in infancy. She is also exploring aspects of neonatal immune development as they relate to childhood respiratory diseases such as RSV. Her immune studies are integral to Dr. F. Martinez's genetic research in asthma.

Donata Vercelli, M.D.
Dr. Vercelli is an internationally prominent investigator in the field of immunology, particularly the mechanisms of B-cell class switching. Her current studies revolve around the role of single nucleotide polymorphisms in cytokine and other related genes in the pathophysiology of asthma and atopic diseases.

John W. Bloom, M.D., Associate Professor of Pharmacology and Medicine
Dr. Bloom has his primary appointment in the Department of Pharmacology. His past research activities have focused on the role of muscarinic receptor in the neural modulation of bronchial hyper reactivity and on the role of airway epithelia in the modulation of airway inflammation, and in particular the role of the glucocorticoid receptor in that process. More recently his lab has become extensively involved in the role of single nucleotide polymorphisms in cytokine and other related genes in the pathophysiology asthma.

Duanne Sherrill, Ph.D., Associate Professor of Public Health
Dr. Sherrill is a statistician and Head of the Arizona Clinical Research Training Program. He provides expert biostatics services and participates in m any of the research projects conducted within the Respiratory Science Center.

Joanne Douthit, R.N., M.N.
Ms. Douthit is the Pediatric Pulmonary Clinical Nurse Specialist. She has a special interest in-patient and health care professional education and has won teaching awards from both the University and State Teacher's Association for her efforts. She is also the PPC Faculty Nurse, overseeing the nursing training aspects of that program.

Marty Reimer, R.N.
Ms. Reimer is an advanced practice nurse, also involved in the nursing education component of the PPC. In addition, she works with Dr. Guilbert on asthma clinical studies.

Lisa Rascon, M.A.
Ms Rascon is the PPC Project Coordinator. With an extensive background in education (masters degrees in both Educational Leadership and Multicultural Education, former vice-principal in the Tucson school district), she brings educational professionalism to the PPC and section.

Valerie Vickers, R.N.
Ms. Vickers is the Apnea/BPD Nurse Coordinator. She coordinates the outpatient clinic dealing with infants on home cardiac/apnea monitors and oxygen. She also coordinates RSV prophylaxis.

Yvonne Gathers, M.S.W.
Ms Gathers is the PPC Faculty Social Worker. In addition to overseeing social work trainees, she provides social work services for pulmonary patients, especially CF patients.

Corine Neumiller, R.D., M.S.N
Ms. Neumiller provides nutritional support services for both inpatients and outpatients with pulmonary diseases, particularly CF. She provides nutritional evaluation and counseling services, and is presently developing a study of the efficacy of appetite stimulants in CF. She is the PPC Faculty Nutritionist.

Betty Pauline "BP" Polanco, MA, R.R.T
Ms. Polanco is the PPC Faculty Respiratory Care Practitioner. She is actively involved in clinical research projects and provides patient and staff education on airway clearance techniques in CF. She has participated as an instructor at the national level in this area.