Year 1
During the first year of the fellowship the fellow has a continuity clinic (½ day per week) at each training site). There is an additional half day at CCF besides the continuity clinic which is spent performing joint injections on sedated children followed by an outpatient clinic for the remainder of the morning. At the primary clinical site, RB&C, the first year fellows spend ½ day per week in their own continuity clinic, and an average of 3 additional ½-days in general pediatric rheumatology clinics making for an average of 5-6 ½ days week in clinic. Three quarters of the RB&C clinics occur at satellite centers within 30 minutes from the main hospital, CCF is 5 minutes from RB&C; on the days on which fellows are off site, they are not expected to be immediately available to see consults. On Friday morning there is time for fellows to read x-rays with the musculoskeletal radiologists or to attend pediatric orthopedic clinic. Inpatient consultative experience occurs primarily at RB&C. The average number of consults is 2-3 per week and therefore consultative experience needs to be acquired over the entire first year since it is rare that an intensive consultative experience is available in pediatric rheumatology. Clinical responsibilities in years 2 and 3 are designed to accommodate the rules put forth by both the American Board of Pediatrics (ABP) regarding continuity clinics and research requirements, and by the NIH for fellows on training grants/NRSA’s. In addition to the regularly scheduled clinics, over the course of their training, fellows will rotate through genetics and rehabilitation services.
Fellows will regularly participate in and present at Rheumatology Grand Rounds (combined internal medicine and pediatrics). They will attend an immunology tutorial either offered by the American Association of Immunologists (spring week long conference) or by CCF (AM conference series). They will present at and attend CCF Rheumatology conferences and are required to attend the RB&C fellows course that meets once per month and is designed so that all fellows at RB&C will meet the ABP requirements for ethics training and training in research methodology. There is a biostatistics course offered annually be the General Clinical Research Center that fellows will be encouraged to attend except if they will receive formal biostatics program through participation in a Masters of Clinical Science program which is also available to them during the second and third years of their fellowship. The program director is responsible for assuring that the fellows acquire the appropriate skills and have access to the necessary resources and expertise to meet these goals. The first year of pediatric rheumatology training will be devoted to developing competency in the area of clinical practice. A syllabus will be distributed that contains key references in the disease specific area and the fellows will have required readings which will be monitored by the faculty.
Years 2 & 3
The goals of the second two years focus on research. Fellows will be asked to choose whether they are interested in basic science, clinical or education research during the early part of the first year. Research proposals will be developed in collaboration with the mentor and time allotted to develop a proposal for external funding during the first or early part of the second year of the fellowship. Basic science researchers will be expected to participate in regularly offered seminars at Case and if they are novices may choose to attend a molecular and cellular laboratory course either at Case or a two week intensive course during the summer of the second year. For fellows choosing the clinical research track every effort will be made to ensure that they attend some formal coursework at Case and they will be encouraged to enter either a certificate program in clinical research or a degree program in which they will obtain a Master’s degree. Fellows choosing the Medical Educator tract will be expected to develop a scholarly project in conjunction with a medical educator. Advice on the selection and mentor for the project will be sought from a nationally recognized rheumatology medical educator.
On call responsibilities (RB&C only):
Fellows will take call from home. The first year fellows will be on call 2 out of 4 week nights per week and 1 out of 4 weekends per month while on the consult service at RB&C. First year fellows will attend rounds on Saturday morning if there are patients in hospital who need to be seen (3 of 4 weekends per month). There will be a minimum of one weekend per month where the subspecialty resident has no clinical responsibility from Friday at 5 P.M. until Monday at 8 A.M. After Saturday A.M. rounds, the subspecialty resident will have no further clinical responsibilities until Monday at 8 A.M. (two out of four weekends). One of every four weekends the fellow will be on call. In contrast to the first year program, during the second and third years, the majority of the fellow’s time will be devoted to research and the clinical time will be substantially less. Faculty members will rotate call and will supervise the subspecialty resident directly during their on call weekend (one of four during years two and three).