Interstitial Lung Disease

Fellowship Program at McMaster

Welcome to the Interstitial Lung Disease (ILD) Fellowship Program at McMaster University. ILD refers to a group of complex heterogeneous diseases characterized by diffuse inflammatory and/or fibrotic infiltration of the alveolar space or interstitial septum. Optimal management requires a collaborative multi-disciplinary team of clinicians, researchers, and patient advocates dedicated to advancing patient care and discovery. Established in 2013, the ILD Fellowship Program at McMaster strives to advance patient care, research, education, and leadership in the realm of parenchymal lung disease.

Dr. Nathan Hambly, Program Director
Dr. Nathan Hambly, Program Director

Welcome

Since 2013, Canadian and international trainees have embraced the opportunity to pursue sub-specialty training in the ILD Fellowship Program at the Firestone Institute for Respiratory Health, McMaster University. Graduates of the program have gone on to develop and lead recognized ILD centres dedicated to clinical care, research, and education. The program’s objectives and curriculum are designed to foster a collaborative multi-disciplinary approach to the management of advanced parenchymal lung disease. Given our evolving understanding of the pathogenies of the various forms of ILD, the divergence and convergence of disease phenotypes, and the development of novel and complex therapeutic strategies to manage these conditions, there is a high demand to train physicians in order to catapult patient care.

Clinical Care

The Firestone Institute for Respiratory Health (FIRH) is internationally recognized as a centre of excellence in respiratory care. The goal of the institute is to provide optimal patient care through clinical practice, translational research and the training of expert health care professionals. Trainees rotate through eight weekly, high-paced sub-specialty clinics, which encompass a broad scope of clinical exposures ranging from fibrotic ILD, connective tissue disease-related ILD, sarcoidosis, vasculitis, PH, and lung transplantation. This experience is enhanced further by the availability of combined multi-disciplinary clinics with Rheumatology, Cardiology, and Nephrology in the specialized connective tissue disease, sarcoidosis, and vasculitis clinics. Our team is spearheaded by four respirologists working in close collaboration with multiple medical subspecialists, radiologists, basic scientists, respiratory therapists, and specialized care coordinators. Over 1200 patients are currently being followed in our ILD program across the spectrum of our subspecialty clinical programs.

Education

Engaged in regular longitudinal outpatient clinics, our ILD fellows are exposed to an enriched and immersive ILD experience. These regular clinical encounters form the foundation for resident education and are the driving force of our clinical and translational research projects. As part of the ILD Fellowship curriculum, trainees are expected to present regularly at our weekly ILD case presentation forum. These sessions are well attended and foster a cooperative learning environment. Recent guidelines recommend that diagnosis in ILD should be agreed upon through discussion by a multi-disciplinary panel of experts. With an effective ILD-multi-disciplinary discussion, and expertise from Respirology, Radiology, Rheumatology and Pathology, learners have the opportunity to share knowledge amongst multiple disciplines. The radiographic interpretation of HRCT in ILD is a point of emphasis throughout the training curriculum.

Research

Residents and Fellows are expected to complete a dedicated research project during their tenure with the program. The scope of the project will vary depending on the specific learning objectives of each fellow. As an enrollment centre for the Canadian Registry for Pulmonary Fibrosis, the Canadian Pulmonary Hypertension Registry, and the National Cardiac Sarcoidosis Registry (CHASM-CS), residents have ample opportunity to participate in robust clinical research projects. A number of fellows also pursue basic science projects, founded in the principles of translational medicine, in collaboration with the fibrosis research team at the FIRH.

Certification Outcome

The successful completion of the fellowship will grant a Fellowship McMaster Certification

Entry Requirements

  1. The fellowship program is designed for current residents or recent graduates of respirology training programs. Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.
  2. Residents enrolled in the programs of general internal medicine and medicine subspecialties may participate in this training program with the approval of their Program Director.

Application Deadline

Friday of the third week in November

Featured Fellows

Dr. Ilan Azuelos – Montreal, Canada
I joined as a clinical fellow in 2017 and found the ILD fellowship at FIRH to be invaluable: it was very well structured and allowed for substantial clinical experience with a focus on both new diagnosis of ILD, follow-up of patients on antifibrotics and immunosuppressants, combined respiratory-rheumatology clinics and pulmonary hypertension supervised by world-renown experts in the field. The fellowship also included regular multidisciplinary rounds, presentations on novel topics in the field of ILD and allowed for many research opportunities. The team was very friendly and dedicated to teaching. I have now returned to the McGill University Health Center where, thanks to my experience at McMaster, the ILD clinic has developed into an established referral center. I am now a member of the combined respiratory-rheumatology clinics, organize the ILD MDD and enroll patients in various clinical research trials.
Dr. Fahad Alobaid – Riyadh, Saudi Arabia
I had the pleasure to study in one of the most prestigious universities in Canada in a leading educational program. I have completed my 18 months of specialty training in interstitial lung disease at McMaster University from 2019-2020. During that period, I had excellent guidance and teaching on how to approach and treat patients afflicted with this illness. This experience was full of great memories, fun activities, and working with expert professors in that field who became wonderful friends. I highly recommend this training program for anyone planning to pursue a career in interstitial lung disease. 
Dr. Sy Giin Chong – Dublin, Ireland
An Ontario fine winery grows, harvests, ferments and nurtures grapes
Into the best wine it could be
Firestone, McMaster is no exemption
Where I grow, shape and sharpen my critical thinking

