Allergy and immunology fellowship at Children's Hospital of Richmond at VCU

The ACGME accredited Allergy/Immunology training period typically is two years in duration with the exception of the ABIM or Pediatric research tracks, which would extend their time in the program to fulfill the research requirements. Also, some trainees have been granted, at the request, an additional year of research training beyond the two years of training that enabled them to sit for the certification exam. 

Prerequisite training consists of completion of a residency in Internal Medicine or Pediatrics that would qualify them to sit for the certification exam of the American Board of Internal Medicine or the American Board of Pediatrics. Selection criteria consists of medical school performance, residency performance, USMLE scores, personal interview, ECFMG certification (if applicable), valid visa/green card/permanent residency card (if applicable) and other accomplishments (e.g., research publications) as considered appropriate. 

The goal of our Allergy/Immunology Program is to provide trainees with a comprehensive experience in allergy/immunology, both in the care of adult and pediatric patients with allergic and immunologic diseases and in scholarly activities related to this field that are tailored to the interests of each trainee.? Clinical training consists of practical clinical rotations, didactic instruction, conference preparation and presentation and both self-directed an assigned reading. Clinical rotations are designed to provide our residents with the knowledge base and technical proficiency that they will need to become outstanding practitioners of allergy and immunology and in some cases to pursue academic careers as clinician-educators or research investigators. 

Clinical training in both pediatric and adult allergy emphasizes both inpatient and outpatient management of allergic and immunologic disease. The majority of clinical practice is in the outpatient setting, with approximately 400 adult and 600 pediatric allergy outpatients seen in the allergy clinics each month in 2 VCU and 2 satellite locations. Active in-hospital consultative practices are provided at VCU Medical Center, and with a tendency toward a greater volume of adult consults versus pediatric. Overall contact breaks down to about 60% pediatric and 40% adult patients. In addition to the routine outpatient and inpatient consultative encounters, fellows are expected to participate in daily rounds on patients with primary immunodeficiency who are being treated with bone marrow transplantation. Elective rotations include bone marrow transplantation, community allergy practice, and rhinoscopy in the otolaryngology clinics. Some cross training in rheumatology is provided, but fellows may additionally elect to participate in adult or pediatric rheumatology clinics.

Ample opportunities are available to pursue basic and clinical research. Each fellow is expected to develop has his or her own research project that they work on, in addition to any projects they may have teamed up with the faculty to pursue. Fellows can team up with faculty to work on many different projects.? Basic science research opportunities are available in the areas of mast cell biology and basic immunology. Trainees have participated in studies defining two types of human mast cells, cloning of the gene(s) for mast cell tryptase, and development of immunoassays for tryptase to serve as precise clinical indicators of mast cell involvement in human disease. Clinical research focuses on training fellows in principles of clinical research including designing, collaborating, collecting data, interpreting and writing a paper. Clinical research opportunities in asthma, urticaria, immunodeficiency, anaphylaxis, eosinophilic esophagitis, mastocytosis, desensitization and allergic rhinitis are available to fellows. 

For two to three months beginning in July of each year, a series of basic lectures is given by the faculty to orient and educate the first-year fellows on the most common conditions seen in the clinics. This also serves as review of potential board material for upper level fellows. First-year fellows also required to attend and pass the graduate-level Immunobiology course offered by the VCU School of Medicine. Additionally, educational conferences are held on a regularly scheduled basis with attendance required of all fellows and faculty. 

• Clinical allergy/immunology journal club – Friday afternoons 
• Basic allergy/rheumatology journal club – Friday afternoons 
• Allergy/rheumatology Grand Rounds – Friday afternoons? 
• Medical Grand Rounds – Thursday at noon 
• Pediatric Grand Rounds – Tuesday at noon 

As part of fellowship training, regularly scheduled sessions are held for fellows in the VCU simulation lab to enhance patient safety and quality care. Examples include treating status asthmaticus and acute anaphylaxis. 

Also, while the standard training program is two years, fellows with a strong interest in basic science or clinical research are encouraged to apply for funding for third year of training, with time protected for research pursuits. 

During the two years of training, each fellow will attend both the national conferences (AAAAI and ACAAI) and is encouraged to attend other meetings on the national level (e.g., Clinical Immunology Society) and regional level (e.g., Swineford Allergy Conference). Some funds for travel are provided by a Personal Expense Account, but fellows are strongly encouraged to submit case reports and/or research data in order to apply for travel grants. 

As part of fellowship training, regularly scheduled sessions are held for fellows in the VCU simulation lab to enhance patient safety and quality care. Examples include treating status asthmaticus and acute anaphylaxis. 

Opportunities are available throughout the fellowship training years to teach and educate residents and medical students. Fellows are encouraged to participate in and contribute to both pediatrics and medicine morning reports. Fellows are actively involved in teaching the house staff during the inpatient consultations and as the house staff rotate through our clinics. Exceptional fellows may be asked to participate in Pediatric and Internal Medicine residency core lectures.