Allergy and Immunology

I. Goals and Objectives

The Allergy/Immunology elective is a 2 week elective available to all Internal Medicine residents. Opportunity for 3 months research elective is available for interested residents.

Please contact Dr. Manis Ramesh at mramesh@montefiore.org to coordinate your individualized schedule.

I. Overview:

The Allergy/Immunology elective is designed to provide house officers with a high quality education in Allergy/Immunology and necessary skills for the diagnostic evaluation and management of patients with allergic and immune disorders.

The elective includes participation in the in-patient consult service, weekly Journal Clubs and Allergy Grand Rounds but will primarily be an out-patient experience involving general Allergy Immunology clinics at Jacobi and both Montefiore campuses as well as specific clinics such as Drug Allergy, Food Allergy and Patch Test Clinics. Residents can participate in all those clinics or select those that are of particular interest to them. Patients are very diverse both ethnically and socioeconomically, and represent the neighboring Montefiore communities.

At the end of the elective those who successfully complete the elective rotation will be able to:

· Independently identify, diagnose and manage patients with majority of allergic diseases.

· Independently identify patients with complex spectrum of allergic and immune disorders and refer them the for consultation services to appropriate medical providers

· Provide education and awareness about allergic and immune diseases to patients and community in general

· Successfully answer Allergy/Immunology questions on the Board Certifying Examination.

II. Level Based Goals & Objectives:

1. Patient Care: Recognize the significance of problems in patients with multiple Allergy and Immunology problems; be able to prioritize urgent problems requiring immediate attention such as evaluation for drug allergy and drug desensitization or evaluation of anaphylaxis. Explain and provide understanding of various treatment modalities, their benefits and complications, normal immune responses and pathogenesis of allergic and immune disorders.

2. Medical Knowledge: Use literature, reference sources and lectures by our faculty and fellows to increase knowledge in understanding pathophysiology of allergic and immune disorders; teach subspecialty specifics of interviewing, examining and managing patients with suspected allergic

disorder and/or immunodeficiency; demonstrate basic knowledge in immune mechanisms which take place in related medical conditions such as rheumatologic disorders; eosinophilia and organ transplantation.

3. Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients and staff; exhibit ability to work with multidisciplinary team of allergists, dermatologists and pulmonary specialists while caring for patients with such diseases as atopic and contact dermatitis, asthma, sarcoidosis or hypersensitivity pneumonitis. House staff is expected to accept all assignments graciously, work to fulfill patients’ needs and attend Journal Clubs and conferences.

4. Interpersonal and Communication Skills: Write comprehensive notes including environmental, contact and dietary histories; select and explain to the patient appropriate diagnostic procedures and specific immunologic laboratory evaluation; communicate verbally both with patients and staff and work effectively as the health care team.

5. Practice Based Learning and Improvement: Recognize limitation of your knowledge; use references, literature and discussion with faculty to improve practice pattern; accept feedback and change behavior accordingly; ask for help when needed.

6. System Based Practice: Be an advocate for patient’s needs; help eliminate occupational and environmental triggers; learn and apply guidelines such as asthma treatment guidelines, guidelines for evaluation of immune disorders and immunotherapy guidelines.

II. Areas Covered During Allergy/Immunology Elective

1. Principles, Physiology and Basic Science

a. Basic Immunology Lecture Course

b. Principles and Pathophysiology of Allergic Disorders

c. Immune mechanisms of related disorders

2. Practical Skills Unique to Allergy & Immunology

a. Obtaining environmental, contact and dietary history

b. Obtaining chronological history of infections for evaluation of immune disorders

3. Specific Diagnostic Skills in Allergy & Immunology

a. Performing percutaneous skin testing with a variety of environmental and food extracts, fresh foods and multiple medications

b. Performing intradermal skin testing with a variety of environmental extracts and parenteral medications

c. Placing of patch tests for diagnoses of contact allergy

d. Conducting and interpretating spirometry

e. Algorithm for diagnosis of food allergies including challenges with suspected foods

f. Algorithm for diagnosis of penicillin, aspirin and other drug allergies including challenges with various medications

g. Algorithm for diagnosis of occupational allergy

h. Evaluation of acute and chronic angioedema and urticaria

i. Laboratory evaluation of multiple immune disorders such as common variable immunodeficiency, complement abnormalities, chronic granulomatous disease and other deficiencies of the innate immune system

4. Specific Treatment Modalities in Allergy & Immunology

a. Environmental control

b. Specific allergen immunotherapy

c. Drug desensitization

d. IVIG treatment

IV. Schedule of Activities

The weekly elective schedule is attached and can be viewed separately. The majority of time is spent in variety of out patient settings and allows free time for literature search and in patient consultations. The schedule is structured to allow the resident flexibility, and they may choose to participate in the following:

1. General Allergy/Immunology practices serving pediatric and adult populations on East and West Montefiore campuses

2. Two adult allergy clinics in Jacobi Medical Center.

3. Drug allergy and drug desensitization clinic, which provides a unique opportunity in diagnosis of drug allergy, drug challenges and drug desensitization.

4. Food allergy clinic

5. Patch test clinic

6. Asthma Center

7. Wednesday weekly Journal Club

8. Friday weekly Allergy Course

9. Interested residents have the opportunity to conduct clinical research and participate in National and Regional Allergy/Immunology meetings

V. Methods of evaluation and assessment.

The rotating house officers are constantly evaluated during their elective and feedback in given by faculty members throughout the elective. The final evaluation is entered through www.new-innov.com and assesses overall clinical competence in clinical judgment, medical knowledge, clinical skills, humanistic qualities, professionalism, medical care and scholarship. House officers will have the opportunity to evaluate both the rotation and faculty with whom they worked most closely.

II. Typical Weekly Schedule

Example Shown Below: