UNIVERSITY OF ROCHESTER ALLERGY/IMMUNOLOGY & RHEUMATOLOGY DIVISION CURRICULUM IN ALLERGY AND CLINICAL IMMUNOLOGY

TRAINING PROGRAM MISSION STATEMENT The mission of the University of Rochester Allergy/Clinical Immunology fellowship program is to prepare specialists to provide expert medical care for patients with allergic and immunologic disorders, and to serve as consultants, educators, and physician scientists in allergic or hypersensitivity disorders, autoimmunity, immunodeficiency, and other immune-mediated disorders OVERALL GOALS AND OBJECTIVES A !roviding state-of-the-art clinical training in allergy and immunology "mphasis will #e placed on atopic disorders, such as asthma, rhinitis, sinusitis, drug allergy, urticaria and dermatitis, #ut this will #e #alanced with experiences in immune deficiency and autoimmune disease $ %eveloping a solid foundation in #asic immunology to understand and manage clinical disorders This is intended to provide the #ase for careers in academic medicine and clinical practice The goal for the fellows in Allergy-Immunology residency program is to #ecome a competent, certifia#le practitioner in the su#specialty of allergy immunology as measured #y competency in & areas outlined #y the AC'(" ) !atient care that is compassionate, appropriate, and effective for the treatment of health pro#lems and the promotion of health *istory ta+ing and physical examination s+ills (edical record +eeping s+ills !ro#lem solving a#ility %ifferential diagnosis Treatment plan Clinical ,udgment !atient communication s+ills, patient education Competent performance of procedures *umanistic -ualities . (edical +nowledge a#out esta#lished and evolving #iomedical, clinical, and cognate /eg, epidemiological and social-#ehavioral0 sciences and the application of this +nowledge to patient care $asic science +nowledge Clinical +nowledge 1nowledge and clinical application of current literature 2 !ractice-#ased learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care Analysis and modification of clinical practice in systematic manner Use of information technology and resources to improve patient care %emonstration of self directed learning

3 Interpersonal and communication s+ills that result in effective information exchange and colla#oration with patients, their families, and other health professionals Communication that is effective with patients and family 4unction as a team mem#er/leader /commensurate with residency year0 5uality of oral presentations 6 !rofessionalism, as manifested through a commitment to carrying out professional responsi#ilities, adherence to ethical principles, and sensitivity to a diverse patient population 7eadership "thical conduct %emonstration of respect, compassion and integrity towards patients and family %emonstration of on-going professional development 8ensitivity to culture, age, gender and disa#ility issues & 8ystems-#ased practice, as manifested #y actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the a#ility to effectively call on system resources to provide care that is of optimal value %emonstration of a#ility to utili9e availa#le resources to provide -uality medical care !ractice of cost-effective high -uality medical care %emonstration of understanding of role as allergist in the larger context of the health care system GOALS AND OBJECTIVES FOR EACH YEAR OF TRAINING ) !atient Care 8+ills a Caring and respectful #ehavior !rovide care that is sensitive to each patient:s age, gender, culture, and socioeconomic circumstance # Interviewing ;#tain complete allergy < immunology focused history ;#tain complete environmental history ;#tain complete occupational history when indicated c Informed decision-ma+ing 8ynthesi9e clinical history, physical examination findings and la#oratory results to arrive at a correct diagnosis o 1st year I!ter"e#$ate #$a%!&st$' s($))s o *!# year + S($)) )e,e) &- .ra't$'$!% AI s.e'$a)$st d %evelop and carry out patient management plans !rovide written action plans for patients with asthma !rovide written action plans for patients with atopic dermatitis e Counsel and educate patients and families !rovide allergic/immunologic disease specific education on pathophysiology, medication effects, adverse effects Allergen avoidance Inhaler techni-ue !roper use of self-in,ecta#le epinephrine f !erform medical procedures pric+ and intradermal s+in testing o 1st year + '&".)ete .r&-$'$e!'y o *!# year + '&".)ete .r&-$'$e!'y rhinolaryngoscopy o 1st year I!ter"e#$ate #$a%!&st$' s($))s

o *!# year Pr&-$'$e!'y desensiti9ation for drugs, venoms, inhalants o 1st year $!ter"e#$ate s($)) )e,e) o *!# year a/)e t& -&r"0)ate #ese!s$t$1at$&! s'2e#0)e a!# $#e!t$-y a..r&.r$ate oral challenges for foods and drugs o 1st year $!ter"e#$ate s($)) )e,e) o *!# year .r&-$'$e!'y -&r #r0% '2a))e!%es a!# s($))s '&""e!s0rate 3$t2 .ra't$'$!% A&I s.e'$a)$st $! re%ar#s t& -&&# pulmonary function testing and methacholine challenge o 1st year .r&-$'$e!'y $! $!ter.ret$!% s$".)e s.$r&"etry a!# !&,$'e $!ter"e#$ate s($)) )e,e) at .er-&r"a!'e &- "et2a'2&)$!e '2a))e!%e o *!# year .r&-$'$e!'y $! $!ter.ret$!% s$".)e s.$r&"etry4 $!ter"e#$ate s($)) )e,e) at .er-&r"a!'e &- "et2a'2&)$!e '2a))e!%e4 a!# .r&-$'$e!t at $!ter.retat$&! &- "et2a'2&)$!e '2a))e!%e immunotherapy o 1st year #e"&!strates $!ter"e#$ate s($)) )e,e) $! 3r$t$!% IT .res'r$.t$&! o *!# year + '&".)ete .r&-$'$e!'y $! 3r$t$!% IT .res'r$.t$&! I=I' therapy o 1st year + #e"&!strates $!ter"e#$ate s($)) )e,e) $! #&s$!% IVIG a!# (!&3)e#%e &- a#,erse e--e'ts o *!# year #e"&!strates s($)) )e,e) '&""e!s0rate 3$t2 t2e .ra't$'$!% a))er%$st $! #&s$!% IVIG a!# (!&3)e#%e &- a#,erse e--e'ts Immunomodulatory therapy o 1st year + #e"&!strates $!ter"e#$ate s($)) )e,e) $! #&s$!%4 .&te!t$a) $!#$'at$&!s4 a!# a#,erse e--e'ts &- $""0!&"&#0)at&ry a%e!ts o *!# year + #e"&!strates $!ter"e#$ate .r&-$'$e!t s($)) )e,e) $! #&s$!%4 .&te!t$a) $!#$'at$&!s4 a!# a#,erse e--e'ts &$""0!&"&#0)at&ry a%e!ts !atch testing o 1st year + #e"&!strates $!ter"e#$ate s($)) )e,e) $! .er-&r"a!'e a!# $!ter.retat$&! &- .at'2 test$!% o *!# year #e"&!strates $!ter"e#$ate .r&-$'$e!t s($)) )e,e) $! .er-&r"a!'e a!# $!ter.retat$&! &- .at'2 test$!% g !reventive health services Recommend appropriate vaccinations h >or+ within a team (a+e appropriate referrals for specialists including "?T, %ermatology, 'astroenterology, and !ulmonary Appropriate use of asthma educators, social wor+ers, pharmacists, and other health professionals . (edical 1nowledge a Investigatory and analytic thin+ing Actively participate in the design and/or implementation of a clinical or #asic research pro,ect !resent research pro,ect and updates at A < I Research Conference

1st year resear'2 t&.$'s $#e!t$-$e# a!# resear'2 .r&.&sa) .rese!t at tea'2$!% '&!-ere!'es o *!# year C&".)etes resear'2 .r&5e't t& sat$s-a't$&! &- resear'2 "e!t&r Prese!ts -$!a) resear'2 .r&5e't re.&rt Pre.ares "a!0s'r$.t $- a..r&.r$ate # 1nowledge and application of #asic sciences Understand the pathophysiology of inflammation and its relation to asthma, allergic rhinitis, chronic sinusitis, atopic dermatitis and other allergic disorders and its application in anti-inflammatory therapies o 1st year + I!ter"e#$ate (!&3)e#%e )e,e) o *!# year 6!&3)e#%e '&""e!s0rate &r a/&,e t2e a,era%e .ra't$'$!% AI s.e'$a)$st Understand the pathogenesis for primary immunodeficiencies and its application for therapy using I=I', $( transplant, gene therapy and other therapies o 1st year I!ter"e#$ate (!&3)e#%e )e,e) o *!# year 6!&3)e#%e '&""e!s0rate &r a/&,e t2e a,era%e .ra't$'$!% AI s.e'$a)$st o 2 !ractice-$ased 7earning and Improvement a Analy9e own practice for needed improvement Use evaluations #y faculty and others to improve practice # Use of evidence from scientific studies Incorporate new /or novel0 pharmacologic agents and treatment programs into treatment of allergic/immunologic diseases Incorporate diagnostic and management decisions #ased on the Allergy < Immunology !ractice !arameters c Application of research and statistical methods %evelop statistical methods for research pro,ect/s0 in con,unction with statisticians Carry out planned research pro,ects with presentation of results and development of manuscript if a#le Critically review allergy < immunology literature at ,ournal clu# d Use of information technology Use (edline, !u#(ed or other data#ases for information to improve patient care, teaching, or research e 4acilitate learning of others Teach medical students and residents in outpatient clinics and with in-patient consults !erform teaching conferences at core curriculum conference, teaching rounds, ,ournal clu# and research conference o Prese!tat$&! s($))s at $!ter"e#$ate )e,e) f !ortfolio 4ellows will su#mit @ items from their !ractice-#ased learning portfolio 2 times a year /?ov ), 4e# ), (ay)0 3 Interpersonal and Communication 8+ills a Creation of therapeutic relationship with patients "nsuring that patients understand their treatments and action plans "nsuring patients understand treatments for other allergic/immunologic diseases including immunotherapy

# 7istening 8+ills "na#ling patients to #e comforta#le as+ing a#out their disease or medications c 6 !rofessionalism a Respect and altruism Accept responsi#ility for continuity of patient care Respect patient:s privacy and autonomy # "thically sound practice Consistently demonstrate high standards of ethical #ehavior c 8ensitivity %emonstrate respect for the dignity of patients and colleagues as persons %emonstrate sensitivity to individuals regardless of age, culture, disa#ilities, ethnicity, gender and sexual orientation & 8ystems-$ased !ractice a 1nowledge of practice and delivery systems !articipate in -uality management meetings for Asthma or Allergy Clinic !ossess #asic economic and #usiness +nowledge # !ractice cost-effective care %emonstrate +nowledge of formulary medications for asthma and allergic diseases 1now the costs for different tier level asthma/allergy medications As+ patients how they pay for their medications c Advocate for patients within the health care system >or+ to assure access to allergy < immunology clinics for patients in need of specialty care >or+ to provide other consultative services for allergy/immunology patients with other medical needs d 5uality programs 4ellows will participate in the immunotherapy -uality program 4ellows will participate in the desensiti9ation -uality program

TEACHING AND EVALUATION OF CORE COMPETANCE It is expected that fellows will already #e will trained in terms of interpersonal and communications s+ill and professionalism These core competencies will #e evaluated and remedial action ta+en when appropriate ) Interpersonal and communication s+ills !atient -uestionnaire 2&A evaluation . !rofessionalism !atient -uestionnaire 2&A evaluation !ractice- and 8ystem-#ased learning as they relate to Allergy and Clinical Immunology will #e new and continuing areas for learning As fellows face identify and solve pro#lems relevant to these competencies, they will record their efforts as a portfolio which will #e reviewed with them during their semi-annual evaluation

2 !ractice-#ased learning and improvement !ortfolio 3 8ystems-#ased learning !ortfolio !atient care and medical +nowledge specific to the su#specialty of Allergy and Clinical Immunology form the #ul+ of the Allergy and Clinical Immunology curriculum /see 8U$8!"CIA7TB 8!"CI4IC ';A78 #elow0 These will #e monitored semiannually 6 !atient care 4aculty evaluation /C"C and A$AI forms0 !atient and procedure logs & (edical +nowledge A$AI in-service examination 4aculty evaluation #ased on clinical wor+ and conferences SUBSPECIALTY SPECIFIC GOALS The specific goals are derived from the (ission 8tatement and includeD ) %evelopment of clinically competent allergists/clinical immunologists . %evelopment of allergists/clinical immunologists who are competent in managing patients in multiple settings including the am#ulatory clinic, the hospital floors, the emergency room, and the intensive care unit #oth in the private area and the academic setting 2 %evelopment of allergists/clinical immunologists who will #e life-long learners in the areas of clinical practice and research ) Clinical Competence

Clinical competence is essential for all physicians 4or an allergist/clinical immunologist, this is defined as possessing a #asic core of +nowledge and technical s+ills necessary to #e an expert in the clinical manifestations, clinical presentations, pathophysiology, and management of immunemediated diseases and disorders This will re-uire developing a +nowledge #ase in multiple disciplines including anatomy, #iochemistry, epidemiology, ethics, genetics, human #ehavior, immunology, pharmacology, physiology and statistics as they apply to allergy and clinical immunology It will include the a#ility to diagnose and manage anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations It will also include proficiency in allergen immunotherapy, immediate and delayed s+in testing, drug desensiti9ation and challenge, I=I' treatment, methacholine and other #ronchial challenge testing, performance and interpretation of pulmonary function testing, exercise challenge, nasal cytology, oral challenge testing, patch testing, rhinolaryngoscpy In order to achieve this goal, the fellow will develop the a#ility to construct a complete differential diagnosis for complexes of symptoms and signs related to allergic and immunologic diseases #ased upon critical analysis of the history, physical exam findings, la#oratory studies and imaging studies *e will learn the clinical s+ills of data collection including history-ta+ing, physical exam, and appropriate re-uest of la#oratory and imaging studies as they relate to the allergy/clinical immunology patient This will include an understanding of the principles, indications, contraindications, ris+s, cost and expected outcome of tests and procedures In addition, 4ellows

will ac-uire a wor+ing +nowledge of aero#iology, humoral and cellular immunology, molecular #iology, pulmonary physiology, mechanisms of inflammation, pharmacology and pharmaco+inetics, drug meta#olism, drug side effects, drug interactions, preparation and standardi9ation of allergen extracts, means of measuring and controlling allergens, transplantation medicine and tumor immunology, reproductive immunology, and the psychological effects of chronic disease 4ellows will also learn the scientific method and #asic statistics, the principles and techni-ues or clinical immunology la#oratory techni-ues The fellow will also develop an understanding of the design, implementation and interpretation of research studies including methodology, critical interpretation of pu#lished data, and the responsi#le use of informed consent The fellow will continue to develop communication s+ills with patients, peers and other health care personnel *e will continue to develop -ualities of professionalism and humanistic s+ills including integrity, compassion, and respect for patients, peers and other health care personnel Upon successful completion of training, the fellow will #e a#le to perform as a consultant in allergy and clinical immunology providing an expert opinion in the diagnosis and management of allergic diseases and immune-mediated conditions . A#ility to >or+ in a =ariety of 8ettings

It is essential for a Allergist/clinical immunologist to #e a#le to wor+ in a variety of settings #oth as a primary care physician and as a consultant Those settings include inpatient facilities, outpatient clinics, and su#acute facilities In order to achieve this goal, the fellow will evaluate, treat and follow, either as a primary care provider or as a consultant, patients in the am#ulatory clinic, the acute inpatient setting, the emergency department, and the intensive care setting 2 7ife-7ong 7earning

