Translational Genomics Research Institute (TGen) Project

Launched by the Jordan Sterling Foundation

In 2013, the Jordan Sterling Foundation provided the lead gift to TGen in Phoenix, AZ, a nationally and internationally recognized genomics research institute, to launch a significant piece of research, the TGen-Sterling Cystic Fibrosis Project-Next Generation CF Patient Detection and Monitoring Tool that will ultimately benefit every cystic fibrosis patient.

The goal of this research is to develop a non-invasive bedside test to immediately determine which of the 1,300 cystic fibrosis gene mutations the patient carries to be able to better determine which antibiotics and other necessary medications will be the most beneficial in treating each cystic fibrosis patient. The current protocol is to test samples from a cystic fibrosis patient in a lab using several antibiotics administered by hand to see which antibiotics over a period of several days demonstrate an improvement. The computer used in this research to develop a bedside test is the largest computer in Arizona and the initial research has indications that the benefits of this research will be applicable to other genetic-based diseases. TGen is collaborating with the Norton Thoracic Institute at St. Joseph's Hospital and Medical Center in Phoenix, AZ and with the Diamond Children's Hospital at the University Medical Center in Tucson, AZ to conduct this research.

St. Joseph's Hospital and Medical Center

Heart and Lung Institute

Lung Transplant Fellowship Program

Need for physicians with this training - Lung transplantation is the only treatment option for many children and adults with advanced cardiopulmonary disease. There are only a handful of physicians and surgeons that have the knowledge and training to appropriately manage this very complex patient population. The field of lung transplantation is in only its second decade, and there is a rapidly expanding need worldwide for appropriately trained clinical cardiopulmonary transplant specialists. In addition, there is still a poor understanding of the mechanisms behind rejection and infection in the transplanted heart and lung, and there is therefore an extensive need for academic transplant specialists who will conduct clinical and basic science research that will ultimately improve the quality of care of these patients.

This need is clearly evident here at SJHMC Heart and Lung Institute. Our lung transplant program has rapidly become one of the largest in the region. One advantage of developing a fellowship program would be to have the opportunity to train an individual who would subsequently join our transplant faculty.

1. Description of Program

1.1 Length of training: 1-2 years

1.2 Primary Purpose/Educational Goals: The overall purpose of the training program is to provide an advanced level of clinical, research, and administrative subspecialty training in the field of lung transplantation medicine. The goal of the program is to produce clinical and academic leaders in cardiopulmonary transplant medicine; graduates from the program will satisfy the requirements for United Network for Organ Sharing (UNOS) to become a transplant pulmonologist and medical director of a transplant program. The individual goals of the training program are as follows:

1. Acquire clinical skills required to diagnose and evaluate patients and advanced congenital cardiopulmonary disease to determine potential candidacy for transplantation.
2. Acquire experience in the management of multi-organ donors and selection of potential donor organs.
3. Acquire extensive knowledge of the organ procurement process.
4. Become familiar with the significant aspects of the various surgical methods of lung and heart-lung transplant surgery.
5. Acquire clinical skills in the appropriate peri-operative and intensive care management of cardiopulmonary transplant recipients.
6. Acquire clinical skills in the outpatient management of transplant recipients, including rejection and infection prophylaxis, surveillance, and treatment.
7. Acquire advanced bronchoscopy skills necessary for the management of lung transplant recipients.
8. Acquire an in depth knowledge of the immunologic theories and principles behind the strategies for managing rejection and infection, and to develop an extensive understanding of the pharmacological principles behind the use of anti-rejection, infection medications.
9. Acquire the skills and experience in interpretation of lung biopsies with regards to the diagnosis of rejection and infection, as well as the knowledge of pathology procedures (ie. samples preparation, staining methods) necessary to identify pathology unique to the lung allograft.
10. Acquire the skills and experience in performing clinical/translational transplant research to initiate a career in academic cardiopulmonary transplant medicine.
11. Acquire the administrative experience necessary to initiate a career as an academic program director.

1.2.1 PGY Level Required - PGY 6 or greater. Board Eligible or Certified in Pulmonary and Critical Care Medicine

1.3 Research/ academic Component - The fellow will have clinical responsibilities throughout the year of training, but will be given ample opportunity and exposure to develop an in-depth clinical or translational research project. This project will be approved by the director, and directly supervised by the particular mentor with specific expertise in the area of interest.

The fellow will be required to give regularly scheduled lectures in the field of cardiopulmonary transplantation to faculty, residents, and medical students. He/she will also be directly involved in the daily interaction with housestaff pertaining to patient management.

Most clinical training will occur at St. Joseph's Hospital and Medical Center on inpatient units, in operating rooms, bronchoscopy suite, and subspecialty clinics. Some training in donor organ management and procurement will occur at the outside hospitals (location of the donor).

3. ACGME or Other Accreditation - none.

4. Selection Process - Candidates for the Lung Transplant Fellowship Program will be required to complete an application form. To be eligible, the candidate will be board certified in internal medicine and have completed fellowship training in adult pulmonary/critical care medicine (should be board eligible for either subspecialty at the initiation of this training program). The candidate will be asked to provide information concerning any prior scholarly activities including research, as well as any publications. Confirmation of board certification and eligibility, as well as any other academic awards or achievements, will be requested. The application will require two letters of recommendation from individuals who have worked closely with the candidate during their fellowship training. For those candidates who have conducted research during or prior to their residency, a letter of reference will be required from their research mentor. The candidate will be requested to provide a personal statement which describes what the candidate expects to achieve during fellowship training, as well as their own personal academic career expectations. A personal interview with available clinical and research/support faculty will be required.

The selection of the Lung Transplant Fellow from the available candidates will occur by consensus of the Lung Transplant Fellowship Committee. The successful candidate will have the best combination of clinical decision making skills, aptitude and interest in scholarly activities and ability to work and succeed within the environment of the cardiopulmonary transplant program.

Individual educational goals of the transplant fellow will be developed in conjunction with the Fellowship Committee, with discussions and input from all clinical and research/faculty members. The Program Director will discuss the goals of the program with the transplant fellow at the orientation period at the start of the program on July 1. If a mutual decision is made to continue on with a second year, the written plan/goals for the second year of the program will be discussed with the fellow prior to the initiation of the second year.

5. Funding -

6. Program Director - Tony N Hodges, M.D., FCCP

7. Other Faculty Members (see below)

8. Certificate/ documentation of Experience - UNOS required documentation (Verification of number of months of experience, competence, number of procurements and transplant surgeries observed, number of new transplant recipients managed, procedures, overall assessment of clinical competence and scholarly activity).


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