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Center for Immunology and Inflammatory Diseases
The Massachusetts General Hospital Rheumatology Fellowship Program is designed for individuals interested in careers in academic medicine as physician-scientists or physician-educators. Mass General is an extraordinary environment as the patient population is diverse, the spectrum of disease remarkable, and the richness of the Mass General physicians, fellows and residents internationally recognized. In addition to Rheumatology faculty, leading doctors from the Allergy and Clinical Immunology Unit and the Mass General Departments of Orthopaedics, Neurology, Pediatrics, Pathology and Radiology also participate in the training program. As a fellow of Harvard Medical School, trainees benefit from the extensive teaching activities and resources available at Harvard.
The Mass General training program in Rheumatology had its origin with the late Walter Bauer, MD, in the 1930s, who brought basic scientists into the hospital to work side by side with clinicians. Dr. Bauer emphasized pathology as the major scientific discipline since he thought that pathology would provide the background for detailed observation and description of these diseases. A definitive description of the clinical picture and pathology of rheumatoid arthritis resulted from this approach.
Succeeding Bauer, Marion Ropes, MD, one of the first women division chiefs in the nation, guided the Mass General Arthritis Unit to published definitive studies on the major rheumatic diseases in both the clinical and basic sciences.
In 1961, Stephen Krane, MD, became chief of the Rheumatology Unit. Dr. Krane established a tradition of excellence in connective tissue and matrix biology, incorporating all of the modern techniques of cell and molecular biology. During the next 30 years, many physicians emerged from the Mass General Arthritis Unit as leaders in rheumatology, including J. Claude Bennett, Ted Harris, Edward Amento, John Hardin, Laurie Glimcher, Steven Goldring, Graham Russell, Jean-Michel Dayer and Edward Yeh.
In 2000, Andrew Luster, MD, was appointed the chief of a new Division of Rheumatology, Allergy and Immunology (DRAI) at Mass General. This new division includes the former Allergy and Clinical Immunology Unit 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 an expanded NIH sponsored training program in Rheumatology Research at Mass General.
Dr. Luster has put in place a leadership team that includes John Stone, MD, the clinical director of Rheumatology, who oversees all clinical and training activities of the unit. Marcy Bolster, MD, the fellowship training program director, coordinates all teaching and training related activities. Allen Steere, MD, is the director of translational desearch and together with Dr. Stone, they coordinate clinical and translational research between the clinic and the laboratories in the CIID.
Rheumatology fellowships are offered to MDs who have completed three years of post-graduate training in internal medicine or two years under the ACGME research residency. All applicants are expected to be Board Eligible in Internal Medicine when beginning the Rheumatology Fellowship unless in the research residency track. It is expected that all Rheumatology Fellows will have passed USMLE I, II and III as requirements of training.
Waivers to this requirement may be granted on an individual basis. Details regarding certification for ABIM candidates may be found on the ABIM website.
Mass General is an Equal Opportunity Employer and welcomes applications from minority candidates.
Two years of fellowship (one clinical and one research year) are required for Board certification, and fellows may take the Board certification examination after two years of fellowship. However, the NIH-sponsored training program requires a 3-year fellowship with two years of research training (a second and third year of fellowship). In addition to the first clinical year, it is expected that fellows will spend at least two additional years in clinical or laboratory research to develop their scientific skills.
Learn more about the policies, benefits and responsibilities associated with being a graduate trainee at Mass General
The Rheumatology Unit maintains a daily program of teaching conferences for the staff and fellows. A summer rheumatology program runs throughout the first four weeks of the Rheumatology Fellowship, designed to introduce fellows to the musculoskeletal examination, the principles of immunology and an overview of rheumatologic disease. On Mondays, John Mills, MD, professor emeritus of Medicine and world-renowned clinical rheumatologist, meets with the fellows in an informal conference. Reading Club with Mark Fisher, MD, and other faculty meets once a month to review current literature in rheumatology. This aspect of the curriculum is designed to keep current with the literature, and, in addition, to enhance the fellows’ understanding of the statistical basis of published research, and critique the methodology used. Case conferences, New England Journal of Medicine CPCs, Medical Grand Rounds, Radiology Conference and a monthly SLE/Sjogren’s Conference contribute to a strong clinical curriculum.
Weekly Rheumatology Grand Rounds are held on Tuesday mornings. Faculty members from Mass General, other Boston hospitals, or from locations nationally or internationally speak at this conference. Once a month, this conference combines the faculty and fellows from both Mass General and Brigham and Women's Hospital.
Every other Wednesday morning, a journal club is held. One journal club concerns disease mechanisms; papers are presented that explore the pathogenesis of rheumatic disease. The other journal club is a clinical journal club in which papers are presented about the treatment of rheumatic diseases. On alternate Wednesday mornings, a Clinical Case Conference or Research Conference is held in which fellows present cases from the consultation service to faculty and fellows or their research.
On Thursday mornings, fellows are encouraged to attend Medical Grand Rounds at Mass General. In addition, the Mass General Immunology Seminar Series is held at noon on Thursdays.
Every other Friday, Radiology Rounds are held with the musculoskeletal radiology staff, in which faculty and fellows review films of their patients, and thereby receive instruction in the interpretation of musculoskeletal imaging.
A unique feature of fellowship in Boston is Intra-City Rheumatology Rounds, which are held once each month in the evening at a Boston teaching hospital (including Boston University Medical Center, Beth Israel Deaconess Medical Center, Brigham and Women's Hospital and Children's Hospital). Fellows from the host institution present the most difficult and complicated cases to the attending staff of all area hospitals.
Another unique aspect of the conference schedule is the Harvard Post-Graduate Review Course in Rheumatology, which is offered by Mass General and Brigham and Women's Hospital faculty. This outstanding four-day course, which is held in September, brings together preeminent faculty for lectures about each rheumatic disease. This provides an exceptional review of the field for fellows.
Clinical and research fellows participate in the teaching of Mass General medical residents and Harvard medical students. Fellows give didactic lectures, participate in courses, and provide advice and medical literature in the care of individual patients.
The first year of the program is designed to provide in-depth clinical training in all aspects of clinical rheumatology, including critically ill patients in the hospital and diagnostic problems in the clinic. Because of the large number of clinical faculty who participate in the program, trainees are introduced to different approaches by the various faculty members, each with their own clinical and research strengths. A strong commitment is made to hands-on training by the preceptor, whose time is reserved for that purpose in both inpatient and outpatient settings. Guided by the ACGME, post-doctoral fellows are expected to master the core competencies.
First-year clinical fellows are responsible for seeing inpatient rheumatology consultations at Mass General (30 to 40 per month) and Massachusetts Eye and Ear. After evaluation, fellows review findings and treatment plans with the faculty consult attending. In addition, trainees oversee the junior or senior residents and medical students rotating through the rheumatology service. Mass General has long been recognized as an international leader in the care of patients. Patients come here from local, regional, national and international locations. Therefore there is exceptional diversity in the spectrum of rheumatic diseases, including rare and difficult cases. In addition to rotations at Mass General, each fellow spends approximately six weeks on the rheumatology consultation service at Brigham and Women's Hospital.
Since rheumatology is primarily an outpatient specialty, experience in the outpatient rheumatology clinic is an important focus of the fellowship. Each year, the faculty and fellows see more than 12,000 patients in the clinics. During the first year, fellows see patients in the clinic on Monday, Wednesday and Friday mornings, building their own practice and maintaining continuity of care. The fellows are directly responsible for the care of their patients under the supervision of faculty who serve as preceptors. On alternate Tuesdays, fellows participate in a pediatric rheumatology clinic one half day per week, under the direction of Holly Rothermel, MD.
Other clinical rotations include the following:
During the first year, fellows each have a month to explore research opportunities throughout the Mass General campus and each fellow is encouraged to attend conferences in his/her field of interest. By late fall, fellows begin the process of interviewing with faculty and planning research projects. In most instances, fellows select a mentor in the Division’s Center for Immunology and Inflammatory Diseases. However, a defined project is sometimes carried out in another laboratory outside of the Center. The goal is for the fellow to be ready to start a research project by the beginning of the second year of the fellowship.
The goal of the second and third years of the fellowship is to expose fellows to rigorous scientific training in rheumatic diseases. This is accomplished through an individualized program of laboratory or clinical research, under the guidance of a mentor from the rheumatology training faculty, along with structured training in immunology, molecular biology, genetics, clinical trial, biostatistics and ethical issues through courses or conferences. At the same time, maturation of clinical judgment is fostered through continued participation in continuity clinics and clinical conferences. Moreover, trainees benefit from contact with a large number of PhD fellows in the various laboratories. The research portion of the fellowship is supported by a Rheumatology Training Grant from the National Institutes of Health.
The major laboratory research component of the Division of Rheumatology, Allergy and Immunology is the Center for Immunology and Inflammatory Diseases, which is directed by Andrew Luster, MD PhD, chief of the division. Research in the center focuses on the elucidation of immune and inflammatory responses in autoimmune and inflammatory diseases. Areas of particular interest include autoimmunity, MHC-peptide-T cell interactions, dendritic cell biology, chemokine and cytokine biology and signaling, leukocyte trafficking, innate, adaptive and mucosal immunity, collagen degradation and cell differentiation.
Training opportunities are also available in clinical or translational research, including clinical trials in rheumatic diseases, biomarkers of disease activity, and diagnostic tests. Fellows who elect a career as a clinician-scientist may take advantage of several opportunities for additional training in the Harvard system.
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.
During the research years, fellows participate in the weekly laboratory meetings and journal clubs of the laboratory in which their project is being done. In addition, once a month, all members of the laboratories in the center for Immunology and Inflammatory Diseases gather for presentations of current research by fellows or faculty.
Training in translational research, clinician educator pathways and outcomes research are all available to fellows grounded in an understanding of basic pathophysiology of rheumatic diseases.
During the research years, fellows continue to see patients in the outpatient setting one or two, half-day sessions per week. Two years of fellowship (one clinical and one research year) are required for Board certification and fellows may take the Board certification examination after two years of fellowship. However, the NIH-sponsored training program requires a three-year fellowship with two years of research training (a second and third year of fellowship). Thus, in addition to the first clinical year, it is expected that fellows will spend at least two additional years in clinical or laboratory research to develop their scientific skills and most spend more.
The Mass General Hospital Fellowship in Rheumatology processes fellowship applications through the Electronic Residency Application Service (ERAS) Fellowship Applicant site.
Marcy Bolster, MD, Fellowship Director
Rachel Fouché, Fellowship Coordinator
All fellowships begin July 1. We encourage applicants to complete their applications as early as possible, and we will continue to accept new, completed applications until September 15, 2016. To apply, visit: ERAS Fellowships Applicant Site
ABIM Research Pathway Information
American College of Rheumatology
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