Revised 3/25/08
GOALS AND OBJECTIVES
RESIDENT CURRICULUM FOR ALLERGY AND IMMUNOLOGY ROTATION
Rotation Coordinator:
David Tottori, M.D.
4000 E. Charleston Blvd. Suite 100
Las Vegas, NV 89104
OVERVIEW
Educational Purpose
The Allergy and Immunology elective rotation provides an opportunity for PGY-2 and
PGY-3 residents to have basic exposure to the principles of the field of allergy and
immunology.
Many clinical states caused by allergic and immunologic disorders are regularly
encountered by the general internist. Care for the asthma patient is commonly provided
by general internist.
Patient allergies can cause profound occupational and
socioeconomic changes as well as require extensive environmental alterations. The
allergy and immunology rotation is primarily an office-based rotation in the private office
of a faculty allergist. Each resident should develop an understanding of basic allergic and
immunologic disease processes and how to initiate work-ups and treatment of those
disorders. The resident should also gain an understanding of when consultation with an
allergist is indicated.
Residents in the allergy and immunology rotation will participate in supervised patient
encounters, discussion sessions with the attending, required readings, and may be
required to submit a completed series of self-assessment concerning basic aspects of the
field of allergy and immunology.
Teaching Methods
The Senior PGY-2 or -3 resident will be working closely with the Allergy attending in
the care of each patient. Each patient seen will be discussed with, then evaluated by the
attending, emphasizing the unique aspects of the consultative process and allergy care.
Residents will be required to continue their regular Morning report and Noon conference
core curriculum. The resident and attending will review and discuss any required reading.
Mix of Diseases
The following disorders will be reviewed during the rotation with the supervising
attending or through direct patient interactions:
A. Outpatient asthma management, including evaluation of pulmonary function tests
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B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
Asthma diagnosis, pathophysiology and treatment
Rhinitis, classification, diagnosis and treatment
Atopic dermatitis
Anaphylaxis, diagnosis and treatment
Drug reactions, diagnosis and treatment
Food reactions, diagnosis and treatment
Uticaria, diagnosis and treatment
Initial evaluation of immunodeficiency states
Allergy skin testing
Allergen immunotherapy
Status asthmaticus, diagnosis and treatment
Care of patient with asthma and allergic rhinitis during pregnancy
Sinusitis
Allergic contact dermatitis, diagnosis and treatment
Atopic dermatitis, diagnosis and treatment
Stinging insect reactions, diagnosis and treatment
Clinical immunology, including components of the immune system and
immunological reactions in the more common immunodeficiency states
Patient Characteristics and Types of Clinical Encounters
Patients are almost exclusively outpatients presenting in non-acute settings. Patients
evaluated by the resident will range from adolescent to older adult. A wide range of the
clinical problems noted in the above will be encountered including initial evaluation,
chronic maintenance, and relapse.
Resident Supervision
The resident will be supervised at all times by the attending allergist who will be present
on site.
Procedures and Services
Procedures and services include those typically performed by an allergist, including skin
testing, pulmonary function testing, rhinoscopy, and immunotherapy.
Didactic Teaching
Morning Report
Residents rotating on the allergy service are required to maintain greater than 60
% attendance at morning report. Morning Report begins at 8 a.m. on Monday
through Thursday and at 8:30 a.m. on Friday.
Noon Conference
Residents rotating on the allergy service are required to maintain greater than 60
% attendance at noon conference. Noon conference occurs daily, Monday
through Friday. These sessions cover the basic core curriculum, and other
curriculum topics such as ethical issues, geriatrics, computer systems and
informatics, health care systems, occupational and environmental health issues,
and other topics of concern.
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Core Reading Materials
Harrison’s Principle’s of Internal Medicine, 16th ed., Kasper Dl, ed. McGraw
Hill
The Washington Manual of Medical Therapeutics, 32nd ed.
The Washington Manual Allergy, Asthma, and Immunology Subspecialty Consult
(Washington Manual Subspecialty Consult Series), Jost BC, ed. LippincottWilliams and Wilkins
Ancillary Educational Materials
Subspecialty Texts of Neurology, Pulmonary Medicine, Nephrology,
Endocrinology, Infectious Diseases, Rheumatology as well as General Medical
References (Harrison’s Principles of Internal Medicine, Cecil’s Textbook of
Medicine) are available 24 hours a day, seven days a week in the resident lounge.
Savitt Medical Library On-Line
Residents have access to the on-line services of Savitt Library (the main library of
the University of Nevada - Reno) via their computer in the resident room, Suite
300 of the 2040 W. Charleston Building. Access to this room is available 24
hours a day, seven days a week.
Full text is available for many peer-review journals including, but not limited to:
ACP Journal Club
Annals of Internal Medicine
British Medical Journal
Cancer
Circulation
Journal of the American College of Cardiology
The Lancet
New England Journal of Medicine
Stroke
Also available on-line:
Harrison’s Principle’s of Internal Medicine, 14th ed.
Merck Manual, 17th ed.
Guide to Clinical Preventive Services, 2nd ed.
