Goals: In-depth analysis of a smaller number of patients with more complicated problems; exposure to unique problems that would not necessarily be seen in a community practice; exposure to patients with more severe problems who have failed therapy in a community practice.
Objectives: learn advanced techniques for diagnosis and management of more complicated patients and problems; learn appropriate use of other university subspecialists and coordination of care; become familiar with translational care, bringing the bench science to the bedside; learn how to interact with referring physicians. Since internal medicine, pediatric, and family medicine residents and medical students rotate through these clinics, the A&I fellows have the opportunity to do teaching.
Goals: in-depth exposure to a wide variety of patients with suspected and proven immunodeficiency disorders.
Objectives: learn the indications for evaluation for immunodeficiency, the appropriate initial and secondary laboratory evaluations; learn specific physical exam for signs of immunodeficiency or specific immunodeficiency disorders; learn the appropriate use of IVIG, bone marrow transplant and potentially gene therapy; learn appropriate F/U for immunodeficient patients; perform inpatient and outpatient consults on patients with suspected or known immunodeficiencies; complications of immunodeficiency therapy.
Goals: Exposure to a wide variety of patients with a broad spectrum of disorders that could present to the allergy office.
Objectives: learn an approach to the evaluation of problems that are not typical allergy problems, including appropriate laboratory evaluation and referral; learn specialty physical examinations; learn appropriate use of laboratory tests that are not common in an allergy practice; learn what patients should be referred and who can be cared for in an allergy practice.
Goals: exposure to a different viewpoint on the management of patients with allergic or infectious problems that can be managed in the allergy office.
Objectives: learn subspecialty surgery exams; learn appropriate indications for surgery; become familiar and observe specific surgical procedures for problems that are commonly seen in an allergy office.
Goals: familiarity with the use and performance of a variety of pulmonary function techniques.
Objectives: learn the appropriate tests to order for a given disorder or differential diagnosis; learn what tests are useful in distinguishing disease states; learn to interpret results of such tests.
Goals: exposure and hands-on experience with a wide variety of clinical laboratory immunology procedures.
Objectives: learn the principles behind various tests; clinical indication for certain tests; techniques used to perform tests; limitations and problems with certain tests; interpretation of results.
Combines some of the goals and objectives of community practices and university clinics with the additional experience of global health issues, international environments and exposures, bioterrorism issues and vaccination practice and adverse effects. In particular, MAMC treats soldiers and their families who have lived throughout the world due to assignments across the U.S., Asia, Middle East, Europe and other regions. This gives the residents exposure to patients who present with unusual infectious process and immune dysregulation. Highly mobile population of military patients typically have exposures to greater variety and different regional aeroallergens than is seen just in the Northwest. Residents are taught regional differences in the U.S. and how to write allergen immunotherapy to patients based on different geographic locations such as for fire ant hypersensitivity that is not seen frequently in the general Northwest population. Due to high risk of biologic weapons, army soldiers deploying receive smallpox and anthrax vaccinations. Residents are exposed to management of adverse effects with these and other vaccines. Residents have exposure to travel medicine and assessing for travel immunizations.
Goals: exposure to a large number of patients with a wide variety of allergy problems. Experience a variety of practice styles and practice models. Development of the skills necessary for the community practice of allergy, including business models.
Objectives: learn the keys to specialty history taking and physical examination; develop differential diagnoses for a specific clinical problem; become familiar with community and referral sources; learn appropriate tests including skin testing; develop management plans for a variety of problems; learn the prescription and preparation of immunotherapy sets, advancement protocols and maintenance doses, adjustment of dosing; become familiar with the principles of clinical research and design of protocols for research concepts.
To initiate a project, the A&I fellow is expected to perform outside reading of the biomedical literature in an area of interest. Both clinical and laboratory mentors with whom the fellow is working are expected to provide input into the area of interest, and also guidance regarding the literature in that area. A listing of the research faculty follows this section. Based on their interests and background reading, the A&I fellow will meet with the principal investigator (PI) of various laboratories, and discuss potential laboratory projects. Typically, the laboratory project will be in an area of focus of the PI, designed to accommodate the long term research interests of the A&I fellow, and feasible within a 2-year period of time. The choices of PI and project are also discussed and vetted with the training program head. Finally, upon choosing a laboratory, the fellow will establish a mentoring committee that will include the laboratory mentor and 2-3 additional faculty with synergistic expertise. The committee will assist in monitoring research progress and additional aspects of career planning for the fellow. Project completion is expected to coincide with the accumulation of sufficient data to lead to a publication. Through weekly meetings and on-going discussions with their laboratory head/mentor, the A&I fellows will acquire the ability to assess their data, and move their project towards a coherent and medically relevant conclusion. Once a coherent body of data is completed, the A&I fellow will be expected to write an initial draft of a manuscript, and will work with the laboratory head/mentor through subsequent drafts until a final draft satisfactory to both is generated. The A&I fellow and laboratory head/mentor will then choose a suitable journal, and submit the manuscript for review and publication.
The fellow is responsible for sufficient effort to complete the project with the expectation that the results will be reported at a national conference and submitted for publication in a peer-reviewed journal. The mentor in consultation with the program director/co-director individualizes the choice of course work. For example, UW A&I fellows to attend the core graduate course in Immunology (IMM 532, Advanced Immunology). This course covers the principles and experimental approaches relevant to understanding the development and function of the immune system, the molecular basis of immune responsiveness, regulatory mechanisms underlying immune tolerance and cellular homeostasis, and provides an introduction to anti-tumor immunology, host defenses to infectious diseases, and autoimmunity. Other courses, such as one or more of the 5-week Molecular and Cellular Biology graduate courses, may be appropriate in some cases. There is also a short course in Study Design and Statistics, offered through the Clinical Research Center, which trainees take. All trainees complete a formal course in the responsible conduct of research, and the relevant brief courses required for working with radioactive or biohazardous materials and animals as pertinent to their research studies. These courses are augmented by informal training experiences coordinated by the UW Department of Immunology, in which all trainees may participate: