Selection of the Research Area and Preceptor

The research performed by clinical and research fellows is usually related to one of five research disciplines believed to be important to the advancement of knowledge in pediatric pulmonology today. The research may be clinical or basic science in nature.

1. Cystic fibrosis/epithelial transport/mucus rheology and transport
2. Lung injury and development and respiratory cell biology
3. Clinical outcomes in pediatric pulmonary diseases
4. Asthma/allergy/inflammation
5. Infectious diseases/tuberculosis/global health

For fellows who enter the program with well-defined interests and goals, choosing a research area and preceptor is a straightforward process. Few fellows, however, enter the program with specific research interests, so we have created the Research Orientation Program to guide the fellow in selecting an area of research and selecting a preceptor/mentor. The orientation program starts in May when the fellow confers by phone with the program director and/or the chair of the advisory committee to review his/her research areas of interest and their perceived levels of expertise in those areas. During the phone call, the director and/or chair will suggest four to five potential preceptors from the list of participating T32 preceptors who share the fellow’s research areas of interest.

Trainees are then instructed to review the recent publications of the suggested preceptors on PubMed. Following another phone call with the incoming fellow in June, the number of possible preceptors is reduced to three. The orientation program continues in July and August of the fellow’s first year of fellowship. The chair of the Advisory Committee will organize in-person meetings for the fellow with the three potential preceptors. The fellow can also spend one to two weeks with a potential preceptor to become acquainted with their research environment and to have a chance to discuss possible research projects in more detail. The fellow usually has an opportunity to interact with the preceptor’s research team during this introductory period and perhaps even assist with an ongoing project. By September, most fellows are ready to choose their primary preceptor/mentor. This choice will be subject to approval by the program director. Initially, preceptor/mentor and trainee will work together directly on the project. As the fellow gains investigational maturity, he/she will be encouraged to carry out the research protocol independently.

Preceptor teams: In addition to a primary research preceptor, fellows are also encouraged to identify secondary preceptors, particularly if they provide expertise in an area that compliments the primary preceptor. Examples of these complimentary skills include data-mining methodologies (i.e., biostatistical skills, experience with databases and studies with clinical outcomes) and nonpulmonary medicine (i.e., clinical expertise in neuromuscular disease). In addition, each fellow will choose a secondary preceptor in the division. The charge of this faculty member will be to nurture and facilitate the fellow’s success and meet with him/her at least twice yearly. This preceptor also will provide another source of advice concerning research principles, clinical activities, career development and networking and will also offer assistance in finding an academic position upon completion of training.

Selection of the Research Project

After two to three months of library work and discussions with their chosen preceptor, all fellows will choose a specific research project. Research projects may focus on the generation of new data or on the analysis of an existing database. The choice will be based on the fellow’s research interest and skills and on the resources of the mentor. Projects that involve the generation of new data will include all aspects of study planning and design, including the conception of the research hypothesis, development of a research protocol, data-collection and analysis strategies, as well as interpretation and presentation of findings. Research projects that focus on the analysis of existing data will rely on databases available through the mentor (i.e., collected clinical trial or cohort data) or on publicly available data, such as from Medicare/Medicaid, the Nationwide Inpatient Sample or the Medical Expenditure Panel Survey. The use of an existing database may enable the fellow to analyze data from a larger, more extensive sample than is feasible to collect de novo during their training period.

Mandatory Conferences

These conferences provide an important format for all fellows to develop skills in effective delivery of information about their research:

• First-year fellow orientation lectures: During the first two months of fellowship, fellows will attend a series of orientation lectures presented by pediatric pulmonary and adult pulmonary faculty. The series is designed to introduce fellows to key topics in pulmonary medicine and science and to teach basic principles that are important to research in these fields. Simulation Center: We also have a state-of-the-art simulation center. The Simulation Center has fully equipped patient rooms and operating rooms in which pulmonary procedures can be performed to develop expertise in flexible bronchoscopy. Virtual bronchoscopy can be performed 24/7 to develop expertise in handling bronchoscopes and learning airway anatomy.
• Division conferences: Fellows and faculty will participate in weekly 90-minute Research/Work-In-Progress seminar series between September and June. During the first hour of the seminar, faculty preceptors, visiting faculty and fellows will present research results in a formal fashion. Constructive criticism and exchange with the audience will be encouraged. All fellows will be required to present their research findings at least twice each year in this research conference forum. The fellow’s primary research preceptor is expected to attend as well. These presentations provide a format for fellows to hone their conference presentation skills and learn how to respond to questions in front of a live audience. It also provides a way for the faculty to evaluate the fellow’s progress and the fellow/preceptor relationship and identify any need for additional mentoring. The remaining 30 minutes of this seminar will be presented by fellows and either encompass a pathophysiology conference focused on a topic in pulmonary pathophysiology and the latest research in that area or a journal review of an area of research that is brought into focus by a recently published paper. This Journal Review will provide a forum for discussing the scientific method, statistical reasoning, research methodology, study design, scientific writing and the importance of literature review.
• Weekly meetings: All fellows will be required to participate in meetings with their primary research preceptors to provide continuous review of their research progress.
• Weekly board review for clinical fellows: A faculty member leads this interactive session with the fellows. Sessions include reviewing multiple choice pediatric pulmonology boards questions, reviewing clinical and research ethics, discussing research methodology, the business of medicine and practical preparation for transitioning into junior faculty.
• Monthly radiology rounds for clinical fellows: Fellows rotate in presenting two to three cases to fellows and faculty with an attending radiologist reviewing the pertinent imaging findings.
• Department of Pediatrics meetings: All fellows are encouraged to attend conferences given by the Department of Pediatrics, including grand rounds and seminars.
• Annual national scientific meeting: All fellows will be required to attend one national scientific meeting/year during each of their three years of fellowship (i.e., American Thoracic Society or North America Cystic Fibrosis Foundation). In addition, each fellow will be expected to make at least one presentation of their research over the three-year training period at a national scientific meeting. Presentations may be a poster or oral presentation. In preparation for these meetings and presentations, rehearsal sessions will be held, during which each fellow will present his/her talk or poster for constructive criticism. At the meeting itself, fellows will present and defend their work, become acquainted with other workers and ideas in their field of interest and increase their general knowledge base.
• Biannual meeting with clinical mentor: The clinical mentor will be chosen by the fellow and meet with the fellow formally twice a year to discuss clinical and research progress and long-term career goals.

Quality Improvement

As part of the Accreditation Council for Graduate Medical Education (ACGME) requirements, each clinical fellow must participate in a quality improvement project. Typically, fellows participate in the annual division QI project run by a faculty member in either their second or third year of fellowship.

Grantsmanship

Although funding is provided for all three years of fellowship, all fellows are strongly encouraged to submit at least one grant application for research support during their fellowship to gain experience with grant submission.

Clinical Training Requirements

See clinical training requirements.