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Allergy and Immunology

Allergy and Immunology






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    Allergy and Immunology Allergy and Immunology Document Transcript

    • Revised 3/25/08 GOALS AND OBJECTIVES RESIDENT CURRICULUM FOR ALLERGY AND IMMUNOLOGY ROTATION Rotation Coordinator: Jim Christensen, M.D. Asthma and Allergy Associates 2300 South Rancho Drive Las Vegas, NV 89102 OVERVIEW Educational Purpose The Allergy and Immunology elective rotation provides an opportunity for PGY-2 and PGY-3 residents to have basic exposure to the principles of the field of allergy and immunology. Many clinical states caused by allergic and immunologic disorders are regularly encountered by the general internist. Care for the asthma patient is commonly provided by general internist. Patient allergies can cause profound occupational and socioeconomic changes as well as require extensive environmental alterations. The allergy and immunology rotation is primarily an office-based rotation in the private office of a faculty allergist. Each resident should develop an understanding of basic allergic and immunologic disease processes and how to initiate work-ups and treatment of those disorders. The resident should also gain an understanding of when consultation with an allergist is indicated. Residents in the allergy and immunology rotation will participate in supervised patient encounters, discussion sessions with the attending, required readings, and may be required to submit a completed series of self-assessment concerning basic aspects of the field of allergy and immunology. Teaching Methods The Senior PGY-2 or -3 resident will be working closely with the Allergy attending in the care of each patient. Each patient seen will be discussed with, then evaluated by the attending, emphasizing the unique aspects of the consultative process and allergy care. Residents will be required to continue their regular Morning report and Noon conference core curriculum. The resident and attending will review and discuss any required reading. Mix of Diseases The following disorders will be reviewed during the rotation with the supervising attending or through direct patient interactions: A. Outpatient asthma management, including evaluation of pulmonary function tests 1
    • B. Asthma diagnosis, pathophysiology and treatment C. Rhinitis, classification, diagnosis and treatment D. Atopic dermatitis E. Anaphylaxis, diagnosis and treatment F. Drug reactions, diagnosis and treatment G. Food reactions, diagnosis and treatment H. Uticaria, diagnosis and treatment I. Initial evaluation of immunodeficiency states J. Allergy skin testing K. Allergen immunotherapy L. Status asthmaticus, diagnosis and treatment M. Care of patient with asthma and allergic rhinitis during pregnancy N. Sinusitis O. Allergic contact dermatitis, diagnosis and treatment P. Atopic dermatitis, diagnosis and treatment Q. Stinging insect reactions, diagnosis and treatment R. Clinical immunology, including components of the immune system and immunological reactions in the more common immunodeficiency states Patient Characteristics and Types of Clinical Encounters Patients are almost exclusively outpatients presenting in non-acute settings. Patients evaluated by the resident will range from adolescent to older adult. A wide range of the clinical problems noted in the above will be encountered including initial evaluation, chronic maintenance, and relapse. Resident Supervision The resident will be supervised at all times by the attending allergist who will be present on site. Procedures and Services Procedures and services include those typically performed by an allergist, including skin testing, pulmonary function testing, rhinoscopy, and immunotherapy. Didactic Teaching Morning Report Residents rotating on the allergy service are required to maintain greater than 60 % attendance at morning report. Morning Report begins at 8 a.m. on Monday through Thursday and at 8:30 a.m. on Friday. Noon Conference Residents rotating on the allergy service are required to maintain greater than 60 % attendance at noon conference. Noon conference occurs daily, Monday through Friday. These sessions cover the basic core curriculum, and other curriculum topics such as ethical issues, geriatrics, computer systems and informatics, health care systems, occupational and environmental health issues, and other topics of concern. 2
    • Core Reading Materials Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper Dl, ed. McGraw Hill The Washington Manual of Medical Therapeutics, 32nd ed. The Washington Manual Allergy, Asthma, and Immunology Subspecialty Consult (Washington Manual Subspecialty Consult Series), Jost BC, ed. Lippincott- Williams and Wilkins Ancillary Educational Materials Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology, Endocrinology, Infectious Diseases, Rheumatology as well as General Medical References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of Medicine) are available 24 hours a day, seven days a week in the resident lounge. Savitt Medical Library On-Line Residents have access to the on-line services of Savitt Library (the main library of the University of Nevada - Reno) via their computer in the resident room, Suite 300 of the 2040 W. Charleston Building. Access to this room is available 24 hours a day, seven days a week. Full text is available for many peer-review journals including, but not limited to: ACP Journal Club Annals of Internal Medicine British Medical Journal Cancer Circulation Journal of the American College of Cardiology The Lancet New England Journal of Medicine Stroke Also available on-line: Harrison’s Principle’s of Internal Medicine, 14th ed. Merck Manual, 17th ed. Guide to Clinical Preventive Services, 2nd ed. The Cochrane Library Medline and GratefulMed Databases Training Sites University Medical Center Occasional allergy consultations are seen at University Medical Center Allergy private practice office 3
    • The resident will participate in this allergy practice under the supervision of the attending allergist, a member of the voluntary faculty. Competency-based Goals and Objectives Allergy and Immunology Rotation Learning Venues Evaluation Methods Level Specificity 1. Allergist Office A. Attending Evaluation N/A 2. Self Study B. Self Evaluations N/A 3. Department C. Staff Evaluation N/A D. Patient Evaluation N/A E. Didactic Testing N/A Competency-Patient Care Learning Evaluation Level Venues Methods 1. Obtain focused history of allergy 1 A N/A related symptoms 2. Perform physical examination, 1 A N/A identifying signs of allergy 3. Observe allergy skin testing 1 A, E N/A 4. Observe and perform pulmonary 1 A,E N/A function testing 5. Observe allergy immunotherapy and 1 A,E N/A immunotherapy Competency-Medical Knowledge Learning Evaluation Level Venues Methods Demonstrate knowledge of the N/A 1,2 A,B,,E established basic biomedical and clinical sciences relevant to allergy and immunology Understand and interpret pulmonary 1,2 A,B,E N/A function tests Understand the treatment of anaphylaxis 1,2 A,B,E N/A Understand the diagnosis and treatment 1,2 A,B,E N/A of asthma Understand the diagnosis and treatment 1,2 A,B,E N/A of allergic rhinitis 4
    • Understand the diagnosis and treatment 1,2 A,B,E N/A of urticaria Understand the diagnosis and treatment 1,2 A,B,E N/A of drug reactions Understand the diagnosis and treatment 1,2 A,B,E N/A of stinging insect reactions Understand the initial evaluation of 1,2 A,B,E N/A immunodeficiency states Understand the interpretation of allergy 1,2 A,B,E N/A skin testing Understand the pathophysiology and ad- 1,2 A,B,E N/A ministration of allergen immunotherapy Competency-Interpersonal and Learning Evaluation Level Communication Skills Venues Methods Show understanding for different patient 1,2,3 A,B,C,D N/A preferences Maintain accurate medical records 1 A,B,C N/A Communicate effectively to patient and 1 A,B,C,D N/A medical support staff Communicate patients problems clearly 1 A,B,C,D N/A with patients family Treat patients and families with 1 A,B,C,D N/A respect/empathy Treat colleagues with respect 1 A,B,C N/A Respect patient confidentiality 1 A,B,C,D N/A Competency-Professionalism Learning Evaluation Level Venues Methods 1,3 A,B,C,D N/A Treat team members, primary care- givers, and patients with respect and empathy Understand, practice and adhere to a code 1,2,3 A,B,C N/A of medical ethics 1 A,B N/A Participate actively in consultations and 5
    • on rounds 3 A, attendance N/A Attend and participate in all scheduled conferences Competency-Practice-Based Learning Learning Evaluation Level Venues Methods Describe two improvements in care from 1,2 A N/A prior practice to attending allergist Competency-Systems-Based Practice Learning Evaluation Level Venues Methods Learn effective and appropriate office 1 A, B N/A practice management relevant to allergy and immunology EVALUATION A. Of Residents At the completion of each rotation, all clinical faculty are required to complete the standard ABIM resident evaluation form. All clinical faculty are encouraged to provide face-to-face feedback with the residents. The night-float resident is evaluated by one of the three-service attendings. In addition, residents may receive interim feedback utilizing the ABIM’s Praise and Early Warning cards. B. Of Rotation and Preceptor All residents are encouraged to evaluate the rotation, and the clinical faculty member at the completion of the rotation. This evaluation form is included at the end of this document. These evaluations are then converted to type and shared anonymously with the clinical faculty. The program director also discusses the rotation with the residents to ensure rotation quality and satisfaction. 6
    • Allergy and Immunology Rotation Intern/Resident Check List 1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty member and resident. 2. Completed assigned readings 3. Attended all assigned activities (excluding scheduled time away, required clinics and emergencies). 4. Completed required case report abstracts and/or posters if assigned by the supervising faculty member. 5. Demonstrated understanding of the basic principals of allergy and immunology 6. Understood the indications and interpretations of allergy skin testing. 7. Understood the diagnosis and treatment of asthma. 8. Demonstrated understanding of appropriate management of anaphylaxis, sinusitis and rhinitis. 9. Receive verbal feedback from attending at end of rotation. Intern/Resident Signature_________________________ Date___________________ Supervising attending__________________________ Date___________________ All items must be completed for rotation credit and checklist returned to the Department of Medicine by the rotation’s end. 7