The pediatric subspecialty fellowship programs develop future leaders of military pediatrics, skilled in clinical practice, teaching, and scholarly activity. The five pediatric subspecialty fellowship programs (Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology & Oncology, Pediatric Infectious Diseases and Neonatal-Perinatal Medicine) exist in affiliation with the National Capital Consortium’s (NCC) tri-service pediatric residency program and are based within the Departments of Pediatrics at USU and at Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD.
CORE CURRICULUM IN SCHOLARLY ACTIVITY
The major component of the Pediatric Subspecialty Fellowships' Core Curriculum in Scholarly Activity is a themed didactic session that occurs bimonthly. Each session has a topic focus, with the cycle of topics repeating every two years to allow fellows the opportunity to remediate missed sessions. The curriculum provides in-depth training in biostatistics, clinical and laboratory research methodology, critical literature review, as well as the principles of evidence-based medicine, quality improvement, health care economics, and special topics in bioethics. Fellows receive focused training in clinical and didactic teaching, evaluation, and feedback. Military-specific topics include cross-cultural care, leadership, military health care management issues, and practice of pediatrics in the context of the military health care delivery system.
QUALIFICATIONS AND APPLICATIONS
Candidates must be board-certified or board-eligible in Pediatrics and be active duty members of one of the uniformed services (Navy, Army, Air Force, Public Health Service). Applicants must apply through and be sponsored for postdoctoral training by the Graduate Medical Education office of their respective branch of service. Application deadlines are usually in September and are determined by the individual services. When feasible, applicants are encouraged to visit the USU facilities and arrange personal interviews with faculty members. If a visit is not practical, applicants should arrange a phone interview with the program director.
The National Capital Consortium Fellowship in Pediatric Endocrinology develops strong, well-rounded clinician-educators, and high-caliber officers who are well-prepared for the unique aspects of practice within the Military Health System (MHS). Emphasis is placed on clinical proficiency in the full spectrum of general pediatric endocrinology, military systems-based practice, relevant scholarly activity, quality improvement, and leadership.
The majority of graduates join the faculty of military medical centers with affiliated pediatric residency programs. For over 15 years, all graduates have taken the American Board of Pediatrics, Pediatric Endocrinology Certification Exam with a first-time pass rate of 100%.
CLINICAL EXPERIENCE AND CURRICULUM
The majority of clinical time is spent at Walter Reed National Military Medical Center (WRNMMC) in the outpatient clinic and on the inpatient consult service. Fellows also participate in the Long-Term Cancer Survivors, Cystic Fibrosis, and Healthy Habits (obesity) interdisciplinary clinics. The service fields consults at WRNMMC from the pediatric inpatient service, pediatric intensive care unit, mother-infant care center, and neonatal intensive care unit. Fellows also spend time in outreach clinics at Ft. Belvoir Community Hospital (Fort Belvoir, VA), and on 1 month rotations with Adult Endocrinology at Walter Reed, at the National Institutes of Health (NIH, Bethesda, MD), and at Children’s National Medical Center (CNMC, Washington, DC). The NIH rotation offers a unique experience at a clinical research center with exposure to rare endocrine disorders. The CNMC rotation offers experience at a large civilian children's hospital in both the outpatient and inpatient settings. The service sees additional patients at Naval Health Clinic Annapolis (Annapolis, MD) and Malcolm Grow Medical Center (Joint Base Andrews, MD). The fellowship program benefits from the clinical and academic synergy of four other Pediatric Subspecialty Fellowships that are part of the NCC, as well as a full representation of Faculty from Pediatric and Pediatric surgical subspecialties.
One full day per week is devoted to academic conferences, in cooperation with the NIH Pediatric Endocrinology Program. The weekly academic day conferences include board review and case conference at NIH, patient discussion, faculty-led core topics, journal club, a formal Quality Improvement curriculum, research updates/curriculum, bioethics, and guided textbook reading. Regular academic conferences also occur with Adult Endocrinology at Walter Reed and as part of the Pediatric Subspecialty Fellows Core Curriculum Series. Faculty Development is included in the didactic curriculum and fellows are actively involved in teaching medical students and residents.
MILITARY UNIQUE TRAINING
The program provides training in unique military aspects of caring for military dependent children with chronic disease, to include navigating military systems of care, the Exceptional Family Member Program (EFMP), and unique concerns for the child with a deployed active duty family member. The military pediatric endocrinologist responds to consults from a wide range of geographic areas, including overseas. Fellows complete the LEAD 2.0 curriculum, a longitudinal military leadership curriculum for GME trainees. Fellows also take the Medical Humanitarian Assistance Course during training, and the Clinical Management Course during their final year of training to enhance business skills required for clinic leadership.