The Cochrane Library
Medline and GratefulMed Databases
Training Sites
University Medical Center
Occasional allergy consultations are seen at University Medical Center
Allergy private practice office
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The resident will participate in this allergy practice under the supervision of the
attending allergist, a member of the voluntary faculty.
Competency-based Goals and Objectives
Allergy and Immunology Rotation
Learning Venues
Evaluation Methods
1. Allergist Office
2. Self Study
3. Department
Competency-Patient Care
Level Specificity
A. Attending Evaluation
B. Self Evaluations
C. Staff Evaluation
D. Patient Evaluation
E. Didactic Testing
Learning
Evaluation
Venues
Methods
N/A
N/A
N/A
N/A
N/A
Level
1. Obtain focused history of allergy
related symptoms
2. Perform physical examination,
identifying signs of allergy
3. Observe allergy skin testing
4. Observe and perform pulmonary
function testing
5. Observe allergy immunotherapy and
immunotherapy
1
A
N/A
1
A
N/A
1
1
A, E
A,E
N/A
N/A
1
A,E
N/A
Competency-Medical Knowledge
Learning
Venues
Evaluation
Methods
1,2
A,B,,E
1,2
A,B,E
N/A
1,2
1,2
A,B,E
A,B,E
N/A
N/A
1,2
A,B,E
N/A
Demonstrate knowledge of the
established basic biomedical and clinical
sciences relevant to allergy and
immunology
Understand and interpret pulmonary
function tests
Understand the treatment of anaphylaxis
Understand the diagnosis and treatment
of asthma
Understand the diagnosis and treatment
of allergic rhinitis
Level
N/A
4
Understand the diagnosis and treatment
of urticaria
Understand the diagnosis and treatment
of drug reactions
Understand the diagnosis and treatment
of stinging insect reactions
Understand the initial evaluation of
immunodeficiency states
1,2
A,B,E
N/A
1,2
A,B,E
N/A
1,2
A,B,E
N/A
1,2
A,B,E
N/A
Understand the interpretation of allergy 1,2
skin testing
A,B,E
N/A
Understand the pathophysiology and ad- 1,2
ministration of allergen immunotherapy
A,B,E
N/A
Competency-Interpersonal and
Communication Skills
Learning
Venues
Evaluation
Methods
Show understanding for different patient
preferences
Maintain accurate medical records
Communicate effectively to patient and
medical support staff
Communicate patients problems clearly
with patients family
Treat patients and families with
respect/empathy
Treat colleagues with respect
Respect patient confidentiality
1,2,3
A,B,C,D
N/A
1
1
A,B,C
A,B,C,D
N/A
N/A
1
A,B,C,D
N/A
1
A,B,C,D
N/A
1
1
A,B,C
A,B,C,D
N/A
N/A
Competency-Professionalism
Learning
Venues
Evaluation
Methods
1,3
Treat team members, primary caregivers, and patients with respect and
empathy
Understand, practice and adhere to a code 1,2,3
of medical ethics
1
Participate actively in consultations and
Level
Level
A,B,C,D
N/A
A,B,C
N/A
A,B
N/A
5
on rounds
Attend and participate in all scheduled
conferences
3
A, attendance
N/A
Competency-Practice-Based Learning
Learning
Venues
Evaluation
Methods
Describe two improvements in care from
prior practice to attending allergist
1,2
A
Competency-Systems-Based Practice
Learning
Venues
Evaluation
Methods
Level
Learn effective and appropriate office
practice management relevant to allergy
and immunology
1
A, B
N/A
Level
N/A
EVALUATION
A. Of Residents
At the completion of each rotation, all clinical faculty are required to complete the
standard ABIM resident evaluation form. All clinical faculty are encouraged to
provide face-to-face feedback with the residents. The night-float resident is
evaluated by one of the three-service attendings. In addition, residents may
receive interim feedback utilizing the ABIM’s Praise and Early Warning cards.
B. Of Rotation and Preceptor
All residents are encouraged to evaluate the rotation, and the clinical faculty
member at the completion of the rotation. This evaluation form is included at the
end of this document. These evaluations are then converted to type and shared
anonymously with the clinical faculty.
The program director also discusses the rotation with the residents to ensure
rotation quality and satisfaction.
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Allergy and Immunology Rotation Intern/Resident Check List
1. Evaluation reviewed at mid-month and end of rotation by the supervising faculty
member and resident.
2. Completed assigned readings
3. Attended all assigned activities (excluding scheduled time away, required clinics and
emergencies).
4. Completed required case report abstracts and/or posters if assigned by the supervising
faculty member.
5. Demonstrated understanding of the basic principals of allergy and immunology
6. Understood the indications and interpretations of allergy skin testing.
7. Understood the diagnosis and treatment of asthma.
8. Demonstrated understanding of appropriate management of anaphylaxis, sinusitis and
rhinitis.
9. Receive verbal feedback from attending at end of rotation.
Intern/Resident Signature_________________________
Date___________________
Supervising attending__________________________
Date___________________
All items must be completed for rotation credit and checklist returned to the
Department of Medicine by the rotation’s end.
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