Clinically competent physicians must #e life-long learners This is necessary for the ac-uisition, critical analysis, synthesis and reassessment of +nowledge, s+ills and professionalism In order to achieve this goal, the fellow will demonstrate independent study ha#its in the ac-uisition of clinical and research +nowledge and s+ills through attendance, presentation and participation in Unit and %epartment educational conferences as well as regional and national professional scientific conferences They will also gain experience in teaching ,unior fellows, residents, medical students and health care professionals in formal teaching sessions, on rounds, and in the clinic SPECIFIC OBJECTIVES OF THE TEACHING PROGRAM ) Clinical Competence a 4ellows will possess a #asic core of +nowledge and technical s+ills necessary to #e an expert in the clinical manifestations, clinical presentations, pathophysiology, and management of allergic and immune-mediated diseases and conditions 4ellows will possess an understanding of the design, implementation and interpretation of #asic and clinical research studies They will possess the a#ility to critically review the literature 4ellows will possess communication, professionalism and humanistic s+ills necessary to interact with patients, peers, and health care professionals

A#ility to >or+ in a =ariety of 8ettings a # c 4ellows will #e a#le to function as #oth a primary care physician and a consultant in Allergy/Clinical Immunology 4ellows will #e a#le to care for patients in the acute care setting and the am#ulatory clinic setting 4ellows will #e a#le to lead a multidisciplinary health care team

7ife-7ong 7earning a # c 4ellows will attend Unit and %epartment conferences as well as professional scientific conferences 4ellows will assist in coordinating conference topics for the Unit and will present at Unit conferences 4ellows will demonstrate proficiency in teaching ,unior fellows, residents and medical students in formal conferences and teaching sessions, on rounds and in clinic

TEACHING METHODS OF THE TRAINING PROGRAM A Year 1 ) %evelop the #asic clinical s+ills and +nowledge re-uired to practice the specialty of Allergy < Immunology . !rogressive development of independent clinical ,udgment and decision-ma+ing s+ills 2 %evelop medical and lay communications s+ills, particularly in regards to the su#specialty of Allergy < Immunology ;utpatient Allergy Immunology Continuity Clinic !ediatric Clinic Adult Clinic Inpatient Allergy Immunology Consult 8ervice Inpatient Rheumatology Consult 8ervice Year * ) Attain sufficient clinical s+ills and +nowledge re-uired to practice the specialty of Allergy < Immunology and pass the American $oard of Allergy and Immunology . A#ility to ma+e independent clinical ,udgment and decisions s+ills 2 Attain proficiency in clinical pro#lem solving s+ills, particularly in relation to complex su#specialty cases 3 %emonstrate proficiency in written and spo+en communications, regarding #oth clinical and research content 6 (astery of the fundamentals of hypothesis testing and the -uantitative analysis of clinical and la#oratory data & Apply +nowledge #ase and develop teaching s+ills for the education of residents and other physicians ;utpatient Allergy Immunology G&a)s a!# O/5e't$,es -&r C)$!$'a) Ass$%!"e!ts

Continuity Clinic !ediatric Clinic Adult Clinic Inpatient Allergy Immunology Consult 8ervice Inpatient Rheumatology Consult 8ervice "?T outpatient clinic %ermatology outpatient clinic !ediatric !ulmonary rotation $ G&a)s a!# O/5e't$,es -&r R&tat$&!s G&a)s a!# O/5e't$,es A#0)t a!# Pe#$atr$' O0t.at$e!t R&tat$&! G&a)s & O/5e't$,es 7$!')0#$!% C&!t$!0$ty C)$!$'8 ) ;utpatient management of children and adults with asthma a Understand the immunologic and pathologic #asis of asthma # Understand the criteria for the diagnosis of asthma c %emonstrate the a#ility to o#tain a history pertinent to the diagnosis and management of asthma d. %emonstrate the a#ility to categori9e asthmatic patients #y severity according to the ?ational Asthma "ducation and !revention !rogram guidelinesD httpD//www nhl#i nih gov/health/prof/lung/index htmEasthma e 1now the differential diagnosis of asthma including asthma mimics such as vocal cord dysfunction f Understand the factors that may exacer#ate asthma and how to address them g %evelop and demonstrate the a#ility to interpret and utili9e pulmonary function tests in the diagnosis and management of asthma h $e conversant with and understand the indications for the different categories of medications used in asthma i %ocument critical asthma history items in all ver#al and written communicationsD asthma severity, medications, symptoms, and ris+ factors j. %evelop familiarity with the "!R-2 guidelines for asthma managementD httpD//www nhl#i nih gov/guidelines/asthma/asthgdln htm + >rite and explain to the patient their asthma action plan . %iagnosis and management of children and adults with sinusitis a Understand the anatomical, pathological and micro#iological #asis of sinusitis particularly as it relates to the pediatric patient population b. Read the Foint Council on Asthma, Allergy and Immunology !ractice !arameters for the %iagnosis and (anagement of 8inusitisD httpD//www aaaai org/professionals/resources/pdf/sinusitis.AA6 pdf c %emonstrate the a#ility to medically manage sinusitis d Understand the indications for the surgical management of sinusitis 2 %iagnosis and management of children and adults with rhinitis a. Read the Foint Council on Asthma, Allergy and Immunology !ractice !arameters on RhinitisD httpD//www aaaai org/professionals/resources/pdf/rhinitis)@@G pdf # %emonstrate the a#ility to diagnose allergic rhinitis, non-allergic rhinitis, vasomotor rhinitis and aspirin sensitive rhinitis c %evelop appropriate s+ills for diagnosis and management of allergic rhinitis d Understand medical management of allergic rhinitis, including use of topical steroids, antihistamines, anti-leu+otriene agents, cromolyn sodium, and decongestants e Understand the immunology of immunotherapy and the manufacture, testing, and standardi9ation of allergen extracts f Appropriately prescri#e allergen immunotherapy for treatment of rhinitis

3 %iagnosis and management of children and adults with food allergy a Understand the different types and different pathophysiologies of food allergy # Ta+e elements of history relevant to classify/diagnose adverse reactions versus allergic reactions to foods c 7earn the foods most commonly associated with hypersensitivity reactions in children d Understand the patterns of immunological cross-reactivity #etween different foods e (anage patients with suspected food allergy #y means of appropriate food avoidance and/or reintroduction of #enign foods f Create appropriate action plan for patients with food allergy as guidance in case of accidental ingestion g Understand the procedure and indications for #linded food challenge h Interpret s+in test and RA8T results in diagnosis of food allergy i. Read 4ood AllergyD A !ractice !arameterD httpD//www aaaai org/professionals/resources/pdf/foodHallergyH.AA& pdf 6 %iagnosis and management of children and adults with Immunodeficiency a Understand the #asic functioning of the innate and ac-uired immune system in its response against infection # 1now the clinical manifestations of primary immunodeficiency, with regards to complement deficiency, neutrophil function and adhesion defects, $ and T cell function a#normalities c $e a#le to order and interpret la#oratory tests used in the diagnosis and management of immunodeficiency disorders d Understand the indications for the different treatment modalities used in the management of immunodeficiency disorders e. Read the practice parameter regarding diagnosis and management of immunodeficiencyD httpD//www aaaai org/professionals/resources/pdf/immunodeficiency.AA6 pdf & %iagnosis, clinical presentation and management of dermatologic conditions, including atopic dermatitis, urticaria, angioedema, and contact dermatitis a. Read and #e conversant with the Foint Council on Asthma, Allergy and Immunology !ractice !arameters on atopic dermatitis httpD//www ,caai org/pp/practiceHparameters asp # Identify and +now the typical distri#ution of atopic dermatitis in #oth pediatric and adult populations c Understand the clinical presentation, diagnosis, pathophysiology, and management of urticaria and angioedema d Understand the etiology and presentation of contact dermatitis, the diagnostic wor+up including patch testing, and approaches to management e Understand the clinical presentation, diagnosis, pathophysiology, and management of s+in diseases associated with immunodeficiency I %iagnosis and management of children and adults with other immunologic and allergic diseases a 1now the differential diagnosis and pathogenesis of diseases associated with elevated Ig" levels and/or eosinophilia # Understand the clinical presentation, diagnosis, and management of patients with *yper Ig" 8yndrome, *ypereosinophilic syndrome, and "osinophilic gastroenteritis c "valuate and treat patients with suspected primary immunodeficiency, #y means of I=I' supplementation where indicated d "valuate and treat children with autoinflammatory diseases, as well as hemophagocytic syndrome, and autoimmune lymphoproliferative syndrome G %iagnosis and management of children and adults with mastocytosis a Understand mechanisms of mast cell growth and differentiation in normal individuals and those with mastocytosis

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# 1now the diagnostic criteria for, and differential diagnosis of mastocytosis c !erform a history and physical examination pertinent to the diagnosis and management of mastocytosis d Understand the clinical presentation, diagnosis, and management of patients with mastocytosis @ 7eadership and communication s+ills to coordinate the care of a child or an adult with an allergic or immunologic disorder ) %evelop s+ills to coordinate a multidisciplinary care to inpatients with immunologic and allergic diseases, incorporating issues of nursing, pharmacy, social wor+ and occupational therapy . Recogni9e conditions re-uiring consultations from other specialty services 2 !rovide letters to the referring physicians to communicate the diagnostic findings and management recommendations related to the allergic and immunologic diseases )A Continuity Clinic 7ong-Term 4ollow Up ) "ach fellow will have their own dedicated panel of patients that they will have primary responsi#ility for during the duration of their fellowship . !atients seen on an inpatient #asis will #e transferred to the fellow:s clinic that saw the patient in the hospital where outpatient care is warranted 2 %evelop appropriate communication s+ills with primary care as well as other su#specialist providers to successfully manage complex allergy-immunology patient 3 "ach fellow will #e responsi#le for ta+ing overnight call for their own clinic patients and addressing any acute issues that arise 6 4aculty #ac+-up will #e availa#le at all times for difficult cases or -uestions that cannot #e answered #y the fellow )) !rocedures - 4or the following procedures learn the principles, indications, methods, and interpretation, then perform and document competency a 8pirometry J competent )st year # Assessment of #ronchial hyper-reactivity J competent .nd year c !ea+ flow meters J competent )st year d "picutaneous pric+ testing and intradermal s+in testing for aeroallergens and venoms J competent )st year e !rescri#ing immunotherapy J competent )st year f "picutaneous pric+ testing and intradermal s+in testing for medications J competent ) st year g %esensiti9ation for medication allergies J competent .nd year h "picutaneous pric+ testing for food allergies J competent )st year i !atch testing for contact dermatitis J competent . nd year , Testing for physical urticaria J competent )st year + Rhinoscopy J competent .nd year l 8+in punch #iopsy J competent .nd year m ;pen and #linded food challenge J competent .nd year n !rescription and manufacture of allergy extracts J competent .nd year o (anagement of allergy immunotherapy including J competent . nd year p !rescri#e and supervise the administration of I=I' J competent . nd year G&a)s a!# O/5e't$,es URMC A#0)t/Pe#$atr$' I!.at$e!t A))er%y I""0!&)&%y C&!s0)t Ser,$'e ) %rug Allergy a !erform the appropriate history and physical exam for those patients suspected of having an adverse reaction to medication # Recogni9e and perform the suita#le diagnostic procedures for those patients with suspected adverse reaction to medication including pric+ testing and intradermal s+in testing

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c d e

Create and supervise relevant graded challenges or desensiti9ation protocols for anti#iotics in the appropriate patient Understand and if possi#le carry out desensiti9ation to aspirin "valuate and carry out desensiti9ation protocols for chemotherapeutics in colla#oration with the hematology/oncology service

. Anaphylaxis and Angioedema a Identify and discriminate #etween the #road num#er of li+ely causative factors in identifying patients with anaphylaxis and angioedema that present to #oth the emergency room as well as those already hospitali9ed # %esign, implement, and relay to the primary physician team the optimal diagnostic evaluation and treatment regimen for patients experiencing anaphylaxis and angioedema c %esign, implement, and relay to the patient and primary team the appropriate transition from inpatient to outpatient care for those patients experiencing anaphylaxis and angioedema 2 (anagement of 8evere Asthma a Recogni9e the indications for inpatient admission in the setting of an acute asthma exacer#ation # Understand the appropriate use of spirometry and pea+ flow measures in the hospitali9ed patient with asthma c $e a#le to institute the appropriate inpatient medical therapy for the treatment of patients with severe asthma exacer#ations d Identify those patients at ris+ for impending respiratory failure and the appropriate ensuing ventilator management e 1now the #road differential of conditioning mimic+ing severe asthma and #e a#le to succinctly order and interpret those relevant diagnostic tests f %esign, implement, and relay to the patient and primary team the appropriate transition from inpatient to outpatient asthma care 3 (anagement of "osinophilic %isorders a 1now the differential diagnosis and wor+-up of patients with #oth acute and chronic eosinophilia # $e a#le to identify the relevant medications potentially causing eosinophilia in the hospitali9ed patient and guide the inpatient service to successfully eliminate that drug from the patient:s care plan c Understand the pathophysiology of eosinophilic disorders, the molecular diagnostics availa#le for evaluation, and the potential therapies for these disorders d $e a#le to coordinate care with #oth gastroenterology and nutrition services for the diagnosis and treatment of patients with "'I% 6 (anagement of Inpatient Immunodeficiency !atients a Identify the appropriate diagnostic wor+up for patient with recurrent infections # Understand the clinical features and immune dysregulation #ehind #oth primary immunodeficiency as well as secondary immunodeficiency /#oth *I=/AI%8-related and non *I=/AI%8 related0 c Understand the clinical features and immune dysregulation #ehind #oth complement deficiencies as well as neutrophil adhesion glycoprotein defects d $e a#le to interpret the diagnostic studies used in identifying patients suspected of having #oth primary and secondary immunodeficiency, neutrophil adhesion glycoprotein defects, and complement deficiency e Understand the appropriate use as well as adverse effects of different treatment modalities including immunosuppressive, immunostimulatory, and immunomodulatory therapy in patients with immune dysfunction

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f g

%evelop a comprehensive understanding of each immunodeficiency so that the AI fellow is a#le to lead a multi-disciplinary team in the total care of patients with immunodeficiency $e a#le to recogni9e and treat true emergency situations that arise in the field of immunodeficiency

G&a)s a!# O/5e't$,es I!.at$e!t R2e0"at&)&%y C&!s0)t Ser,$'e ) . 2 3 6 & I 7earn appropriate indications for Rheumatology consultation %evelop familiarity with diagnosis and management of vasculitis, including >egener:s granulomatosus, microscopic polyangiitis, Churg-8trauss disease, urticarial vasculitis, 1awasa+i:s disease, Ta+ayasu:s disease, 'iant cell arteritis, $ehcet:s disease %evelop familiarity with diagnosis and management of systemic autoimmune disease, including systemic lupus erythematosus, 8,ogren:s disease, rheumatoid arthritis, scleroderma, and myositis Understand theories of pathophysiology and immunology related to vasculitis and systemic autoimmune disease 7earn indications for, ma,or toxicities of, and immunomodulatory effects of immunosuppressive agents including cyclophosphamide, mycophenolate mofetil, tacrolimus, a9athioprine, methotrexate 7earn indications for, ma,or toxicities of, and immunomodulatory effects of #iologic agents including T?4 inhi#itors /etanercept, adalimuma#, inflixima#0 anti-T cell agents /a#atacept0 anti-$ cell agents /rituxima#0 and I=I' 7earn interpretation of serologic assays of immune functioning, including "7I8A and immunofluorescence assays for autoanti#odies, tests of the complement system, and acute phase reactants

G&a)s a!# O/5e't$,es ENT R&tat$&! ) . 2 3 6 & 7earn appropriate indications for "?T consultation in patients with allergic and imunologic diseases $ecome facile with evaluation, including history-ta+ing and physical examination, of patients with symptoms related to the ear, nose and throat %evelop familiarity with rhinoscopic evaluation of the upper airway 7earn anatomy of the sinuses and upper airway $e a#le to interpret radiographic studies, including Crays, CT scans, and (RI of the head and nec+ and understand their role in the diagnosis of patients with allergic and immunologic diseases 7earn surgical management of ear, nose, and throat disorders in patients with allergic and immunologic diseases

G&a)s a!# O/5e't$,es Der"at&)&%y R&tat$&! ) . 2 3 5. & 7earn appropriate indications for %ermatology consultation in patients with allergic and imunologic diseases $ecome facile with evaluation, including history-ta+ing and physical examination, of patients with symptoms related to the s+in 7earn appropriate diagnosis and management of contact dermatitis and atopic dermatitis 1now the indications for and #e a#le to interpret results of patch testing for contact dermatitis Read practice parameter on management of atopic dermatitisD httpD//www aaaai org/professionals/resources/pdf/atopicHderm.AA3 pdf 1now the differential diagnosis of atopic dermatitis and typical presentation in children and adults

13

I G

Understand pathiophysiology and immunology of atopic dermatitis 7earn the indications for and typical findings of s+in #iopsy in the evaluation ofpatients with allergic and immunologic diseases of the s+in

G&a)s a!# O/5e't$,es Pe#$atr$' P0)"&!ary R&tat$&! ) . 2 3 6 7earn indications for and interpretation of spirometry and pulmonary function testing in children with respiratory complaints 7earn to evaluate children with respiratory complaints #y means of history-ta+ing and physical examination 7earn inpatient management of children with asthma and #ronchiolitis, including R8= infection 7earn the principles of diagnosis and management of children with cystic fi#rosis Review literature related to natural history of asthma and whee9ing from early #irth to adulthood from well-+nown asthma cohorts 7earn differential diagnosis of chronic cough in children

G&a)s a!# O/5e't$,es Resear'2 Pr&%ra" ) . 2 3 6 & I G Ta+e part in the clinical and research immunology course and apply #asic immunology principles to clinical and research pro#lems Atta$! '&".ete!'y 1st year a!# .r&-$'$e!'y *!# year Understand the #asic steps involved in implementation of a clinical research protocol Complete the *uman 8u#,ect:s !rotection !rogram at the University of Rochester and o#tain a *8!! num#er 1st year Adherence to the principles of human su#,ect:s protection in clinical and translational research at all times Atta$! '&".ete!'y 1st year Understand good clinical practice as it pertains to research protocols Atta$! '&".ete!'y 1st year Read and understand the current allergy and immunology clinical research protocols that are occurring in the outpatient clinics !articipate in the safe and accurate implementation of the research protocols Atta$! '&".ete!'y *!# year 8chedule meetings with unit and non-unit investigators to evaluate a potential research mentor %iscuss these meetings with the program director (entors should have a successful research program and it is highly desira#le that they have a trac+ record of mentorship %ecide on a research mentor #y the end of 8eptem#er your first fellowship year 1st year Understand the #asic steps involved in implementation of a clinical or #asic #iomedical research 1st year %evelop a focused, hypothesis-driven research pro,ect that fits in well with the mentor:s research program 1st year Read and understand the current clinical research protocols that patients in our unit might participate in 1st year !resent your research plan at Thursday morning:s meeting 1st year !resent your experimental results at Thursday morning:s meeting at the end of the academic year *!# year !resent your results at a national meeting and prepare a manuscript for su#mission to a peer reviewed ,ournal *!# year %emonstrate scholarship #y preparing in colla#oration with a faculty mem#er #y preparing at least one of the following *!# year a A care report with review of the literature # A su#,ect review, commentary, or editorial c !erform a peer review of a manuscript

@ )A )) ). )2 )3 )6

14

C C&!-ere!'es There are 6 conferences, each held wee+lyD the AIR Clinical Conference, Case Conundrums, the Fournal Clu#/Research Conference, the Allergy Conference, and the Immunology Course ) A77"R'B/I((U?;7;'B A?% R*U"(AT;7;'B C7I?ICA7 C;?4"R"?C" D The conference is held wee+ly 4ellows and residents rotating on the service with the guidance of the faculty prepare the presentations Conference has four different formatsD Case Conference, (ultidisciplinary Conference, 'eriatric Conference and 'rand Rounds Through these Conferences, the fellow will gain +nowledge a#out patients of all ages from children to elderly adults The will also care for patients from all socioeconomic groups They will discuss patients with a wide variety of diagnoses including anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations These conferences will provide an opportunity for the fellow to integrate medical pro#lems with health promotion as well as cultural, socioeconomic, ethical, occupational, environmental and #ehavioral issues a Case Conference E#0'at$&!a) G&a)s &- Case C&!-ere!'e /)0 !rovide an opportunity to learn a#out specific diseases including #ut not limited to anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations !rovide an opportunity to learn a#out the ris+s, #enefits, contraindications and necessary monitoring of pharmacotherapy /including anti-histamines, glucocorticoids and other anti-inflammatory drugs, leu+otriene inhi#itors, anti#iotics, I=I', #iologic response modifiers, cytotoxic drugs, immunosuppressive drugs0, allergen avoidance and immune interventions /allergen immunotherapy, desensiti9ation, immuni9ation0 /.0 !rovide an opportunity to develop a differential diagnosis and therapeutic plan in complicated patients #y drawing upon the experience of multiple allergist/clinical immunologists /20 !rovide an opportunity for self-study through critical review of the literature /30 !rovide an opportunity for the application of the data o#tained from a critical review of the literature to patient evaluation and treatment /60 !rovide an opportunity for developing teaching and presentation s+ills /&0 !rovide an opportunity to review histologic specimens with a pathologist

O/5e't$,es &- Case C&!-ere!'e /)0 4ellows will learn a#out specific diseases including #ut not limited to anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis,

15

sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations 4ellows will learn a#out the ris+s, #enefits, contraindications and necessary monitoring of use pharmacotherapy /including anti-histamines, glucocorticoids and other anti-inflammatory drugs, leu+otriene inhi#itors, anti#iotics, I=I', #iologic response modifiers, cytotoxic drugs, immunosuppressive drugs0, allergen avoidance and immune interventions /allergen immunotherapy, desensiti9ation, immuni9ation0 in a didactic setting and will draw upon the experience of other allergist/clinical immunologists /.0 4ellows will draw upon the experience of other allergist/clinical immunologists to develop s+ills in formulating an appropriate differential diagnosis and treatment plan /20 4ellows will develop the s+ills necessary for life-long learning and teaching /30 4ellows will gain experience in interpreting histologic specimens

Met2&#s &- Tea'2$!% -&r Case C&!-ere!'e Case Conference is held approximately 2 times per month %uring this conference a case in which there is a diagnostic or treatment dilemma is presented #y a fellow or #y a resident rotating on the service with the assistance of the fellow This is followed #y discussion #y the group and review of any histologic specimens #y a pathologist This is followed #y a critical review of the literature focusing on evidence-#ased medicine E,a)0at$&! &- Case C&!-ere!'e /)0 "valuation of the 4ellowD An evaluation form will #e completed at the end of each conference #y attendees The fellow will #e evaluated semi-annually through ver#al feed#ac+ gathered #y the !rogram %irector from the faculty Residents who complete an Allergy/Immunology and Rheumatology elective will provide feed#ac+ on the fellow:s effectiveness as a teacher 8emi-annually, the !rogram %irector will review with the fellow his evaluation forms and ver#al feed#ac+ /.0 "valuation of the Case ConferenceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from faculty and fellows At the end of the year the fellows will complete an anonymous evaluation of the program # multidisciplinary conference E#0'at$&!a) G&a)s &- M0)t$#$s'$.)$!ary C&!-ere!'e /)0 !rovide an opportunity to learn a#out specific diseases including #ut not limited to diffuse anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations /.0 !rovide an opportunity to learn a#out the ris+s, #enefits, contraindications and necessary monitoring of use nonsteroidal anti-inflammatory drugs, disease-modifying drugs, #iologic response modifiers, glucocorticoids, and cytotoxic drugs /20 !rovide an opportunity to develop a differential diagnosis and therapeutic plan in complicated patients #y drawing upon the experience of multiple allergist/clinical immunologists /30 !rovide an opportunity for self-study through critical review of the literature

16

/60 !rovide an opportunity for the application of the data o#tained from a critical review of the literature to patient evaluation and treatment /&0 !rovide an opportunity for developing teaching and presentation s+ills /I0 !rovide an opportunity continuous -uality improvement /G0 !rovide an opportunity to review histologic specimens with a pathologist O/5e't$,es &- M0)t$#$s'$.)$!ary C&!-ere!'e /)0 4ellows will learn a#out specific diseases including #ut not limited to anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations in a didactic setting and will draw upon the experience of other allergist/clinical immunologists /60 4ellows will learn a#out the ris+s, #enefits, contraindications and necessary monitoring of use nonsteroidal anti-inflammatory drugs, disease-modifying drugs, #iologic response modifiers, glucocorticoids, and cytotoxic drugs in a didactic setting and will draw upon the experience of other allergist/clinical immunologists/rheumatologist /&0 4ellows will draw upon the experience of other allergist/clinical immunologists/rheumatologist to develop s+ills in formulating an appropriate differential diagnosis and treatment plan /I0 4ellows will develop the s+ills necessary for life-long learning and teaching /G0 4ellows will develop the s+ills necessary for life-long continuous -uality improvement /@0 4ellows will gain experience in the interpretation of histologic specimens Met2&#s &- Tea'2$!% -&r M0)t$#$s'$.)$!ary C&!-ere!'e (ultidisciplinary Conference is held once per month and is a mor#idity and mortality conference Although named multidisciplinary Conference, cases presented and discussed include any allergic or rheumatologic disease or any systemic disease with allergic or rheumatologic manifestation %uring this conference a very complex case in which there is a diagnostic and treatment dilemma is presented #y a fellow or faculty mem#er This is followed #y a multidisciplinary discussion which includes ll relevant specialists who were involved in the case, review of pathologic specimens, and a review of the pertinent literature focusing on evidence-#ased medicine E,a)0at$&! &- M0)t$#$s'$.)$!ary C&!-ere!'e /)0 "valuation of the 4ellowD An evaluation form will #e completed at the end of each conference #y attendees /see attached0 The fellow will #e evaluated 8emi-annually through ver#al feed#ac+ gathered #y the !rogram %irector from the faculty Residents who complete an Allergy/Immunology and Rheumatology elective will provide feed#ac+ on the fellow:s effectiveness as a teacher 8emi-annually, the !rogram %irector will review with the fellow his evaluation forms and ver#al feed#ac+ /.0 "valuation of the (ultidisciplinary ConferenceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from faculty and fellows At the end of the year the fellows will complete an anonymous evaluation of the program c geriatric conference E#0'at$&!a) G&a)s &- Ger$atr$' C&!-ere!'e /)0 !rovide an opportunity to learn a#out specific diseases including #ut not limited to anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy,

17

/.0

/20 /30 /60 /&0 /I0

immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations as they relate to the geriatric population !rovide an opportunity to learn a#out the ris+s, #enefits, contraindications and necessary monitoring of use nonsteroidal anti-inflammatory drugs, disease-modifying drugs, #iologic response modifiers, glucocorticoids, cytotoxic drugs, antihyperuricemic drugs, and anti#iotic therapy as they pertain to the geriatric population !rovide an opportunity to develop an appreciation for the influences of age on patient expectations, -uality of life concerns, and end of life planning !rovide an opportunity for self-study through critical review of the literature !rovide an opportunity for the application of the data o#tained from a critical review of the literature to patient evaluation and treatment as it pertains to the geriatric population !rovide an opportunity for developing teaching and presentation s+ills !rovide an opportunity for reviewing histologic specimens with a pathologist O/5e't$,es &- Ger$atr$' C&!-ere!'e

/)0 4ellows will learn a#out specific diseases including #ut not limited to anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, immunodeficiency, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, connective tissue diseases /CT%0, rheumatoid arthritis /RA0, systemic lupus erythematosus /87"0, scleroderma /!880, polymyositis /!(0, dermatomyositis /%(0, seronegative spondyloarthropathies, vasculitis, and systemic diseases with rheumatic manifestations in a didactic setting and will draw upon the experience of other allergist/clinical immunologists/rheumatologist as well as geriatricians /.0 4ellows will learn a#out the ris+s, #enefits, contraindications and necessary monitoring of use nonsteroidal anti-inflammatory drugs, disease-modifying drugs, #iologic response modifiers, glucocorticoids, cytotoxic drugs, antihyperuricemic drugs, and anti#iotic therapy in a didactic setting and will draw upon the experience of other allergist/clinical immunologists/rheumatologist and geriatricians /20 4ellows will draw upon the experience of other allergist/clinical immunologists, rheumatologists and geriatricians to develop s+ills in formulating an appropriate differential diagnosis and treatment plan /30 4ellows will appreciate the uni-ue needs of the geriatric population as they pertain to expectations for health care, -uality of life, and end of life planning /60 4ellows will develop the s+ills necessary for life-long learning and teaching /&0 4ellows will gain experience in interpreting histologic specimens Met2&#s &- Tea'2$!% -&r Ger$atr$' C&!-ere!'e 'eriatric Case Conference is held twice a year and is a multidisciplinary conference, which focuses on a immunologic or rheumatologic disease or a systemic disease with a rhematologic manifestation %uring this conference a case in which there is a diagnostic or treatment dilemma in a geriatric patient is presented #y a fellow or faculty mem#er This followed #y a discussion which includes all relevant specialists, including a geriatrician, who were involved in the case, review of pathologic specimens /were applica#le0, and a review of the pertinent literature focusing on evidence-#ased medicine E,a)0at$&! &- Ger$atr$' C&!-ere!'e

18

/)0 "valuation of the 4ellowD An evaluation form will #e completed at the end of each conference #y attendees /see attached0 The fellow will #e evaluated semi-annually through ver#al feed#ac+ gathered #y the !rogram %irector from the faculty Residents who complete an Allergy/Immunology and Rheumatology elective will provide feed#ac+ on the fellow:s effectiveness as a teacher 8emi-annually, the !rogram %irector will review with the fellow his or her evaluation forms and ver#al feed#ac+ /20 "valuation of 'eriatric ConferenceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from faculty and fellows At the end of the year the fellows will complete an anonymous evaluation f the program E#0'at$&!a) G&a)s &- Gra!# R&0!#s /)0 !rovide an opportunity to participate in systematic reviews of diseases or treatments in greater depth than in Case Conference /.0 !rovide an opportunity to learn a#out the ris+s, #enefits, contraindications and necessary monitoring of therapies for less common allergic or rheumatologic diseases /20 !rovide an opportunity for self-study through critical review of the literature /30 !rovide an opportunity for the application of the data o#tained from a critical review of the literature to patient evaluation and treatment for less common allergic or rheumatic diseases /60 !rovide an opportunity for developing teaching and presentation s+ills /&0 !rovide and opportunity to draw on the experience of clinicians and researchers from other academic institutions O/5e't$,es &- Gra!# R&0!#s )0 4ellows will have an opportunity to participate in systematic reviews of diseases or treatments in greater depth than in Case Conference .0 4ellows will learn a#out the ris+s, #enefits, contraindications and necessary monitoring of therapies for less common allergic or rheumatologic diseases in a didactic setting 20 4ellows will draw upon the expertise of clinicians and researchers from other academic institutions 30 4ellows will develop the s+ills necessary for life-long learning and teaching Met2&#s &- Tea'2$!% -&r Gra!# R&0!#s 'rand Rounds are held intermittently through the year They consist of a scholarly review of a topic pertinent to Allergy/Immunology/Rheumatology that has not presented itself through a Case Conference or on which a more detailed review is desired It also provides a venue for visiting clinicians and researchers to share their expertise through a scholarly presentation on a topic for which they are an expert in the field E,a)0at$&! &- Gra!# R&0!#s /)0 "valuation of the 4ellowD An evaluation form will #e filled out at the end of each conference #y attendees /see attached0 The fellow will #e evaluated semi-annually through ver#al feed#ac+ gathered #y the !rogram %irector from the faculty Residents who complete an Allergy/Immunology and Rheumatology elective will provide feed#ac+ on the fellow:s effectiveness as a teacher 8emi-annually, the !rogram %irector will review with the fellow his evaluation forms and ver#al feed#ac+ /.0 "valuation of =isiting 4acultyD An evaluation form will #e completed at the end of each conference #y attendees /20 "valuation of 'rand Rounds ConferenceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from faculty and fellows At the end of the year the fellows will complete an anonymous evaluation of the program

19

CA8" C;?U?%RU(8D The conference is held wee+ly and cases are presented #y faculty and fellows

E#0'at$&!a) G&a)s &- Case C&!0!#r0" /)0 !rovide an opportunity to discuss cases which pose a diagnostic, therapeutic, or ethical dilemma in an informal setting /.0 !rovide an opportunity to discuss practical day to day issues of patient care /20 !rovide an opportunity for continuous -uality improvement O/5e't$,es &- Case C&!0!#r0" /)0 4ellows will develop the a#ility to diagnosis and manage complicated patients #y drawing on the experience of multiple allergist/clinical immunologists/rheumatologist /.0 4ellows will develop the s+ills necessary to address day to day practice issues in patients with rheumatologic pro#lems /20 4ellows will develop the s+ills necessary for life-long continuous -uality improvement Met2&#s &- Tea'2$!% -&r Case C&!0!#r0" Conference will #e held once per wee+ Cases will #e presented #y fellows and faculty mem#ers ?o formal presentation will #e prepared The presenter will pose his -uestion/s0 to the group The focus of the conference will #e on group discussion of the -uestions proposed #ased on personal experience and expertise and personal +nowledge of the literature Met2&#s &- E,a)0at$&! -&r Case C&!0!#r0" 8emi-annually, the !rogram %irector will elicit feed#ac+ from the faculty and fellows At the end of the year, fellows will complete an anonymous evaluation of the program 2 F;UR?A7 C7U$/R"8"ARC* C;?4"R"?C" /monthly0 a ,ournal clu# E#0'at$&!a) G&a) &- J&0r!a) C)0/ /)0 !rovide an opportunity to review current scholarly pu#lications which are pertinent to allergy, immunology and rheumatology in order to increase ones #asic fund of +nowledge /.0 !rovide an opportunity to develop expertise in the critical review of peer reviewed literature /20 !rovide an opportunity to develop the a#ility to apply critically reviewed literature to the diagnosis and management of patients with allergic or rheumatologic diseases /30 !rovide an opportunity to develop life-long learning s+ills O/5e't$,es &- J&0r!a) C)0/ /)0 4ellows will increase their #asic fund of +nowledge as it applies to allergy, immunology and rheumatology and will develop an understanding of design, implementation and interpretation of research studies /.0 4ellows will develop the s+ills necessary to critically review pu#lished data /20 4ellows will learn to interpret and appropriate apply pu#lished data to the diagnosis and management of patients with allergic or rheumatologic diseases /30 4ellows will develop the s+ills necessary for life-long learning

20

Met2&#s &- Tea'2$!% -&r J&0r!a) C)0/ Fournal Clu# will #e held monthly ;ne to three articles, depending on length and complexity will #e presented at each meeting 4ellows and faculty mem#ers will present Articles will #e chosen from ?ature, 8cience, Cell, Fournal of Clinical Investigation, Fournal of Immunology, Fournal of Allergy and Clinical Immunology, Arthritis and Rheumatism, ?ew "ngland Fournal of (edicine, or Annals of Internal (edicine !resenters will discuss and criti-ue the techni-ues used, statistical analysis, results and conclusions E,a)0at$&! &- J&0r!a) C)0/ /)0 "valuation of the 4ellowsD 8emi-annually, the !rogram %irector will gather ver#al feed#ac+ on the fellow:s participation from the faculty and share it with the fellows /.0 "valuation of the 4acultyD 8emi-annually, the !rogram %irector will o#tain feed#ac+ from the fellows and share it with the faculty At the end of the year, the fellows will complete an anonymous evaluation of the faculty /20 "valuation of the 4acultyD At the end of the year, the fellows will complete an anonymous evaluation of the program # research conference E#0'at$&!a) G&a)s &- Resear'2 C&!-ere!'e /)0 !rovide a format in which to discuss preliminary results of current research in progress at the University of Rochester /.0 !rovide an understanding of study design and implementation /20 !rovide an understanding of state-of-the-art research techni-ues /30 !rovide an opportunity to increase ones fund of +nowledge as it pertains to immunology and molecular #iology /60 !rovide an opportunity for fellows to discuss their research and o#tain constructive feed#ac+ regarding the interpretation of current data and direction for future studies O/5e't$,es &- Resear'2 C&!-ere!'e /)0 4ellows will remain informed a#out current research pro,ects and preliminary results at the University of Rochester that are pertinent to allergy, immunology and rheumatology /.0 4ellows will develop expertise in study design and implementation /20 4ellows will develop expertise in the application if data generated using of state-of-the-art research techni-ues including its limitations /30 4ellows will expand their #asic science fund of +nowledge as it pertains to allergy, immunology and rheumatology /60 4ellows will receive constructive guidance in their research endeavors /&0 4ellows will develop the necessary s+ills for effective presentation of data Met2&#s &- Tea'2$!% -&r Resear'2 C&!-ere!'e Research Conference will #e held monthly 4ellows will #e expected to present at least yearly %uring their first year, they will present their scholarly review of the existing data which is pertinent to their area of investigation as well as their hypothesis and study design They will have the guidance of their chosen mentor with the development of the hypothesis and study design 4aculty mem#ers in the Allergy/Immunology Unit will present updates of their research pro,ects and new preliminary data ;ther faculty at the University of Rochester who are actively

21

investigating areas of interest with application to allergy, immunology and rheumatology will also #e invited to present E,a)0at$&! &- Resear'2 C&!-ere!'e /)0 "valuation of the 4ellowD %uring the -uarter in which the fellow presents, the !rogram %irector will gather ver#al feed#ac+ from the faculty /see attached0 and share it with the fellow /.0 "valuation of the 4acultyD 8emi-annually the !rogram %irector will elicit ver#al feed#ac+ from the fellows and share it with the faculty At the end of the year, the fellow will complete an anonymous evaluation of the faculty /20 "valuation of the Research ConferenceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from the faculty and fellows At the end of the year, the fellow will complete an anonymous evaluation of the program 3 A77"R'B C;?4"R"?C" is held wee+ly This conference is attended #y the Allergy/Immunology 4ellows and %rs 7ooney and Rosenfeld and community Allergists

E#0'at$&!a) G&a)s &- A))er%y C&!-ere!'e /)0 !rovide an opportunity to systematically cover clinical topics in allergy /.0 !rovide an opportunity to discuss research design and techni-ues peculiar to allergy /20 !rovide an opportunity to present new research advances in allergy and identify -uestions that still need to #e answered O/5e't$,e &- t2e A))er%y C&!-ere!'e /)0 4ellows will increase their clinical +nowledge as it applies to allergy and will develop an understanding of design, implementation and interpretation of research studies /.0 4ellows will increase their #asic fund of +nowledge as it applies to allergy and will develop an understanding of design, implementation and interpretation of research studies /20 4ellows will develop the s+ills necessary to critically review pu#lished data /30 4ellows will learn to interpret and appropriately apply pu#lished data to the diagnosis and management of patients with allergic diseases /60 4ellows will develop the s+ills necessary for life-long learning Met2&#s &- Tea'2$!% /)0 The clinical and #asic aspects of anaphylaxis, asthma, atopic dermatitis, contact dermatitis, drug allergy, food allergy, rhinitis, sinusitis, stinging insect hypersensitivity, urticaria and angioedema, #ronchopulmonary aspergillosis, eosinophilic disorders, hypersensitivity pneumonitis, mastocytosis, ocular allergies, occupational lung disease, will #e covered using *olgateKs and (iddletonKs text#oo+ as well as selected primary research articles /.0 %iscuss and in some cases practice s+ills such as allergen immunotherapy, immediate and delayed s+in testing, drug desensiti9ation and challenge, I=I' treatment, methacholine and other #ronchial challenge testing, performance and interpretation of pulmonary function testing, exercise challenge, nasal cytology, oral challenge testing, patch testing, rhinolaryngoscopy E,a)0at$&! &- t2e A))er%y C&!-ere!'e 8emi-annually, the !rogram %irector will elicit the ver#al feed#ac+ of faculty and fellows At the end of the year, the fellows will evaluate the program 6 I((U?;7;'B/8TATI8TIC8

