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Allergy & Clinical Immunology Unit
Two fellows are recruited to the program each year and the program is open to internists and pediatricians interested in allergy and immunology. Fellows are strongly encouraged to commit to 3 to 4 four years of training at this level. The training is structured such that the first two years are devoted to fulfillment of the requirements for certification by the American Board of Allergy and Immunology. Fellows typically spend a majority of the first year in clinical training and subsequent years in further preparation for a career as a laboratory investigator or as a clinician-educator. During the first year of training the fellow is expected to select a faculty preceptor, who will provide mentorship in research in subsequent years. The American Board of Allergy and Immunology, a conjoint group that includes input from the American Board of Pediatrics and the American Board of Internal Medicine, accredits this fellowship.
Dr. Francis Rackemann, a clinician scholar, founded the Mass General Allergy Unit in 1919. He established a large outpatient clinic for the care of patients with allergic rhinitis and asthma. This clinic continues to flourish, under the current leadership of Dr. Aidan Long, offering care to patients with a broad spectrum of allergic and immunologic diseases. In 1959, Dr. Francis Lowell was appointed Chief of the Allergy Unit based on his ability to conduct clinical research. Drs. Lowell and William Franklin performed the first controlled studies of the efficacy of repeated injections of ragweed pollen extract in relieving the symptoms of ragweed allergic rhinitis. Beginning in the 1950’s, there was a dramatic expansion of knowledge in basic immunology accompanied by the realization that immunologic concepts, techniques and therapies were applicable to the care of patients. In 1976, following the retirement of Dr. Lowell, Dr. Kurt Bloch was appointed to head the combined Allergy/Immunology Unit. Dr. Bloch established the Clinical Immunology Laboratory, which provides specialized Immunological testing for Allergy and Rheumatology, as well as for the entire medical community. The Clinical Immunology Laboratory continues to remain an important part of the Division under the new leadership of Dr.Murali. During his 24-year tenure, Dr. Bloch expanded the impact of this Unit on inpatient care. Several novel approaches were developed to desensitize patients who were dangerously allergic to drugs that were essential to their care.
In 2000 following the retirement of Dr. Bloch, Dr. Andrew Luster was appointed the Chief of a new Division of Rheumatology, Allergy and Immunology (DRAI) at the Mass General. This new Division includes the former Allergy and Clinical Immunology Units and the former Arthritis Unit. The impetus for this new initiative was to develop a Division within the Department of Medicine that would focus on the immunological and inflammatory basis of human disease. To accomplish this goal, the Center for Immunology and Inflammatory Diseases (CIID) was established as part of the DRAI to serve as the basic and clinical science foundation for the clinical departments of Rheumatology, Allergy and Clinical Immunology. Dr. Luster, the Division Chief, is also the Director of a new NIH sponsored training program in Allergy and Immunology Research at the Mass General.
Dr. Luster has put in place a leadership team that includes Dr. Aidan Long, the Clinical Director of Allergy, who oversees all clinical and training activities of the Unit. Dr. Long is also the Fellowship Training Program Director, and together with Dr. Aleena Banerji, the Assistant Training Program Director, coordinates all teaching and training related activities. Dr. Daniel Hamilos, the Director of Clinical and Translational Research, coordinates clinical and translational research between the clinic and the laboratories in the CIID.
Graduates of the Allergy/Immunology Unit have contributed importantly to the field of Allergy and Immunology and hold leadership positions, including John Bienenstock (former medical school Dean, Chairman of Pathology and Professor of Medicine and Pathology, McMaster University School of Medicine), Raymond Dattwyler (Professor of Medicine, New York Medical College), Theodore Freeman (Chief, Allergy Unit, Lackland AFB), and Richard Moscicki (Vice President, Clinical, Medical and Regulatory Affairs, Genzyme Corporation). Many other graduates of our Allergy/Immunology Fellowship program practice Allergy and Clinical Immunology in the Boston area and throughout the United States, including members of our part-time staff James McLean and Johnson Wong.
Fellowships are offered to MDs who have completed three years of internal medicine or pediatric residency or two years under the ACGME research residency “short-track”. All applicants are expected to be board eligible (ABIM or ABP) at the beginning of the Allergy and Immunology Fellowship unless in the research residency track. It is expected that the fellows will have passed USMLE Steps I, II and III. MGH is an equal opportunity employer and welcomes applications from minority candidates.
Didactic conferences (clinical years) are held on a regularly scheduled basis with attendance required of all first and second year MD fellows and divisional faculty. Attendance is encouraged in subsequent year trainees.
Faculty and trainees meet weekly at the Mass General Immunology Seminar Series. This allows trainees to have world-renowned experts in immunology visit and exchange ideas with the faculty and trainees. Following the seminar the trainees meet these scientists over lunch to discuss scientific issues as well as receive career advice.
Opportunities are available for teaching residents and medical students rotating through the allergy and immunology elective programs. Allergy and Immunology fellows are encouraged to participate in and contribute to housestaff conferences at Mass General. The program provides an academic environment, which fosters and rewards teaching activities. This includes the education of medical students, residents, attending physicians, other allied health personnel, and patients. Fellows are strongly encouraged to participate and present at the conferences, journal clubs and seminars listed above, and are actively involved in teaching the house staff during the inpatient consultations and as the house staff rotate through the Allergy ambulatory clinics. Fellows receive instruction and feedback in counseling and communication techniques.
Evaluations are performed at a minimum on a semi-annual basis by the program director, with input from precepting and supervising faculty.
Allergy Fellowship Program
The core clinical activities of the Allergy and Immunology Fellowship take place at Massachusetts General Hospital in the dedicated Allergy and Immunology outpatient suite located on the second floor of the Cox building and on the patient floors during inpatient consultations. Some of the elective rotations are also scheduled at the adjacent Massachusetts Eye and Ear Infirmary and at Children’s Hospital, Boston located in the Longwood Medical Area. The fellowship does not include in-hospital call. Fellows are on call from home at nights and weekends on a shared basis with other fellows in the program.
The first year fellow participates in the Adult Allergy/Immunology Clinic at the MGH and in the Pediatric Allergy/Immunology Clinics of the MGH for Children and the Children’s Hospital, Boston. In these settings, the trainee interacts with patients who have allergic or other rhinitis, sinusitis, asthma, atopic dermatitis, hypersensitivity to foods, drugs, or stinging insects, urticaria and angioedema, and other immunologic diseases, including autoimmune and immunodeficiency diseases. Fellows are assigned patients whom they treat and monitor longitudinally over the period of their fellowship always appropriately supervised by dedicated attending faculty members. Generally, fellows see an average of 3-6 patients per half-day session. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time. The outpatient experience continues in a limited way in year 2 to ensure that our MD trainees meet the training requirements of the ABAI and is not required in subsequent research years. The acquired skills include the development of an appropriate differential diagnosis, diagnostic evaluation strategies, and treatment plans. Communicating with the referring physicians and ensuring support for continuing care of the patients’ allergic condition is central to the consultative service.
Fellows rotate on the inpatient Allergy/Immunology Consultation Service at Mass General, MassGeneral for Children and Massachusetts Eye and Ear. The Consultation Service includes the supervised evaluation of inpatient consultations on patients admitted to Mass General and Mass Eye and Ear who present with or develop allergic or immunologic problems, as well as the continued daily longitudinal follow-up of these patients during their hospitalization. A fellow performs literature research on topics appropriate to the case, and will participate actively in the teaching activities to the consulting team, especially as it pertains to house-staff. In all cases a written report of consultation is completed in the electronic medical record. At all times immediate faculty supervision is available. Mass General and Mass Eye and Ear serve frequently as tertiary (and occasionally quaternary) referral centers and carry a high census of extremely complex medical and surgical patients. The acquired skills include the development of an appropriate differential diagnosis, diagnostic evaluation strategies, and treatment plans. Communicating with the referring physicians and ensuring support for continuing care of the patients’ allergic condition is central to the consultative service.
As part of the training in the management of allergic and immunologic diseases, the trainee receives in-depth outpatient teaching in pulmonary, dermatologic, otolaryngologic, ophthalmologic and radiologic aspects of allergic and immunologic disorders, as well as clinical immunology laboratory techniques.
A fertile environment for physician-scientists and PhD scientists with an interest in allergic diseases exists in the Center for Immunology and Inflammatory Disease (CIID) at the MGH-East Charlestown Navy Yard Research Facility. Faculty and fellow collaboration is at the heart of the research training program.
The basic science research training program is focused on training fellows in research in immunology and allergic inflammation. The Center for Immunology and Inflammatory Diseases (CIID) was established to serve as the basic and clinical science foundation for the clinical departments of Rheumatology, Allergy and Clinical Immunology. Offering a diverse, integrative and interactive training experience, exceptional investigators at MGH and members of the Harvard Medical School Immunology Graduate Program are also included amongst research supervisors and mentors of our trainees. Basic science techniques are taught in the laboratory and in conferences and course work. Under the guidance of the sponsor, the fellow learns to formulate hypotheses and design experiments to test these hypotheses, to perform laboratory techniques, to analyze data, and to write manuscripts and grants.
The clinical research training program focuses on training fellows in the principles of clinical and translational research or clinical epidemiology in the area of allergic and immunological diseases. The Allergy Clinical Research Unit is located at the Mass General main campus and conducts clinical research and drug trials of allergic and immunologic diseases under the directorship of Dr Daniel Hamilos. Epidemiology research training in Allergy and Immunology, also located at the main Mass General Campus under the directorship of Dr. Carlos Camargo. Fellows may apply for admission to the Scholars in Clinical Science Program at Harvard Medical School, which is designed for individuals interested in careers in clinical trials, human pharmacology, or translational investigation. This two-year program consists of formal didactic course work, seminar series, and a mentored clinical research project. www.hms.harvard.edu/gradprograms/scsp
Each faculty sponsor meets weekly with his or her team, including the trainees; and each sponsor meets individually with each trainee at least weekly. At the end of the year, the entire training faculty will meet to discuss the progress of each trainee. Each fellow has his or her own project, which is carried out under the supervision of the research sponsor. Trainees meet with their sponsors at least weekly. Ninety percent of the MD trainees’ time and effort during the second and subsequent years is devoted to research. In the remaining time, these MD fellows attend conferences and one longitudinal clinic one-half day each week. The usual time for completion of the program is two years of research training, but most trainees will continue working on their projects for three or four years.
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