In interstitial lung disease
Wisdom and knowledge are collected
With a helping hand from the faculty
Regardless of the long and careful nurturing time endured

Firestone will be reminisced with sweet memories.
Dr. Amornpun Wongkarnjana – Bangkok, Thailand
Over the two-year period, the ILD fellowship training that I received at McMaster greatly improved my knowledge in ILD and formed the foundation to direct me to become an ILD specialist clinician and researcher. I have learned so many clinical points not only from my expert mentors, but also from a substantial number of cases. I would recommend this valuable program to anyone desiring to be an ILD expert.
Toyoshi YANAGIHARA – Fukuoka, Japan
As a post-doctoral fellow at the FIRH from August 2017 to March 2020, I learned a wide range of methodologies necessary in pulmonary fibrosis research including the rat fibrosis model by adenovirus encoding active TGF-beta1. Dr. Kolb has a remarkable scientific network and he continually introduced me to many international scientists who will be an important asset for me after I return to Japan. Dr. Kolb also gave me opportunities to review papers which improved my critical assessment and reasoning skills. I was thus in such an outstanding environment to become an independent physician-scientist.
trainee map ILD respirology

Goals of Training

Upon the completion of training the trainee is expected to be competent in the following:

  1. Understand the pathogenesis and natural history across the spectrum of fibrotic and inflammatory lung diseases.
  2. Develop a robust clinical approach to the diagnosis and management of ILD
  3. Demonstrate proficiency in the interpretation of HRCT chest in the setting of ILD
  4. Understand health risks and complications of ILD
  5. Cultivate a management approach to ILD related comorbidities including: pulmonary hypertension, lung cancer, emphysema, connective tissue disease, and extrapulmonary manifestations
  6. Implement evidence-based principles of ILD treatment to clinical practice
  7. Understand the role and evaluation of palliative care and lung transplantation in the setting of ILD
  8. Understand the of role of clinical research in the evolving field of ILD
  9. Communicate to patients and relatives diagnostic and management plans clearly, concisely, and compassionately


Length of Training

We offer two separate fellowship streams depending on the learning/career objectives of each fellow. A one-year intensive clinical fellowship with opportunity for clinical research projects and a two-year research-based fellowship.



Funding

Funding opportunities for the fellowship are flexible and include:

  1. Robert Davidson Fellowship through the Canadian Pulmonary Fibrosis Foundation
  2. National fellowship funding agencies
  3. Self-funded clinical fellow

Curriculum Highlights

  1. Training will be delivered in the ambulatory setting with inpatient consultations as required. The main objective of the training is to provide clinical training in several overlapping areas of respiratory medicine. Points of emphasis will include:
  2. A formal academic curriculum that consists of clinical sessions, lectures, journal clubs, group discussions, and clinical research and multidisciplinary clinical team meetings.
  3. Clinical and research education in the setting of supervised research projects.


Supervision & Feedback

Evaluation of Fellow performance and educational initiative will be centered on:

  1. Completion of rotation specific entrustable professional activities and milestones.
  2. Improving student performance using self-directed learning facilitated by quarterly self-assessment evaluations and the utilization of multi-source feedback surveys with an emphasis on non-medical expert CanMEDS roles
  3. Implementation of a validated instrument to measure the perceived quality of instructional activities in the outpatient environment (see appendix).
  4. Standardized evaluations of learner skills in teaching during their presentations at the ILD-MDD and case-based discussions.
  5. The quality and number of presentations and peer-reviewed publications covering a breadth of clinical, medical education, and translational research projects.

Nathan Hambly

MD, FRCPC
Medicine, Respirology
Nathan Hambly
Assistant Professor
Interstitial Lung Disease Program Director

905-525-9140 ext. 36704
hamblyn@mcmaster.ca


Martin Kolb

MD, PhD
Medicine, Respirology
Martin Kolb
Professor
Moran Campbell Chair in Respiratory Medicine; Respirology Division Director; Research director, Firestone Institute for Respiratory Health

905-525-9140 ext. 33683
kolbm@mcmaster.ca


Gerard Cox

MD, MB, FRCPCI, FRCPC
Medicine, Respirology
Gerard Cox
Professor
Coordinator, Regional Clinical Programs in Respirology; St. Joseph's Healthcare Hamilton

905-525-9140 ext. 34929
coxp@mcmaster.ca


Ciaran Scallan

MB BCh, FRCPC
Medicine, Respirology
Scallan, Ciaran
Assistant Professor


scallc@mcmaster.ca


Sonia Brooke

Staff
Medicine, Respirology
Placeholder portrait image for Sonia Brooke
Program Administrator


sbrooke@mcmaster.ca