VCU Internal Medicine Training Program
Asthma, Allergy & Immunology Consult Curriculum
PGY Levels: All
Duration: Two or four weeks
Revision Date: May 2008
Revised by: Shelley Olds Burns, M.Ed./Lawrence Schwartz, M.D., Ph.D.
Purpose:
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The purpose of the allergy & clinical immunology rotation is to prepare the resident to recognize
and treat commonly and uncommonly encountered problems in allergy and immunology, to
familiarize the patient with the diagnostic techniques used in the field, and to determine when it
is appropriate to initiate a referral to an allergist/clinical immunologist.
Exposed to common clinical presentations in both the outpatient clinic and inpatient consultation
settings, residents who complete this rotation should be able to:
o Identify, diagnose and begin treatment of patients with asthma
o Identify, diagnose and begin treatment of patients with allergic disease
o Adequately assess the presenting features, diagnosis, and treatment of individuals with
primary immunodeficiency, mast cell-associated and eosinophil-associated diseases.
o Provide informed discussions regarding these clinical conditions with patients, health care
team members and referring physicians
o Define the role of the primary care practitioner in prevention related to allergy and
clinical immunology
Consideration: Given the seasonal nature of allergic disease, the scheduled rotation and timing of
the year may impact exposure.
Learning Objectives
At the end of the rotation, residents will be able to:
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Patient Care:
o Demonstrate competency in history taking and physical examination skills for a patient
who presents with asthma
o Describe the key elements of managing asthma
o Complete a comprehensive allergy/immunology consultation including identification, chief
complaint, history of present illness, past history, review of systems, personal and social
history and complete physical examination with particular focus on the allergy and
immunology examination; and
o Independently create and justify an appropriate management plan
Medical Knowledge:
o Recall Step therapy for asthma
o Recall the pathophysiology, evaluation, and management of allergy and allergy-related
problems such as:
ƒ Anaphylaxis
ƒ Asthma
ƒ Urticaria and Angioedema
ƒ Food allergies
ƒ Nasal obstruction and sinusitis
ƒ Eczema
ƒ Rhino conjunctivitis
ƒ Drug allergies
ƒ Eosinophilic disorders
Describe symptoms of an allergic reaction and educate patients
Formulate the diagnosis and treatment of insect venom allergy
Describe the action and pharmacology of common allergy and immunology medications
and treatments including:
ƒ inhaled medications
ƒ steroids
ƒ other anti-inflammatory agents; and
ƒ ancillary pharmacological therapies
o Report the indications and basic interpretation of tests including but not limited to
pulmonary function testing and nasal & sputum stains
o Demonstrate knowledge of the indications, benefits, and side effects of the major
modalities of testing including:
ƒ Skin testing
ƒ In vitro allergen-specific IgE testing
ƒ Patch testing
ƒ Complement levels
ƒ Quantitative immunoglobulins
ƒ Methacholine challenge
ƒ Nasal smears
ƒ Spirometry
o Diagnose humoral immunodeficiency; and
o Describe the physiologic and anatomical features of cellular and humeral immunity and
related medical conditions.
Practice-Based Learning and Improvement:
o Exemplify continual self-evaluation with insight and initiative to correct deficiencies and
develop new skills.
o Analyze and evaluate practice experiences and implement strategies to continually
improve the quality of patient care; and
o Locate, critically appraise, and assimilate evidence from scientific studies; and/or other
available methodologies to access and manage information, support patient care
decisions, and enhance both patient and physician education.
Interpersonal and Communication Skills:
o Integrate effective listening, nonverbal questioning, and narrative skills necessary to
communicate difficult issues to patients with severe allergy and immune based conditions
and their families
o Identify the rationale, risks and benefits of treatment plans to patients in understandable
language.
o Provide education and counseling to patients, families, physicians, and other health care
professionals as well as sustain therapeutic and ethically sound professional relationships
with them; and
o Maintain comprehensive, timely, and legible medical records
Professionalism:
o Exemplify appropriate professional behaviors (e.g., respect, compassion, and integrity)
with ancillary staff, nurses, physicians, and patients in all clinical settings
o Project sensitivity and responsiveness to the gender, age, culture, religion, sexual
preference, socioeconomic status, beliefs, behaviors, and disabilities of patients and
professional colleagues.
o Demonstrate commitment to ethical principles including but not limited to patient
confidentiality and informed consent
o Complete thorough and timely consultations that include prompt communication with
other care team members
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Reflect a commitment to excellence and continuous professional development through
self-reflection and peer performance evaluations; and
o Demonstrate punctuality and personal responsibility for attendance at learning
opportunities.
Systems-Based Practice:
o Access and utilize the resources, providers, and disease management protocols for the
care of patients with allergic and immunologic conditions.
o Identify indications for inpatient management of various conditions and learn to
differentiate those that can be managed safely as an outpatient.
o Recognize the circumstances under which the general internist should consult other
health care professionals, including allergists, immunologists, pharmacologists,
toxicologists, nutritionists, etc.
o Incorporate considerations of cost effectiveness into diagnostic and therapeutic plans.
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How Learning Objectives are met:
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Direct patient care
Core Allergy & Immunology curriculum reading (as identified by supervising fellows and faculty)
Attendance and active participation at didactic sessions
Attendance at required noon conferences
Weekly clinical journal club
Weekly basic science journal club
Expectations:
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Attendance and punctuality for all patient care activities
Attendance / Punctuality. Call the appropriate CMR ASAP to report acute illness or family
emergency necessitating absence so that coverage may be found.
Attendance at all didactic sessions, unless off or in clinic
Read articles relevant to the patients seen, including articles generated through literature
searches and distributed at morning report or at rounds.
Professional behavior
Completion of the above learning objectives and reading
Attendance at Internal Medicine Core Conference Series daily at noon
Other clinical care duties as outlined by faculty members
Literature searches and textbook readings (including Up-To-Date) on diagnosis and treatment of
patients
Evaluation:
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Residents will be evaluated by the supervising medical admitting attendings on
www.newinnov.com
Residents will evaluate supervising attendings on www.newinnov.com
Contacts:
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Kim George, M.D., Senior Fellow (2008-2009)
Pager 8222
Mary (Jamie) Robinette, Ph.D., Administrator
1112 East Clay Street, McGuire Hall, Room 4-110
P.O. Box 980263
Richmond, Virginia 23298-0263
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Phone: (804) 828-1941, (804)828-9686
Fax: (804) 828-0283
E-mail: mjrobinette@vcu.edu
Lawrence B. Schwartz, M.D., Ph.D.
P.O. Box 980263
Richmond, Virginia 23298-0263
Phone: (804) 828-9685
E-mail: lbschwar@vcu.edu
Resident schedule: