The required and elective clinical rotations are performed at the following components of the University of Washington Allergy and Immunology (A&I) training program:
UWMC is a 450-bed teaching and research hospital offering comprehensive care including complete medical, surgical, ob-gyn, and psychiatric services and is rated as one of the top-10 hospitals in the U.S. Adult Asthma and Allergy clinics are located at UWMC. Patients are referred from the UW Medicine sites and from community practitioners from the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) region. UWMC offers A&I fellows a wide mix of inpatient and ambulatory patients referred from primary care to specialized tertiary care, plus opportunities for research. Fellows gain exposure to the most severe/complex cases of asthma and other allergic disorders. Elective rotations are available in related specialties and training in clinical immunology laboratory methods is provided.
The SCH Immunology Clinic, a national referral center for pediatric and adult patients with primary immunodeficiency disorders (PIDD), is the primary site for training A&I fellows in the evaluation and treatment of patients with PIDD including use of IVIG, immunomodulators, and bone marrow transplantation for severe combined immune deficiencies (SCID) or SCID-like disorders. SCH subspecialty clinics provide exposure to both rare and common pediatric immune-mediated and allergic diseases not available at any other location in the region. SCH also provides an inpatient environment where fellows directly participate in the management of pediatric A&I patients including children with severe asthma.
HMC is a King County-owned medical facility operated by UW. This major UW facility has unique features, including a regional trauma center and an ethnically and socially diverse population. Of note, the Occupational Medicine and Environmental Health elective at HMC is centered around regularly scheduled diagnostic and surveillance outpatient clinics and an environmental challenge chamber is available for occupational agent provocation testing. Residents rotating through the HMC Dermatology Clinic gain experience in patch testing in the evaluation of contact dermatitis. Elective rotations in other related specialties are available including Pulmonary Medicine with Pulmonary Function Laboratory and Rheumatology.
MAMC has a beneficiary population exceeding 350,000 within a six-state region and ~120,000 soldiers, family members, and retirees in its 40-mile catchment area. MAMC (350 physician staff) averages 821,000 outpatient visits per day with 126 inpatients per day. The MAMC A&I clinics are staffed by 2 ABAI-certified A&I attending physicians and both pediatric and adult patients are seen. As part of he allergy and immunology clinics, is the vaccination clinic where routine and biodefense (e.g., smallpox and anthrax) vaccines are administered. Since MAMC A&I clinics treat patients from outside the Pacific Northwest, skin testing includes a wider geographic range of aeroallergens and desensitization strategies (e.g. fire ant immunotherapy) than at other UW A&I teaching sites.
NAAC is a multi-center, private A&I practice in Seattle with satellite clinics throughout Puget Sound and has 12 ABAI-certified A&I specialists who are clinical faculty at the UW School of Medicine and its affiliated hospitals. There are annually ~70,000 patient visits in the Puget Sound NAAC clinics with ~50% of the patients pediatric. NAAC clinic assignments provide the A&I residents with experience with protocol-driven diagnostic and therapeutic approaches to an efficient, patient-oriented clinical practice. NAAC also provides experience in diagnosis and management of vocal cord dysfunction including performance of rhinolaryngoscopy, methacholine challenge, and free running exercise challenge. Exposure is provided to the conduct of clinical research trials in asthma and allergy.
VMMC is a large private, non-profit organization based in Seattle with over 390 physicians offering both primary and specialized care, a regional network of neighborhood clinics, and 336 bed hospital. The VMMC clinic is staffed by 3 ABAI-certified A&I attending physicians who see both adult and pediatric patients. The A&I service is integrated with the Rheumatology service such that A&I residents also gain exposure to the diagnosis and management of patients with rheumatologic disorders. VMMC provides an important teaching venue for patient oriented clinical practice including training in appropriate coding, documentation, and billing. Opportunities for research are with the Division of Basic Immunologic Research in the Division of Clinical Immunology at VMMC.