Respiratory Medicine

Overview

We provide multidisciplinary inpatient and outpatient services for infants and children with acute and chronic respiratory problems, including:

Asthma
Chronic Respiratory Failure/Insufficiency
Complex Diseases
Congenital Lung Abnormalities
Cystic Fibrosis
Lung Transplantation
Primary Ciliary Dyskinesia
Sleep Related Respiratory Disorders

Our patients receive comprehensive care from our physicians, certified nurse practitioners, nutritionists and social workers. We are committed to providing outstanding patient care, instructing young physicians and nurses and researching pulmonary diseases and treatments.

Visit sickkids.ca to read more about the Division of Respiratory Medicine.

The Division of Respiratory Medicine provides comprehensive care for the full range of Pediatric pulmonary diseases such as asthma, cystic fibrosis, interstitial lung diseases, primary ciliary dyskinesia, sleep-related respiratory disorders, complex respiratory care requiring ventilatory support, and congenital lung malformations. It provides diagnostic services including flexible bronchoscopy, polysomnography, exercise testing and pulmonary function testing (including infant testing). It also has the largest Pediatric lung transplant program in the country providing pre- and post-transplantation care. Research in the Division spans from clinical to basic science and there are many research opportunities for trainees.

The training program has Royal College of Physicians and Surgeons of Canada accreditation and is the largest training program for Pediatric Respiratory Medicine in the country. It provides the full range of training that is required for board certification.

A structured weekly academic half-day occurs on Wednesday afternoons, and this is protected time for the Residents. A broad range of topics is covered including respiratory physiology, pediatric respiratory conditions, radiology, sleep physiology, exercise testing, and various CanMeds sessions.

Sleep Medicine

At SickKids, paediatric sleep medicine and or Long Term Ventilation fellowship is offered by the Division of Paediatric Respiratory Medicine, Department of Paediatrics, University of Toronto.

The paediatric sleep and long term ventilation program is an inter-professional service including paediatric subspecialty physicians (respirology, otolaryngology, neurology, psychiatry, developmental paediatrics, and adolescent medicine), advanced practice nurses, nurses, and sleep technologists. The program is committed to providing state-of-the-art clinical care to children and adolescents with sleep-related disorders who may or may not require long term ventilation.

Our program also provides a scholarly environment to foster clinical and basic research.

A clinical fellowship in paediatric sleep medicine and or long term ventilation is one year in duration. A two-year fellowship, combining one year of clinical training with an additional year of research is available. A two-year fellowship combining sleep and long term ventilation is also offered.

Objectives

The overall objective of this training program is to provide an educational opportunity that enables the resident with previous experience in General Paediatrics to obtain the theoretical, clinical, and laboratory knowledge, skills, and attitudes to function as a clinical consultant in Paediatric Respiratory Medicine.

At the completion of the two year training period the candidate should be capable of functioning independently as a consultant with a thorough understanding of the fundamental principles of pulmonary physiology and pathophysiology, and detailed knowledge and experience in the management of paediatric respiratory disorders. The trainee should be capable of supervising a clinical paediatric pulmonary function laboratory, demonstrate scholarship, and have a defined approach toward continuing medical education.

Trainees who wish to pursue an academic career as a clinician-scientist in Paediatric Respiratory Medicine will require an additional two and preferably three years of training where research constitutes 100 per cent of their effort. Such opportunities are available within the Division of Paediatric Respiratory Medicine (Lung Biology or other programmes of the Research Institute of The Hospital for Sick Children).

Sleep Medicine

The sleep and long term ventilation training program at Sickkids is focused on ensuring that fellows obtain the required training and knowledge to thrive in the realm of Sleep Medicine and Long Term Ventilation nationally and internationally. The main goals of the fellowship are:

To provide comprehensive clinical training in the field of paediatric sleep medicine and long term ventilation
To facilitate the pursuit of excellence in paediatric sleep medicine and long term ventilation by providing an enriched clinical and academic environment to foster learning and scientific inquiry
To train future paediatric sleep medicine physicians and or long term ventilation physicians who will be eligible to work as paediatric sleep specialists and or long term care specialists globally.

Training Sites

The Respiratory Medicine Program is based at Hospital for Sick Children in Toronto, with some training rotations taking place at Holland Bloorview and community sites.

Sleep Medicine

The main training site for the Sleep Medicine Training program is The Hospital for Sick children with the possibility of rotations at Holland Bloorview Rehabilitation Hospital, Toronto General Hospital, Sunnybrook Hospital and West Park Healthcare Centre.

Program Content

This residency program is for 2 years. Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.

Twenty-four months with experiences in the inpatient and ambulatory investigation and treatment of children with respiratory disorders. This core training includes rotations:

Respiratory Medicine Wards/Consults, ( approx. 4 -5 blocks per year)
Pulmonary Function lab/Exercise lab (1 block)
Ambulatory clinics Sleep Medicine (1 block)
Allergy/Immunology (1 block)
Pediatric Intensive Care (2 blocks)
Research/Electives (a total of 6 blocks over 2 years)
Residents are encouraged to use a portion of their elective time for research

Elective Content of Training Opportunities include (but are not limited to):

Radiology
ENT
Cardiology
NICU
Infectious Diseases
Long Term Ventilation
Pathology
Anaesthesia
Community Paediatric Respirology
Paediatric Lung Transplant
Adult Lung transplant
Adult Cystic Fibrosis

Research Experience

The Respiratory Medicine program at the hospital provides extensive opportunities for scholarly projects and research in both clinical and basic science. There is a wide range of research opportunities and supervisors. There are 6 months of elective blocks over the 2-year fellowship which can be utilized for research. All trainees are encouraged to complete a research project during their fellowship. The program has a research director that works closely with each trainee to facilitate decisions about projects, supervisors, and funding. Trainees who wish to pursue independent, investigative research careers are encouraged to pursue an additional year(s) of training.

Sleep Medicine

Sleep Medicine and Long-term Ventilation programs at the Hospital for Sick Children are internationally recognized for their patient and family-oriented clinical care and programs of research. The overall goal of our research is to understand and improve the impact of sleep-disordered breathing and long-term ventilation on the patient and family as well as the healthcare system.

One of the unique aspects of our training program is the ability to participate in ongoing research efforts in Sleep Medicine and Long-term Ventilation programs concurrently with their clinical learning. Fellows are advised in the selection of a research project within the first few months of starting their fellowship. The scientific faculty in our Division conducts research in the areas of patient and family outcomes and experience, health services research, sleep-based physiology as well as virtual care. Research is supported by funding from the Canadian Institutes of Health Research, Ontario Thoracic Society, Muscular Dystrophy Canada as well as local hospital grants.

Evaluation

Evaluation of fellows and residents is done through end of rotation In-Training Evaluation Reports (ITERs). In-training examinations are also organized to provide formative assessment and feedback to suggest areas for further study.

From July 2020, the Division of Respiratory Medicine will be launching Competency by Design, which is the new platform for the evaluation of trainees.

Ways To Get Involved

Residents and Fellows are encouraged to participate in a variety of leadership opportunities and committees throughout their training. Residents and Fellows have standing representation on the Residency Training Program Committee. They also participate in our Wellness Committee, Academic Half Day committee and Resident/Fellow selection committee and Quality Improvement.

Additional Educational Opportunities

Weekly activities in the division include Chest Rounds, Multi-D Rounds, Transplant Rounds, Journal club, X-Ray rounds and Academic Half day. Monthly activity Cross Canada Rounds and Mobility and Mortality rounds. In addition, there is a 2-day research course in September. Residents and Fellows also attend the National Fellows day symposium (Canadian Thoracic Society meeting). Opportunities frequently exist to attend or present at local, national, and international conferences. They are encouraged to attend at least one conference per year with full or partial funding.

Application Process

Clinical Subspecialty Residency Training / Fellowship

Clinical fellowships are an opportunity for a physician to obtain advanced training and/or to acquire more specialized expertise that complements their residency training. Training may involve both clinical and research activities. We provide Royal College accredited pediatric respiratory medicine training over a 24 month period. This fellowship can include both clinical training and research.

If you are a PGY-2 or PGY-3 year in Pediatrics at a Canadian University or in an RCPSC-accredited U.S. Pediatrics program - submit your application/documentation through CaRMS.

Candidates from Canadian or US programs must have successfully completed at least three years of training in core Pediatrics. For applicants from non-Canadian programs, completion of core Pediatric training with appropriate certification is required.

The deadline for applications is August 1st of the year preceding the start of the clinical training year. For example: Apply by August 1st 2020 - Successful candidate starts July 01, 2021.

International (including non-accredited US pediatric programs) applicants interested in a Pediatric Respiratory Medicine clinical fellowship:

Email: respmed.trainingprogram@sickkids.ca with their request.

Fellowship Applications

International trainees will be required to upload the following documents as a part of the application process:

Letter of intent, stating the applicant's reasons for applying to the fellowship, as well as their academic goals.
A copy of the applicant's medical degree and specialty certification if applicable.
A complete up-to-date curriculum vitae which includes the applicant’s date of birth, citizenship, clinical and research experience and an email address.
Proof of undergraduate and postgraduate training (e.g. medical degree, specialty/subspecialty certifications) with English translation, where applicable.
A current passport-size photograph.
3 reference letters

Basic Science Research Fellowship

For basic science research fellows engaged solely in research and who have no patient contact whatsoever, licensure by the College of Physicians and Surgeons of Ontario (CPSO) is not required. The minimum qualification for research fellowship training is a medical degree; however, requirements for admission may vary from one research fellowship program to another.

Elective Opportunities

We provide rotations in paediatric respiratory medicine for medical students, residents and fellows in active clinical training programs.

For any additional information please contact us directly at respmed.trainingprogram@sickkids.ca

Sleep Medicine

Rotations in the paediatric sleep medicine and long term ventilation training program are available to medical students, residents and fellows who are participating in active clinical training programs.

For any additional information please contact us directly at sleepmed.training@sickkids.ca

Observership Opportunities

The Respiratory Medicine Program offers observerships for both Local and International academic trainees.

Please contact respmed.trainingprogram@sickkids.ca

Sleep Medicine

The Sleep Medicine training program offers observerships to local and international trainees who are currently enrolled in an academic program.

A 2-week observership is mandatory to all international candidates seeking a sleep and/or a long term care ventilation fellowship.

For more information on observerships please contact sleepmed.trainig@sickkids.ca.

Additional Resources

Funding

Ministry of Health funding is provided for those qualified trainees who are eligible for licensure on the educational register of the Province of Ontario. This requires that the applicant be a Canadian citizen or permanent resident of Canada and have completed the Medical Council of Canada Qualifying Examination and may apply through CaRMS.

Non-ministry funding may be available for certain highly qualified applicants who fail to meet these criteria for provincial funding. The applications of outstanding individuals for whom funding is provided by a foreign government will be seriously considered.

Please contact the program directly for more information: respmed.trainingprogram@scikkids.ca

Qualified residents may also apply for research training positions funded by the Royal College Clinical Investigator Program. Successful candidates will be expected to obtain a graduate degree in a research field during the course of extended training.

Funds are also available to support research training within the Division.