Information for Residents Rotating in Allergy/Clinical Immunology. Welcome to your rotation in Allergy/Clinical Immunology. Enclosed you will find:

Transcription

1 Information for Residents Rotating in Allergy/Clinical Immunology Welcome to your rotation in Allergy/Clinical Immunology. Enclosed you will find: 1. Rotation specific objectives. 2. Transcription requirements. 3. A list of resources in the Division for further reference. The Allergy/Clinical Immunology rotation will include primarily outpatient clinics with some inpatient exposure. Most clinics take place at McMaster University Medical Centre MUMC with adults being in 4Y (Boris Clinic) and paediatrics in 3F. The Adverse Reactions Clinic sees both adult and pediatric patients, mainly for drug and venom allergy. This clinic is located at the Firestone Institute for Respiratory Health at St. Joseph s Hospital. It is your responsibility to ensure you attend all clinics for which you are scheduled. If you are unable to attend a clinic please let the attending staff and chief fellow know. Internal medicine rotators are also responsible for notifying the program office on the day of any unplanned absence. Note: Tuesday and Wednesday morning clinics for Dr. and Dr. are Adverse Reactions Clinic and therefore take place at St. Joseph s hospital. Residents will also participate in the Allergy/Clinical Immunology weekly rounds, and resident teaching sessions. The location of these teaching sessions are indicated on your clinic schedule. Consult service: Inpatient consultations may be received from any of the Hamilton Health Sciences sites, as well as St. Joseph s Hospital. Consults are always triaged via an Allergy & Immunology fellow or directly through attending staff if a fellow is not on call. You may be asked to see inpatient consults on weekdays between 9 and 5 if you are not scheduled in clinic. Educational Sessions: (You are expected to attend all bolded sessions, other session are optional) 1. Fridays 1:15PM-2:15PM - Resident rounds. These rounds are directed teaching for Allergy & Immunology fellows and rotators. Senior residents are expected to present at one of these rounds on an allergy/immunology topic of your choice. Sessions may be clinical or basic science-oriented. The location for these rounds is indicated in your clinic schedule. Please look carefully as it may vary from week to week. * Note in July & August these rounds are moved to 12:15-1:15* 2. Tuesdays, 9:00 to 11:00 AM Respirology half-day. Rotating residents can attend these rounds run by the Department of Respirology provided you do not have a scheduled clinic. Location is in the Campbell Auditorium at St. Joseph s Hospital (level 2). 3. Wednesdays 1:30 PM - Pediatric and Internal Medicine academic half-days. 4. Thursdays, 8:00 to 9:00 AM- Department of Medicine Grand Rounds, MUMC 4E20 (from September June). 1

2 5. Thursdays, 8:00-9:00 AM - Department of Pediatrics. Grand rounds MDCL Fridays, 12:00 to 1:00 PM - Allergy/Clinical Immunology Rounds. MUMC 4E20 (from September June). 7. Twice weekly rotator curriculum mandatory sessions held at lunch hour twice weekly; these sessions review basic allergy and immunology topics. They are given by the fellows. Attendance will be taken. See your clinic schedule for details on location and time. 8. Any additional teaching sessions, video conferences will be announced separately. The general philosophy of the Allergy/Clinical Immunology rotation will be learning and teaching in the setting of graded responsibility. For most of the rotation, in addition to direct staff supervision, a PGY-4 or PGY-5 in Allergy/Clinical Immunology will be involved in teaching and supervision. Dictations: Residents are expected to dictate on patients they have seen in the clinic. All letters are dictated on the central dictation system using your own dictation number. Adverse Reactions Clinic and Dr. Denburg s clinic letters are dictated via Dictaphone. Dictaphones may be obtained from the attending physician at the clinic. Tapes may be obtained from either Anna Scime (secretary to Drs. and ) for adverse reactions clinics or Monica Diana (secretary to Dr. Denburg) for Dr. Denburg s clinic. When dictations are completed place the tape in an envelope and label them as follows: Date, your name, the staff person s name, the location of the clinic (Boris Clinic or Adverse Reactions Clinic) and list the names of the patients that you are dictating on. Dictations will be read by the staff and given back to you as a form of feedback. If you are unfamiliar with how to dictate please ask either a fellow or staff. For Dr. s clinic, tapes and charts should be given to Anna Scime at McMaster when dictations are complete. For Dr., dictations should be completed at the Firestone and charts left with Gail at reception. Tapes should then be returned to Anna Scime. Evaluations: For each week of rotation, there are specific evaluation requirements. These are detailed in the evaluation forms document forwarded to you with your initial clinic schedule. It is the responsibility of the rotator to ensure the required evaluation are complete. You will also be assigned a time for mid and final rotation evaluations. You are expected to attend your evaluation at that time bringing your evaluation forms. If you are unable to attend you should make alternative arrangements as soon as possible. Recommended Readings: 1. JACI allergy & immunology primers: Access the following preface through Libaccess/Pubmed - Links are seen below to individual topic primers. Journal of clinical immunology Preface to the primer on allergic and immunologic disease. 2

3 Shearer WT. This resource provides some more in detailed basis with a focus on basic science. This is a great resource to read further on a topic or to prepare for a presentation. 2. AAAAI Practice Parameters/Guidelines. Access through link below: This provides the current guidelines on the major topics encountered in the practice of allergy and immunology. Evidence and reasoning behind each practice point is provided. 3. Practical guide to allergy and immunology in Canada This provides short summary articles on the major topics in the practice of allergy and immunology. This is a great start to get a brief summary then use the other two resources to really enhance your knowledge. A useful resource is the Primer of Rheumatological Diseases published by the Arthritis Society of Canada. The Hamilton Health Sciences Library and the online HHSC website carries Middleton s textbook of Allergy and Immunology, which is a comprehensive and reputable resource. Other Resources and References: 1. Allergy: Principle and Practice (6 th Edition 2003), Middleton and Reed. 2. Current Therapy in Allergy, Immunology, and Rheumatology (5 th Edition 1996), Lichtenstein and Fauci. 3. Training Program Directors Reading List - sponsored by the American Academy of Allergy, Asthma, and Immunology. ( 4. American College of Allergy, Asthma, and Immunology Practice Parameters. ( 5. MKSAP Allergy and Immunology (3 rd Edition 2000) and full series. 6. Handbook of Clinical Immunology Laboratory procedures prepared for residents by clinical laboratory staff. Other Resources and References 1. Nelson Textbook of Pediatrics (19 th edition, 2011), Kliegman et al. 2. Immunologic Disorders of Infants and Children (5 th edition, 2004), Stiehm et al. 3. Textbook of Pediatric Rheumatology (6 th edition, 2011), Cassidy et al. 4. A Resident s Guide to Pediatric Rheumatology, (2 nd edition 2014) Laxer and Cellucci (available in 3F clinic) 5. Journals: Journal of Allergy and Clinical Immunology. Annals of Allergy, Immunology Today, New England Journal of Medicine, Annals of Internal Medicine Clinical and Experimental Allergy (online and in Dr. s office). 3

4 Rotation Specific Objectives: At the end of this rotation, you will be able to: Overall Objectives: Perform history and physical examination relevant to the Allergy/Clinical Immunology patient. Manage common problems in Adult & Pediatric Allergy/Clinical Immunology patients. Specific Objectives: o Allergic and Non-Allergic rhinitis. The resident will encounter different types including seasonal and perennial allergic rhinitis, vasomotor rhinitis, non-allergic rhinitis, and rhinitis secondary to medication. Diagnosis as well as the role of allergy skin testing, and management will be emphasized. o Asthma and cough syndromes. The resident will be able to differentiate asthma from other causes of cough including gastroesophageal reflux, cough secondary to nasal disease, cough secondary to medication, and to occupational causes if applicable. Work up for asthma including the role of allergy skin tests, pulmonary function, will be emphasized. Also, the resident will understand the different medications used in treatment, and the asthma action plan. o Food allergies. The resident will be able to diagnose and manage common food allergies in adults and children, and counsel the patient on proper avoidance measures and the use of an Epi-pen. o Urticaria. The resident will be able to diagnose acute and chronic urticaria, and their different etiologies as well as make recommendations regarding management. o Adverse reactions. In this clinic, the resident will encounter adverse reactions to a variety of antibiotics, local and general anesthetics (where available), stinging insects, latex, etc. The resident will develop a strategy to diagnose and manage adverse reactions with a focus on certain drugs, e.g., Penicillin, ASA, NSAIDs, and others. o Autoimmune disease. The resident will diagnose and manage common autoimmune diseases including SLE, Sjögren s syndrome, mixed connective tissue disease, as well as some of the common vasculitities including PAN and Wegener s (where available). The resident will understand the role of biopsy and autoantibody testing as well as management including the use and side effects of the different immunosuppressive agents. Skills and Procedures: o The resident will understand the role of allergy skin tests and their interpretation as well as environmental avoidance measures. The resident will also understand the role and interpretation of relevant pulmonary function tests. o The resident will understand how to use and demonstrate the Epi-pen. 4

5 Clinic Locations MUMC: McMaster University Medical Centre, 1200 Main St. West. The Boris Clinic in 4Y is located on the 4 th floor near the yellow elevators. The 3F pediatric clinic is located on the 3 rd floor between the red and purple elevators. St. Joseph s Hospital is located at 50 Charlton Avenue East. Parking is in the Fontbonne building connected to the main hospital, with entrance off of James Street. The Firestone clinic is located in the Juravinski tower near the corner of James and Charlton on the main floor. Within the hospital you will find it near the main Tim Hortons. Right about here. 5

6 McMaster Allergy and Immunology Clinic Schedule schedule may be adjusted on a week by week basis McMaster University Medical Centre (MUMC) 4Y= Adult (Boris Clinic) MUMC 3F = Pediatrics SJH = St Joseph s Hospital Firestone Clinic (adverse reaction clinic); Adult and Pediatrics Morning (9am unless indicated) Monday Tuesday Wednesday Thursday Friday Cyr SJH MUMC 3F Dent MUMC 3F SJH Quirt (8:30 am) SJH SJH Denburg (MUMC 4Y (8:30 am) Messieh (8:30 am) Haaland (8:30am) Quirt (8:30am) Senior resident clinic (8:30am) Abdurahman MUMC 3F Afternoon (1:30pm unless indicated) (1:00pm) Mixed Immunology / Rheumatology None MUMC 3F Haaland 6