The program provides a platform for military-specific research. Current military-specific research includes healthcare disparities in type 1 diabetes in the Military Healthcare System and childhood obesity in military families.
A Scholarly Activity project is required by the American Board of Pediatrics. The project results in a paper published in a peer-reviewed journal with the Fellow as the first author. The program’s Scholarly Activity Curriculum encompasses a Core Curriculum in Scholarly Activity and steps to completing a Scholarly Activity project. Fellows perform faculty-mentored scholarly activity, to include Quality Improvement. Progressively more time over the 3-year training program is dedicated to scholarly activity. Current research areas include obesity, healthcare disparities, implicit bias, educational research, and the molecular basis of thyroid cancer invasion and metastasis.
Additional information for the specialty can be found on the Council of Pediatric Subspecialties website.
PROGRAM CONTACT INFORMATION
The Pediatric Gastroenterology and Nutrition program is sponsored by the NCC, with clinical practice mainly located at its primary affiliated hospital WRNMMC, and other affiliated hospitals in the National Capital Region to include MedStar Georgetown University Hospital and INOVA Fairfax Children's Hospital. The diversity of clinical and scholarly experience is designed to produce academic pediatric gastroenterologists ready to serve as military pediatric subspecialists and educators.
The clinical experience provides intensive exposure to all aspects of the practice of pediatric gastroenterology, including inpatient and outpatient evaluation of patients with a wide diversity and severity of conditions. The pediatric GI service performs approximately 400 procedures annually including upper endoscopies, esophageal stricture dilations, esophageal motility studies, foreign body extractions, intraesophageal pH and impedance monitoring, breath hydrogen studies, percutaneous endoscopic gastrostomies, percutaneous liver biopsies, colonoscopies, polypectomies, anorectal manometry, rectal biopsies, capsule endoscopy, control of upper and lower GI bleeding, and varicocele banding. Endoscopic procedural and teaching capabilities are enhanced by a fully equipped, dedicated pediatric endoscopy unit, as well as access to the state-of-the-art endoscopic simulation center. All fellows attend the American Society of Gastrointestinal Endoscopy First Year Fellows Course. Additional senior fellow rotations dedicated to procedures galvanize procedural skills.
MILITARY UNIQUE TRAINING
The program graduates competent, skilled, and caring pediatric gastroenterologists who pursue careers as physician-educators and/or academicians. Graduates are prepared to become future leaders in the military pediatric and medical community.
The program provides training in unique military aspects of taking care of dependent children with chronic disease, to include navigating military systems of care and unique concerns for the child with a deployed active duty family member. The military pediatric gastroenterologist responds to consults from a wide range of geographic areas to include OCONUS. The program provides training in responding to these consults within the context of the inherent capabilities of the outlying facilities. The NCC Pediatric Gastroenterology program includes a one month rotation on military humanitarian medicine. This rotation includes completing the Military Medical Humanitarian Assistance Course which is uniquely focused on the military humanitarian response capability of the military medical corps across the uniformed services. Additionally, fellows complete the Fundamentals of Global Health Engagement Course. This course teaches the broader implementation of military humanitarian operations. Fellows may also select to participate in a humanitarian medicine operation to Honduras.
Clinical, basic science, or educational research opportunities are available. Opportunities for clinical research are provided through the outpatient clinics and inpatient services at WRNMMC, and basic science research is conducted primarily at USU, WRAIR, or in collaboration with the University of Maryland.
Research Administration provides research review services, computerized data analysis, statistical support, and publication pre-review and approval. Funding and education opportunities through the WRNMMC Department of Research Programs and the USU Office of Research are available to help funding the fellows in their research. We also have a corps of faculty mentors skilled in clinical research in the areas of observational, outcomes/comparative effectiveness and health services research. Fellows may elect to engage in educational research which can be accomplished in conjunction with formal certification in Health Professions Education at USU.
The combined NCC pediatric subspecialty fellowships are founded among a rich scientific research community. This facilitates flexibility in choosing a high impact fellowship research project and providing the experienced mentoring required for success. Recent and ongoing research projects and areas of interest of the Pediatric Gastroenterology faculty and fellows.
PROGRAM CONTACT INFORMATION
Since 1972, the three year Pediatric Hematology & Oncology Fellowship program has trained physicians to serve as outstanding pediatric hematology/oncology faculty in the Department of Defense. Graduates have assumed senior clinical, academic, and administrative roles for their respective services and have been associated with internationally-acclaimed, ground-breaking research related to the care of children, adolescents, and young adults with cancer and blood disorders.
A unique aspect of the Pediatric Hematology/Oncology program is its inclusion in the John P. Murtha Cancer Center (MCC) at WRNMMC, the only Department of Defense designated Cancer Center of Excellence. Because of geographic proximity, MCC has a special collaborative relationship with the National Institutes of Health (NIH), which strengthens the clinical and research activities of all three institutions: the NIH, WRNMMC, and USU.
- 3 year program
- ⅓ of program is clinical training
- Additional information for the specialty can be found on the Council of Pediatric Subspecialties website.
The fellowship program’s clinical experiences occur mainly at the NCC’s primary affiliated hospital: WRNMMC. Other locations in the National Capital Region include Fort Belvoir Community Hospital (FBCH), Fort Belvoir, VA, and, for specific rotations, Children's National Medical Center (CNMC), Washington, DC, and Inova Fairfax Children's Hospital (IFCH), Fairfax, VA.
Approximately one-third of the curriculum is devoted to clinical training, the majority of which occurs in the first year, with the remaining time devoted to study of ancillary specialty areas (e.g., transfusion medicine, pathology, and radiation oncology) and research activities. Continuity patients and clinic at WRNMMC and FBCH are maintained throughout. The fellow routinely will participate in the supervision of the management of hospitalized pediatric hematology/oncology patients through daily contact with the residents and students on the ward team; make ward rounds with the pediatric hematology/oncology staff; participate in general pediatric hematology/oncology and multi-disciplinary clinics (e.g., long-term follow-up, sickle cell); and teach pediatric residents and medical students through informal teaching rounds and prepared conferences.
MILITARY UNIQUE TRAINING
The fellows gain invaluable military experience and further develop excellence through their training in the program. All elements of our military-unique curriculum are strongly encouraged including, but not limited to, participation in the annual conferences on Radiation Biology & Medical Effects of Ionizing Radiation, Medical Management of Chemical and Biological Casualties, Military Medical Ethics, and completion of the Military Medical Humanitarian Assistance Course sponsored by USU.
The program provides training in unique military aspects of the care of dependent children with chronic disease, to include navigating military systems of care, and unique concerns for the child with a deployed active duty family member. The military pediatric hematologist/oncologist responds to consults from a wide range of geographic areas, including OCONUS. The program is designed to graduate competent, caring pediatric hematologist/oncologists who pursue careers as physician-educators and/or academicians and are prepared to become future leaders in the military pediatric and medical community.
Research opportunities are available at USU and through the Murtha Cancer Center (MCC), as well as other federal agencies to include the National Institutes of Health (NIH), the U.S. Food and Drug Administration (FDA), and the Walter Reed Army Institute of Research (WRAIR). The diversity of clinical and scholarly experience is designed to produce an exceptional academic hematologist/oncologist ready to fulfill the unique requirements of military and government practice.
Regular conferences are held throughout the week to focus on, and promote, individual scholarship. Patient conference and didactic sessions are held weekly, while two joint tumor boards are held bi-weekly: one with the Pediatric Brain Tumor Consortium (based at CNMC), the other with the Uniformed Services Oncology Consortium. Formal didactics, Journal Club, and Board Review sessions are held monthly. Fellows and staff also have the opportunity to attend educational and research conferences at USU and the NIH. In addition, all fellows participate in the Joint Core Pediatric Fellowship Curriculum. The fellowship program benefits from the clinical and academic synergy of four other Pediatric Subspecialty fellowships that are part of the NCC, as well as a full representation of faculty from Pediatric and Pediatric Surgical subspecialties. All fellows are encouraged to attend and present at national meetings.