22

E#0'at$&!a) G&a)s &- t2e I""0!&)&%y C&0rse /)0 !rovide a #asic and advanced understanding of the principles of immunology including #ut not limited to an understanding of cellular elements of the immune system, immune and inflammatory mechanisms, cellular interactions and immunomodulation, immune responses, and immunoregulation /.0 !rovide an understanding of the current theories of pathogenesis of immune mediated diseases /20 !rovide an understanding of the current research exploring the pathogenesis of immune mediated diseases /30 !rovide an opportunity to develop life-long learning s+ills /60 !rovide an opportunity to interpret and apply the literature as it pertains to #asic immunology O/5e't$,es &- t2e I""0!&)&%y C&0rse /)0 4ellows will develop a sophisticated understanding of the principles of #asic immunology /.0 4ellows will develop an understanding of the current +nowledge regarding the pathogenesis of immune mediated diseases /20 4ellows will develop the s+ills necessary for life-long learning /30 4ellows will develop the a#ility to critically review the #asic science literature Met2&#s &- Tea'2$!% $! t2e I""0!&)&%y C&0rse The first six months of the year are focused upon developing a solid #ac+ground in #asic immunology using Immuno#iologyD The Immune 8ystem in *ealth and %isease, 3th "dition #y Charles Faneway /see Recommended Reading 7ist0 as well as relevant review articles "ach wee+, the first year fellow/s0 lead/s0 a discussion of the assigned chapter in Immuno#iologyD The Immune 8ystem in *ealth and %isease while the senior fellow/s0 review a relevant peer reviewed article %uring the second six months of the year selected advanced topics such as *I=, transplant immunology, inflammation induced #one resorption, and others are covered This is done as a two wee+ #loc+ with the first wee+ dedicated to the review of recent original articles on the su#,ect %uring the second wee+, an invited expert on the topic leads the discussion E,a)0at$&! &- t2e I""0!&)&%y C&0rse /)0 "valuation of the 4ellowD ;n semi-annually #asis, the !rogram %irector will elicit ver#al feed#ac+ from the faculty and will share it with the fellow /.0 "valuation of the 4acultyD 8emi-annually the !rogram %irector will elicit ver#al feed#ac+ from the fellows and will share it with the faculty At the end of the year, the fellows will complete an anonymous evaluation of the faculty /20 "valuation of the Immunology CourseD 8emi-annually the !rogram %irector will elicit ver#al feed#ac+ from the faculty and fellows At the end of the year, the fellows will complete an anonymous evaluation of the program & ("%ICA7 'RA?% R;U?%8

(edical 'rand Rounds are held wee+ly and offer scholarly presentations on the #road spectrum of diseases encompassed #y Internal (edicine 'rand Rounds also address medical/legal issues, medical ethics, and the uni-ue issues of aging

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A9 Resear'2 a!# S'2&)ar)y A't$,$t$es ) Research "xperienceD "ach fellow will, with the guidance of a faculty mentor, #e involved in a research pro,ect which may #e clinical or #asic science in nature They will also #e involved in the enrollment, evaluation, and monitoring of patients in clinical trails

E#0'at$&!a) G&a)s &- t2e Resear'2 E:.er$e!'e /)0 /.0 /20 /30 /60 /&0 %evelop an understanding of the design and implementation of an original research pro,ect %evelop an understanding of the role of statistics in the design of a study %evelop an understanding of the role of statistics in the interpretation of original data %evelop an understanding of informed consent %evelop the s+ills necessary for critical review of pu#lished data %evelop the a#ility to communicate findings clearly utili9ing #oth written and ver#al venues O/5e't$,es &- t2e Resear'2 E:.er$e!'e /)0 4ellows will gain experience in the design and implementation of an original research pro,ect /.0 4ellows will gain experience in the use of statistics in the design of a study /20 4ellows will gain experience in the use of proper statistical methods for interpretation of data generated through original experiments /30 4ellows will learn the responsi#le use of informed consent /60 4ellows will gain experience in critical review of the literature /&0 4ellows will gain experience in writing a#stracts for presentation at meetings, in writing articles for pu#lication, and in presenting data in conferences /I0 4ellows will develop the s+ills necessary for life-long learning Met2&#s &- Tea'2$!% D0r$!% t2e Resear'2 E:.er$e!'e %uring the first year of the fellowship, the fellow will meet with individual faculty mem#ers to discuss their research Upon deciding on a pro,ect, the fellow will complete a review of the relevant literature and preliminary data, and under the guidance of his mentor, will develop a hypothesis and experimental plan This will #e presented to the Unit at a Research Conference %uring the second year, the fellow will carry out the proposed experiments, interpret the data, and prepare the results for pu#lication This will occur under the supervision of a faculty mentor The will attend appropriate University seminars and appropriate national and regional meetings to gain further insight into their field of study The fellow will also present his data at Unit Research Conference/s0 %uring #oth years of fellowship, the fellow will wor+ under the supervision of a faculty mem#er as they participate in clinical trials ongoing in the Unit They will #e involved in the enrollment, evaluation and monitoring of patients E,a)0at$&! D0r$!% t2e Resear'2 E:.er$e!'e /)0 "valuation of the 4ellowD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from the faculty and will share it with the fellow /.0 "valuation of the (entorD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from the fellow and will share it with the faculty At the end of the year, the fellow will complete an evaluation of his mentor /20 "valuation of the Research "xperienceD 8emi-annually, the !rogram %irector will elicit ver#al feed#ac+ from the faculty and fellows At the end of each year, the fellow will complete an anonymous evaluation of the program

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ALLERGY/CLINICAL IMMUNOLOGY FELLO;SHIP READING LIST The following is a list of resources for pertinent reading during the fellowship It includes clinical and #asic sciences references /)0 /.0 /20 /30 /60 AAAAI Recommended Reading 7ist for 4ellows .AA) /see attached0 Allergy, .ne "dition, "d 8tephen T *olgate, (os#y, 7ondon, .AA) !atterson:s Allergic %iseases 6the "dition, "d ! A 'reen#erger and 7 ' 'rammer Allergy !rinciples and !ractice, 6th "dition, " (iddleton, Fr , (os#y, 8t 7ouis, )@@G Text#oo+ of Rheumatology, 6th "dition, "d 1elly, *arris, Ruddy, and 8ledge, > $ 8aunders, !hiladelphia, )@G) /&0 Immuno#iologyD The Immune 8ystem in *ealth < %isease , 6th "dition, "d Faneway, Avery !u#lishing, "ast Rutherford, .AA) /I0 FACI, current articles /G0 Arthritis and Rheumatism, current articles /@0 Annals of Internal (edicine, current articles /)A0?ew "ngland Fournal of (edicine, current articles /))0?ature, current articles /).08cience, current articles /)20Fournal of "xperimental (edicine, current articles /)30Fournal of Immunology, current articles /)60Cell, current articles /)&0Immunity, current articles /)I0Fournal of Clinical Investigation, current articles

$y signing #elow, I indicate that I have received and read a copy of this curriculum and have had the opportunity to have my -uestions answered

HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH 8ignature of the 4ellow

HHHHHHHHHHHHH %ate

Revised &/.A)A

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