CLINICAL IMMUNOLOGY AND ALLERGY  

GENERAL OBJECTIVES:Candidates Certificated in Internal Medicine or Pediatrics may be eligible for the Certificate of Special Competence in Clinical Immunology and Allergy.The specialist in clinical immunology and allergy is expected to possess indepth knowledge of theoretical immunology and of other basic sciences relevant to the understanding and practice of clinical immunology and allergy. At the conclusion of training, trainees should be able to apply their knowledge of basic immunology and other relevant basic sciences to the understanding of disease processes in which immune mechanisms play a significant role and to the assessment of patients suffering from such diseases.

Their knowledge should thus encompass, with a degree of specific expertise that may vary, the broad field of clinical immunology and allergy, which generally includes atopic diseases, adverse reactions to environmental agents of all types, (i.e. drugs, foods, industrial exposures etc.), autoimmune disorders, immune deficiencies, immunoproliferative disorders, immunotherapy of all types (biological, pharmacological, physical) and the immunological aspects of systemic diseases.

In keeping with the realities of clinical practice, residents may elect to develop a broad base of clinical competence and skills allowing them to participate actively in the diagnostic evaluation and treatment of patients suffering from any one of many possible immunological diseases, or they may elect to acquire a particular clinical expertise in selected areas of clinical immunology and allergy. In the latter instance, residents will be expected to meet high standards of competence in their areas of predilection and to be able as consultants to offer, in the assessment and management of patients in other areas of the specialty, advice which is above and beyond that which might be expected of an internist or pediatrician, depending on the circumstances.

Specialists in clinical immunology and allergy are expected to achieve competence in the utilization and interpretation of common laboratory procedures relevant to clinical immunology and allergy. They should also be capable of critically evaluating scientific publications in this field and of teaching clinical immunology and allergy to students, residents and allied health personnel.

 In keeping with his or her background (Internal Medicine or Pediatrics), a resident may emphasize the acquisition of knowledge and skills in areas of greater relevance to the appropriate age group, but should nonetheless have a sound understanding of immunological and allergic diseases as they affect both children and adults.

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of program in adult and pediatric clinical immunology and allergy must be consistent with the specialty training requirements.

Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to the level of training, ability and experience in both the clinical and laboratory aspects of the specialty.

In addition to offering the components noted in the specialty training requirements all accredited programs in adult and pediatric clinical immunology and allergy should offer community-based learning experiences.

RESOURCES:

There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in clinical immunology and allergy.

In those cases where a university has sufficient resources to provide most of the training in adult and pediatric clinical immunology and allergy but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

Learning environments must include experiences that facilitate the acquisition of knowledge, skills, and attitudes relating to aspects of age, gender, culture, and ethnicity appropriate to adult and pediatric clinical immunology and allergy.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents and provide teaching in basic and clinical sciences related to clinical immunology and allergy. The teaching staff should have an appropriate nucleus of full-time teachers.

  1. Number and Variety of Patients

There should be adequate numbers of patients available to provide opportunities for training and experience in the clinical evaluation and treatment of known and suspected diseases relevant to the specialty of clinical immunology and allergy which should include atopic diseases; adverse reactions to environmental agents such as drugs, foods, and industrial materials; autoimmune disorders; immune deficiencies; and immunoproliferative disorders.

There must be opportunity for training in the relevant aspects of dermatology, endocrinology, gastroenterology, hematology, infectious diseases, nephrology, neurology, oncology, otolaryngology, respirology, rheumatology, and transplantation.

  1. Clinical Services Specific to Adult and Pediatric Clinical Immunology and Allergy
    1. In-Patient

There must be an adequate number of referrals from wards and intensive care units for acute management of allergic problems including asthma, anaphylaxis and allergies to medication.

    1. Ambulatory

Adequate ambulatory care facilities must be available for the clinical investigation, treatment and follow-up of patients.

In-patient and out-patient teaching services should be integrated to provide continuity of observation of patients both in and out of the hospital. Organized clinics or other ambulatory care facilities must be available to provide opportunities for consultative work-ups on referred patients, pre-admission investigation and post-discharge follow-up of patients. Coordination of out-patient consultation services with those of other associated clinical services is highly desirable.

    1. Consultation

There must be well-developed and efficient consultation services, with an adequate number of consultations performed annually. In addition to assuming appropriate and progressive responsibility for the care of patients, residents should take an active part in providing a consultative service.

Consultations and rounds creating interchanges between clinical immunology and allergy physicians and other medical disciplines are essential.

    1. Intensive Care

An intensive care unit organized for teaching is required to provide consultative experience, under appropriate supervision, in the care of seriously ill patients with problems relevant to clinical immunology and allergy.

  1. Supporting Services — Clinical, Diagnostic, Technical
    1. Liaison with Other Specialties and Subspecialties

There must be appropriate liaison with diagnostic and teaching services in pathology, laboratory medicine, radiology and nuclear medicine. Hospitals with a major role in the clinical immunology and allergy program should also be engaged in medical undergraduate teaching.

    1. Clinical Immunology Laboratory

There should be an organized clinical immunology laboratory under the supervision of qualified teaching personnel associated with the program. Residents should spend sufficient time assigned to the laboratory to assure that they achieve competence in the utilization and interpretation of immunologic laboratory tests.

    1. Pulmonary Function Laboratory

There should be an organized pulmonary function laboratory under the supervision of qualified teaching personnel associated with the program. Residents must acquire competence in the ordering and interpretation of pulmonary function and blood gas studies.

    1. Emergency Medicine

Residents must have access to emergency departments and appropriate supervision to ensure the development of expertise in the management of emergencies relevant to the subspecialty of adult and pediatric clinical immunology and allergy.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

  1. Organized Scholarly Activities

The program must include lectures and seminars, which may be interdisciplinary in nature, teaching rounds, special conferences, technical demonstrations, and journal clubs.

  1. Basic and Clinical Sciences Relevant to Clinical Immunology and Allergy

The program must include organized teaching in the basic sciences relevant to the subspecialty of clinical immunology and allergy, including anatomy, physiology, biochemistry, pathology, immunobiology and genetics.

  1. Biomedical Ethics

The program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to clinical immunology and allergy.

  1. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

  1. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

  1. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

  1. Management Skills

Residents must be given opportunities to develop skills in management as applied to adult and pediatric clinical immunology and allergy such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

  1. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

  1. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. It is essential that there be facilities for clinical investigation and research within the program, and that an active research program be conducted under the direction of the teaching staff. It is desirable that residents have the opportunity to participate actively in research programs, and all residents should be able to follow the progress of such programs.

  1. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

  1. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:

1. Certification in Internal Medicine or Pediatrics.

2. Approved residency in immunology and allergy.

Residents in internal medicine-based training programs have some exposure to pediatric patients including infants for training in disorders relevant to clinical immunology and allergy in this age group. Correspondingly, it is mandatory that residents in pediatrics-based programs have some exposure to adults for training in disorders relevant to clinical immunology and allergy in this age group.

PROGRAMS (WITH TRAINING REQUIREMENTS):

Diplomas(Dip):

Six months of approved residency training.

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training