Allergy and Immunology Curriculum

Department: Internal Medicine

Faculty Coordinator: Matthew Feldman, M.D.

Hospital: Texas Health Presbyterian Hospital Dallas

Periods offered: All

Length: 2 weeks

Max no. of residents: 1

First Day Contact: JoAnn Kroener (214) 691-1330

First Day Time: 9:00 a.m.

First Day Place: Dr. Matthew Feldman’s office, 5499 Glen Lakes, Suite 100, Dallas, TX

Requirements: Hours: 8:00 a.m. to 4:30 p.m. Monday - Friday

Vacation: None

I. Course Description:

Residents will work with an allergist in outpatient practice and will be exposed to a wide variety of immunological diseases. They will participate in initial evaluations as well as follow up evaluations in allergy clinic. They will also see inpatient consults when available.

II. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: Residents will obtain an accurate history, perform an appropriate physical exam, form an assessment and therapeutic plan on the patient with allergies or asthma.

• Make informed recommendations about preventive, diagnostic and therapeutic options and interventions based on clinical judgment, scientific evidence, and patient preference. Examples: Evaluation of urticaria, interventions for seasonal allergies, prevention of asthmatic exacerbation.

• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: Appropriate use of desensitization; cost effective treatment of seasonal allergies; education regarding allergen avoidance.

• Understand the diagnostic and therapeutic procedures considered essential to the practice of allergy and immunology. Examples: Role of skin testing and RAST.

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and to apply their knowledge to patient care and education.

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Understand relative importance of environmental controls.

• Access and critically evaluate current medical information and scientific evidence. Examples: Recognize the importance of pharmacogenetics.

• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of allergy and immunology. Examples: Understand the biology of the immune system and how it influences clinical presentation of allergies.

• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Evaluate severe asthma with recommendations for management considering drug therapy, environmental controls and ongoing evaluation.

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: Improve understanding of immunodeficiency by reviewing current literature in the area.

• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: Develop a process to ensure patient education regarding prevention of anaphylaxis.

• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: Review management plans and support each recommendation.

• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: Use of allergy/immunology websites and text books.

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues. Examples: Verbally and in writing, communicate with consultants regarding the diagnostic and therapeutic evaluation of the allergic patient.

• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: When interviewing a patient with asthma or allergic rhinitis, use appropriate communication skills.

• Interact with consultants in a respectful, appropriate manner. Examples: Discuss evaluation and recommendations of patients seen in consultation.

• Maintain comprehensive, timely, and legible medical records. Examples: Thorough and complete progress notes reflecting the diagnostic and therapeutic approach to the patient with allergies.

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues. Example: Treat all patients and staff with respect.

• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues. Example: Avoid differential treatment of patients or staff.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. Examples: Avoid discussing patient in their presence and acknowledge uncertainties in medical treatment to peers.

• Recognize and identify deficiencies in peer performance. Examples: Watch for incompetence in peers and discuss it with them or report it to supervisor.

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: Be aware of source of patient benefits, pharmacy access and community setting.

• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: Manage outpatient asthma with an understanding of when hospitalization would be required.

• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: Treatment of allergies and asthma.

• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Examples: Work with staff for performance of pulmonary function testing and other lab testing.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall
Friday mornings 7:30 - 8:00 a.m. - Coffee with Cardiology - IM Training Room

2. Clinical