PROGRAM CONTACT INFORMATION
ANNE B. WARWICK, MD, MPH, COL, MC, USA
Phone: (301) 400-1663/1664/1665
The Pediatric Infectious Diseases Fellowship program is fully accredited by the Accreditation Council for Graduate Medical Education (ACCME) and prepares physicians for careers in clinical pediatric infectious diseases and supports military infectious disease research. It consists of three years of post-graduate medical education, which includes 14 months of inpatient clinical months, and 22 months primarily devoted to research and independent learning. Applicants must have completed, or anticipate successful completion of, a pediatric residency, and be either board-certified or eligible to sit for the certifying examination in general pediatrics. The fellowship comprises clinical and research experience and draws upon a referral base not only from the Washington, DC metropolitan region, but also large portions of the East Coast as well as international sites in Europe, Africa, and the Middle East. The fellowship, which comes under the umbrella of the NCC, is based within the Departments of Pediatrics at WRNMMC and USU. Active duty in one of the uniformed services of the United States (Army, Navy, Air Force, or Public Health Service) and selection by the Joint Graduate Medical Education selection board is required for matriculation as a fellow.
Weekly case presentations are discussed at dual pediatric and adult infectious disease conferences. In addition, both services meet on a weekly basis for an hour of didactic teaching. Participation in the Greater Washington Infectious Diseases conferences (both civilian and military), when the most interesting infectious diseases in the Washington-area are presented monthly, is an added bonus of our location. These conferences are attended by some of the leading experts in the various subspecialties within infectious diseases. Rotations in Tropical Medicine also are encouraged and are taught in collaboration with the USU Department of Preventive Medicine. There also are field rotations in Peru, Thailand, Tanzania, Kenya, and other international sites.
- Clinical pediatric infectious diseases: consult services and clinic patients with fever and neutropenia, complex community-acquired infections, post-surgical infections, unexplained inflammatory conditions, immune deficiency, etc.
- Both basic science and clinical research: cases, case series, prospective clinical projects; as well as work in immunology, vaccinology, tropical and global medicine, models of pathogenesis, enteric toxins, shock, novel therapeutics, etc.
- Teaching: both informal clinical teaching, and teaching in formal settings such as lectures, conferences, workshops, etc.
- Military medicine: in tropical medicine and global health, travel, immunizations, humanitarian relief, and biodefense.
The inpatient clinical experience is augmented by pediatric outpatient clinics for general infectious disease referrals and HIV-specific referrals. The inpatient service is primarily at the WRNMMC. Two outside rotation sites augment their clinical experience. The first is a one-month rotation at the Children's National Medical Center in Washington, DC. This rotation gives our fellows exposure to transplant (solid organ and bone marrow) medicine as well as opportunities to care for children with HIV in the inpatient setting. The second site is Inova Fairfax Children's Hospital, Fairfax, VA. This is a robust community children's hospital, where the fellows are exposed to a diverse cultural experience with high census neonatal and pediatric intensive care units. The ACGME has lauded this diversity in clinical rotation sites. The curriculum is integrated with the Internal Medicine Infectious Diseases fellowship. A unique part of our curriculum includes the experience in Tropical Medicine. All fellows participate in either a one-month or three-month course. The longer course is encouraged and allows the fellows to sit for certification by the American Society of Tropical Medicine and Hygiene, one of very few opportunities that exist in the nation. Furthermore, overseas travel is encouraged and recent graduates have experienced medicine in Kenya, Thailand, Uganda, Peru, Honduras, and Tanzania. The fellowship program benefits from the clinical and academic synergy of four other Pediatric Subspecialty fellowships that are part of the NCC, as well as a full representation of faculty from Pediatric and Pediatric Surgical subspecialties.
Elements of our military-unique curriculum include participation in tropical and global medicine, biodefense agents training, travel medicine, Military Medical Ethics, and completion of the Military Medical Humanitarian Assistance Course sponsored by USU. Following completion of a one- to three-month didactic portion of the course, fellows travel to overseas sites to apply the knowledge learned to practical situations. Due to our unique geography, our trainees are also able to take advantage of the Medical Management of Chemical and Biological Casualties Course (MMBC) offered at Ft. Detrick, MD. This course provides state-of-the-art training in the management of biologic casualties. The fellows also learn by direct hands-on participation in aero-medical evacuation from within and without the United States. They provide telephone consultations to colleagues around the world, building a future pediatric community of international scope.
The fellowship has a long history of excellent research productivity. Present research opportunities include working with investigators at USU, the National Institutes of Health (NIH), Walter Reed Army Institute of Research (WRAIR), and the Naval Medical Research Center (NMRC). Current work within the Department of Pediatrics includes projects focused on the immunology of influenza and on respiratory syncytial virus (RSV).
Recent fellows have worked in various fields that have both pediatric and military relevance. HIV research on the prevention of mother-to-child transmission and vaccine development has been the focus of some recent efforts in conjunction with investigators with the U.S. Military HIV Research Program. Similarly, fellows have worked in both WRAIR and NMRC laboratories in the field of malaria treatment and prevention. This involvement has allowed fellows to experience the process of translational medicine, evolving from basic science research to clinical trials.
