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Pediatric Rheumatology Fellowship
Organization and Overview by Year
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Organization

The pediatric rheumatology fellowship is a three-year program. The length of the program provides fellows with sufficient time to follow patients through the natural history of these chronic diseases and response to long-term therapies. This duration of training also allows for a relatively intense clinical immersion in the first year, with ample time in the second and third years to focus on scholarly pursuits and a research project.

Overview by Year

Year 1
The first year of fellowship training will be primarily clinical service. It is important for trainees to meet a sufficient number of patients with a broad variety of autoimmune diseases early in the program and to be able to follow them longitudinally throughout their training. These long-term relationships with patients is critical for the fellow’s training, both with regard to learning the natural history of these diseases, as well as gaining experience in the psychosocial aspects of chronic disease and its impact on children and families.

Outpatient clinic: The Vanderbilt Pediatric Rheumatology clinic is a high-volume program, with 1,766 patient visits during the six month period of July 2010 – January 2011. The first year fellow will see patients in the pediatric rheumatology clinic during four half-day sessions per week. The fellow will see both new and return patients, gradually building up their personal panel of patients over the course of the year. The fellow will have direct oversight by the attending physician – a board certified pediatric rheumatologist.  This clinic schedule will be ongoing during the first year of training, with the exception of one vacation month.

Outpatient infusion center: Rheumatology patients frequently come to the Vanderbilt Outpatient Infusion Center to receive a variety of intravenous therapies including pulse dose corticosteroid, biologic therapies, and chemotherapeutic agents. The first year rheumatology fellow will not be responsible for all the infusion patients, but will be expected to organize and oversee the infusions for their continuity patients. The fellow will also be expected to respond to urgent calls from the infusion center to gain experience in managing infusion reactions. As always, these activities of the fellow will be done with direct oversight of the attending physician.

Consult service: The Pediatric Rheumatology service functions as the consult service for Vanderbilt Children’s Hospital, covering the inpatient units as well as the emergency department.  The rheumatology service saw 57 consults (wards ER) in the six month period of July 2010 – January 2011, essentially averaging 10 consults per month, or between two and three consults per week. This service provides a rich source of clinical experience with acute presentations of newly diagnosed rheumatologic diseases, serious exacerbations in patients with previously known diagnoses, as well as the opportunity to be involved in the diagnostic process of patients with undefined symptoms.  The first year fellow will be responsible for seeing the consult patients with the attending physician. The fellow will also be the primary person to relay information and recommendations back to the primary service, thereby gaining experience in team-based management of patients. 

Research: The first year fellow will meet with the fellowship director approximately six months into the first year specifically to discuss research interests and to start identification of a research mentor. This process will allow for early and organized planning of the fellows’ primary research focus for their second and third years of training.

Year 2
The second year of fellowship will focus on the trainee’s primary research project, which will have been identified by the end of their first year. The fellow’s clinical responsibilities are greatly reduced to allow ample time to focus on their project.  The fellow will have one half-day clinic session per week, and will only cover the consult service one weekend per month. These clinical duties are necessary to broaden the fellow’s clinical experience, though are at a sufficiently reduced level as to allow focus on their research. They will continue to participate in educational conferences throughout the year. 

Year 3
The third year of fellowship is essentially structured like the second year, with the fellow participating in clinic one half-day session per week, and covering the consult service one weekend per month. The third year fellows will also be expected to continue to attend educational conferences. The bulk of the fellows’ time, however, will be focused on their research project. It is expected that by the end of the third year that the fellow have a defined ‘product’ of their research time. The nature of this product will depend on the focus of the research. Clinical activities during the third year will be associated with increased autonomy and with discussions that will prepare the fellow for independent practice.



 
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Monroe Carrell Jr. Children's Hospital at Vanderbilt