Respirology

The section of Pediatric Respirology accepts pediatric residents for one month clinical elective experiences. Residents are accepted on a first-come, first-served basis. Any trainee from another institution wishing to pursue a postgraduate elective rotation at the University of Calgary must complete an 'elective registration form'. This form will be sent to you once an elective date has been confirmed. You will be instructed to return the form along with a letter from your home program in support of the elective several months before the start date of the elective. 

An elective in Pediatric Respirology includes the following experiences:

Inpatient Wards

As a Pediatric Resident, you will be expected to perform initial consults and follow up on patients admitted to Pediatrics and to other services. With respect to patient care, you will be expected to write a consult note containing pertinent history, physical examination, differential diagnosis, and treatment plan for assigned new patients. The staff, fellows, and residents will help you with this. For the patients you are following, you will need to assess progress and write notes on their charts regularly.

You may also be assigned patients that are admitted to our service. For these patients you will provide the admission note and detailed daily progress notes under the direction of the Respirology staff. In addition, you will be responsible for the discharge summaries on these patients.

Outpatient Respirology clinics

We will aim to have you attend outpatient respirology clinics for approximately half of your rotation. Clinics include asthma, cystic fibrosis, home oxygen, complex airway clinic (CAC), and general pulmonary clinic, among others, and occur on all 5 days of the week.

Prior to your clinic rotations, you will receive a detailed schedule from our program administrator Kathleen Smith. 

Read the “Required” reading prior to clinic (see link below) to develop your knowledge base and maximize your experience. Supplemental reading is also provided for your interest: https://cumming.ucalgary.ca/departments/pediatrics/education-training/pediatrics-postgraduate-medical-education-pgme/respiratory.

For new consultations, we expect you to take a focused history, perform a focused physical exam, anddevelop an impression, differential diagnosis, and treatment plan. You will also have the opportunity of seeing interesting follow-up patients, should time permit. Cases will then be reviewed with the attending physician.

Bronchoscopies

There are scheduled cases throughout the month, as well as those that come up when on the inpatientservice. You may have the opportunity to observe these procedures.

Teaching

The Pediatric Respiratory Medicine Academic Half-Day runs on Thursdays from 8:00 – 10:00. Kathleen Smith will alert you to this schedule and the location of rounds. As usual, you are expected to attend Pediatric Grand Rounds on Wednesdays from 8:30 – 9:30. These rounds occur on the 4th floor at the ACH Auditorium when not scheduled remotely. You will also be excused in time to attend your academic half day, and other educational activities as required. 

Academic Half Day Presentation

You are asked to prepare a 45 minute presentation for delivery during academic half day near the end of your rotation. The topic is your choice, but it is best to address a focused question that you have encountered during your time on our service. If you have difficulties choosing a topic, the Respirology Subspecialty Residents and staff physicians are happy to discuss options. The audience for this talk varies, but often includes Pediatric Residents and Respirology Subspecialty Residents, clinical clerks, staff physicians, nurses, respiratory therapists, dietitians, and pharmacists dedicated to Pediatric Respiratory Medicine.

Call

As a rotating resident, you are not required to perform call, however if this interests you, please discuss it with the subspecialty resident or physician on call.

Research

Pediatric Residents wishing to perform small clinical projects or prepare a case report for publication can discuss potential opportunities with members of the Section of Respiratory Medicine. Such projects could be performed throughout the year and need not be limited to the period of the rotation.

Evaluation

Our division is committed to providing you a timely evaluation. Please ensure that you are completing Entrustable Professional Activity (EPA) with your preceptors regularly during the rotation.  Two to three days before your last day of the rotation, please ask your preceptor if you can establish a time to review your overall evaluation.

Shadowing opportunities for junior medical students

Please contact the physician directly through Alberta Health Services email

Med 440 Electives

Please contact physicians directly to arrange details of a potential elective. You may also try contacting the Education Contact for the section. See Resources below.

• Email should include the following:
  • Dates and times in which you are interested.
  • Note that many doctors only have clinics on certain half-days of the week. Therefore, a 440 elective may not be feasible if the desired dates and time do not coincide with that clinician’s clinics.

U of C Clerkship Electives

Please go on to OSLER and locate the elective catalogue for a description of the program and Instructions on how to proceed. Please contact elective@ucalgary.ca with any other questions you may have.

You may then contact the appropriate Education Contact (see Resources).

Non U of C Clerkship Electives

Please review all of the criteria and guidelines for the University of Calgary described on the following link: https://www.afmcstudentportal.ca/

If you meet the criteria, you may then contact the appropriate Education Contact (see Resources). Once accepted you will need to proceed with the paperwork as described on the website listed above.

The University of Calgary Pediatric Respirology Residency Training Program is a two-year general Pediatric Respirology training program. There is opportunity to apply for third year funding to complete additional research or clinical training. Our program is fully accredited by the Royal College of Physicians and Surgeons of Canada.

Program Highlights include the following:

• Our program fosters an environment of close and collegial contact between faculty and residents which results in an open and supportive learning environment.
• We have an enthusiastic group of faculty, residents, and allied health professionals, who are dedicated to the training program and to each other.
• Our program is flexible, to accommodate the specific interests and goals of each resident.
• Residents are closely involved in the operational aspects of the program, including membership in the Residency Program Committee.
• Our faculty has diverse specialized interests in various areas of Pediatric Respirology which increases expertise in the overall program. This permits us to offer one of the most complete clinical programs in the nation with programs in chronic lung disease of infancy and home oxygen, tracheostomy and complex airway, neuromuscular disease, cystic fibrosis and cystic fibrosis newborn screening, asthma, tracheoesophageal fistula, congenital diaphragmatic hernia, hemoglobinopathy, bone marrow transplant/oncology, sleep disorders, and general pulmonary. We have a very busy outpatient clinical service, providing residents with excellent exposure and learning with a diverse patient population.
• We have an established and smoothly running longitudinal residents' clinic, which is a major strength of our program.
• We are supported by a full polysomnography laboratory (including MSLT and MWT testing), and a full pulmonary function laboratory (performing pre-school and school-aged PFT, as well as exercise and provocation testing).
• We have an active flexible bronchoscopy program (over 100 bronchoscopies/year).
• In-patient activities involve all areas of Pediatric Respirology, and we are actively consulted for a wide variety of general and specialized Pediatric Respiratory problems.
• We have excellent relationships with colleagues in Adult Respirology, Pediatric Allergy/Immunology, Pediatric Radiology, Pediatric Cardiology, and Pediatric Otolaryngology to complement our program.
• We have strong support from the Department of Pediatrics.
• Alberta Children's Hospital has moved (in 2006) to a new, state of the art facility, near the University of Calgary campus, providing an excellent physical learning environment.
• We have significant organized and protected academic programs (academic half day, rounds and seminars, journal club, research methods course, annual retreat).
• We encourage and support attendance at international conferences, as well as at the Canadian Thoracic Society's annual Fellows' Day and Canadian Respiratory Conference.
• We provide support for participation in both the Cincinnati Children's Pediatric Flexible Bronchoscopy Course and the University of Calgary Bronchoscopy Simulation course (with ongoing access to the simulation laboratory).  As well, we have recently introduced a portable bronchoscopy simulator within the section. These opportunities add greatly to the quality of bronchoscopy experience available during training. 

Core clinical training is a two year curriculum. The majority of core training occurs at the Alberta Children's Hospital. PICU blocks are held at Alberta Children's Hospital and Foothills Medical Centre respectively. Electives may occur at Foothills Medical Centre, Rockyview General Hospital, and Peter Lougheed Centre.

Seminars and Rounds

The Section of Pediatric Respiratory Medicine is committed to residency education. Residents and staff attend and participate in a 2 hour Academic Half Day (AHD) every Thursday morning. AHD includes single topic sessions, research presentations, case presentations, journal club and PFT/PSG interpretations. The weekly one hour Friday morning "Scholar's Seminars" facilitated by a staff Respirologist, provide the opportunity for residents to systematically cover Royal College Medical Expert objectives. In addition, residents are encouraged to attend Pediatric Grand Rounds (weekly). Cross-Canada Rounds are held once a month.

Vacation and Call

Vacation: Residents receive four weeks of holiday each year, which can be taken together, or divided into shorter periods. Residents are responsible for creating their own call and service schedule as a group.

Call: Call is taken from home and is a maximum of 1 in 3 throughout the year, though generally fewer on average. Residents create their own call schedule, which must comply with PARA guidelines. Residents in our program have typically chosen to apply for an exception to the PARA guidelines allowing them to complete a full 8 days of call consecutively - this exception has always been granted to date. As such, residents have been expected to complete one full week of call in each block. 

Longitudinal Clinic 

Beginning in the first year of the program, residents participate in a half day longitudinal clinic twice a month under the supervision of one of the attending pediatric Respirologists. Residents continue to follow these patients through this clinic throughout their training.

Research 

Each resident is given, on average, one half day per week to conceptualize a project, with the support of a faculty member. The fifth block of first year is protected to attend the Research Methods Course and to prepare their project for submission for funding/ethics/scientific approval. They then continue to have, on average, on half day per week to work on their project longitudinally.

Residents are also encouraged to use at least one further block of elective time for research, and may take up to 5 blocks of research in addition to the Research Methods Course, depending on the complexity of their project.

Rotation Information

Presentation Guidelines

Asthma

1. Required Reading
   1. Asthma Consensus Guidelines
   2. Achieving Control of Asthma in Preschoolers
   3. Pediatric Asthma: Talk the Same Talk
   4. Recognition and Management of Severe Asthma: A Canadian Thoracic Society Position Statement
       
2. Supplementary Reading
   1. Pulmonary Perspective - Reactive Airways Disease
   2. Asthma Education Form
   3. Asthma Guidelines Education and Follow Up
   4. Asthma Guidelines Immunotherapy
   5. Asthma Guidelines Inhalation Devices
   6. Asthma Guidelines Pharmacotherapy Add-On
   7. Asthma Guidelines Pharmacotherapy First Line
   8. Asthma Guidelines Pharmacotherapy Intermittent Symptoms
   9. Asthma Guidelines Primary Prevention
   10. Asthma Guidelines Secondary Prevention
   11. (Pro) Should Antileukotriene Therapies Be Used Instead of Inhaled Corticosteroids in Asthma?
   12. (Con) Should Antileukotriene Therapies Be Used Instead of Inhaled Corticosteroids in Asthma?
   13. Persistence of Asthma to Adulthood
   14. Preschool Asthma
   15. Preschool Asthma Wheeze Treatment
   16. Summary of recommendations from the Canadian Asthma Consensus Guidelines, 2003 and Canadian Pediatric Asthma Consensus Guidelines, 2003
   17. Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004)

Cystic Fibrosis

1. Required Reading
   1. Cystic Fibrosis Pulmonary Guidelines
   2. Cystic Fibrosis Pulmonary Complications: Hemoptysis and Pneumothorax
   3. Guidelines for Diagnosis of Cystic Fibrosis in Newborns through Older Adults: Cystic Fibrosis Foundation Consensus Report
   4. Treatment of Pulmonary Exacerbations
   5. The Lancet: Cystic Fibrosis
   6. Respiratory Care: Cystic Fibrosis 2017 - The Year in Review
2. Supplementary Reading
   1. Airway-Rehydrating Agents for the Treatment of Cystic Fibrosis: Past, Present, and Future
   2. Managing Cystic Fibrosis: Strategies That Increase Life Expectancy and Improve Quality of Life
   3. Consensus Report on Nutrition for Pediatric Patients With Cystic Fibrosis

Neuromuscular

• Respiratory Care of the Patient with Duchenne Muscular Dystrophy
• Consensus Statement for Standard of Care in Spinal Muscular Atrophy
• Care of Children with Neuromuscular Weakness

Physiology and PFTs

• Developmental Anatomy and Physiology of the Respiratory System
• Pulmonary Function Testing Details and Objectives

Pulmonary

• International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia
• Thoracic Manifestations of Inflammatory Bowel Disease
• The need to redefine non-cystic fibrosis bronchiectasis in childhood
• Non-cystic fibrosis bronchiectasis: diagnosis and management in 21st century
• Underlying Causes of Recurrent Pneumonia in Children
• Evaluation of Recurrent Pneumonia

Home Oxygen Clinic

• Statement on the Care of the Child with Chronic Lung Disease of Infancy and Child
• American Thoracic Society: Home Oxygen Therapy for Children
• The Challenges of Caring for Children Who Require Complex Medical Care at Home: 'The go between for everyone is the parent and as the parent that's an awful lot of responsibility'

RSV and SIDS

• Respiratory syncytial virus infection
• Sudden Infant Death: A global problem, local action. Report to Public Health Agency of Canada (PHAC)
• What Risk Factors for Sudden Infant Death Syndrome are Preterm and Term Medically Complex Infants Exposed to at Home?

Sleep

1. Required Reading
   1. Diagnosis and Management of Common Sleep Problems in Children
   2. Bedtime Problems and Night Wakings in Young Children
   3. Sleep-disordered Breathing in Children
   4. Excessive Sleepiness in Adolescents and Young Adults: Causes, Consequences, and Treatment Strategies
2. Supplementary Reading
   1. Sleep Clinic Worksheet
   2. Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences
   3. Executive Summary of Respiratory Indications for Polysomnography in Children: An Evidence-Based Review

TEF-CDH

• Congenital Diaphragmatic Hernia
• Long-term Complications of Congenital Esophageal Atresia and/or Tracheoesophageal Fistula

Dr. Kirsten Ebbert
Program Director
kirsten.ebbert@ahs.ca

Kathleen Smith
Program Administrator
E: kathleen.smith2@ahs.ca