Opportunities exist for collaboration with investigators in the Enteric Diseases Department at NMRC. A very strong relationship with the USU Department of Microbiology has led to collaborations in many areas. Past fellows have worked with investigators studying the pathophysiology of E. coli and its many disease manifestations. Other fellows have worked in laboratories studying Neiserria gonorrheae and Neiserria meningitidis. These investigations have focused on the developing antibiotic resistance and immunologic aspects of the host response to these organisms.
We also have a corps of faculty mentors skilled in clinical research in the areas of observational, outcomes/comparative effectiveness, and health services research. Recent efforts have looked at the pediatric manifestations of infection due to Clostridium difficile and vancomycin-resistant Enterococcus and there are several ongoing projects related to deployment and travelers health as well as malaria prevention. These long standing research connections train fellows in areas with great operational and pediatric relevance in both the United States and global health communities benefiting both children and service members.
PROGRAM CONTACT INFORMATION
The NCC Neonatal-Perinatal Medicine Fellowship has been training fellows in Neonatology for over 25 years. It is a unique training program, clinically based at the Walter Reed National Military Medical Center (WRNMMC), and exists as a separate, free-standing service within the Department of Pediatrics at WRNMMC. Approximately one-third of the curriculum is devoted to clinical duties, with the remaining time devoted to research activities. The majority of the clinical experience is at the WRNMMC neonatal intensive care unit (NICU). The NICU at WRNMMC is the only Department of Defense NICU in the National Capital Area. NICU admissions number 300 per year in a catchment area that is inclusive of 4000 deliveries per year among local military treatment facilities. The program exists in affiliation with the combined NCC pediatric residency program at WRNMMC.
- Additional information for the specialty can be found on the Council of Pediatric Subspecialties website.
- 1/3 clinical
- 2/3 research
- 300 NICU admissions of 4000 deliveries per year at WRNMMC
Active duty in one of the uniformed services of the United States (Army, Navy, Air Force, or Public Health Service) is required. Information on incurred obligations, pay, and allowances may be obtained from the Office of Graduate Medical Education. Applicants must apply through, and be sponsored by, the Graduate Medical Education office of their respective branch of service for postdoctoral training. Requests for training should list the Neonatal-Perinatal Medicine Fellowship of the NCC at USU as their site of choice. Application deadlines are usually in September and are determined by the individual services. Where feasible, applicants are encouraged to visit the USU and Walter Reed facilities and arrange personal interviews with faculty members. If a visit is not practical, applicants should contact the Program Director for a phone interview and submit an updated Curriculum Vitae.
The program is sponsored by the NCC, with clinical practice mainly located at its primary affiliated hospital: WRNMMC, Bethesda MD. Other training locations in the National Capital Region include Georgetown University School of Medicine, Washington, DC, (one block); Children's National Medical Center, Washington, DC, (one block); Inova Fairfax Children's Hospital, Fairfax, VA (one block); and Shady Grove Adventist Hospital, Rockville, MD (two blocks). Fellows also rotate for one block at the Naval Medical Center Portsmouth NICU (Portsmouth, VA). The fellowship program benefits from the clinical and academic synergy of five other Pediatric Subspecialty fellowships that are part of the NCC, as well as a full representation of faculty from Pediatric and Pediatric Surgical subspecialties.
The core goal of the fellowship program is to train clinically and academically versatile neonatologists for clinical assignments in the Military Health System (MHS). The MHS has NICUs in Okinawa, Japan; Honolulu, HI; Tacoma, WA; San Diego, CA; San Antonio, TX; Portsmouth, VA; Killeen TX; Fayetteville, NC; and Bethesda, MD. Fellows are prepared for these challenging clinical assignments through a combination of clinical rotations, simulation and training at a state-of-the-art Simulation Center, training and performance of high-risk neonatal transports, and interface with the MHS patient transport system. Fellows maintain certification in, and often instruct, the S.T.A.B.L.E. program, Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) courses.
Fellows are matched with a research mentor early in the course of their fellowship. Research facilities utilized by the program include USU, NIH, FDA, the Naval Medical Research Center (NMRC) and the Walter Reed Army Institute of Research (WRAIR). The diversity of clinical and scholarly experience is designed to produce an exceptional academic neonatologist ready to fulfill the unique requirements of military and government practice.