The Allergy/Immunology training program provides basic science oriented physician/investigators (M.D. or M.D./Ph.D) with clinical experience that will meet the Allergy and Clinical Immunology Board requirements, along with training in research. Most graduates of the program are either academic investigators or academic clinicians who are members of medical school faculties. The Allergy/Immunology training program has been remodeled recently to meet the competitive and challenging goals of managed care. The clinical aspects of the program involve teaching and clinical practice. Clinical training in allergy begins with a full-time block of 4 months, during which an introduction into all practical aspects of the discipline is provided. Allergy skin testing, immunotherapy, and pulmonary function testing are reviewed in detail, along with training in relevant aspects of ENT, dermatology, ophthalmology, and pulmonary disease. Training then proceeds to ambulatory rotations on a once-a-week basis to provide a longitudinal experience in parallel with the laboratory program; these ambulatory rotations either occur in the Hypersensitivity Diseases Clinic at the BWH, the Allergy Service offsite in Chestnut Hill (convenient to the suburbs), and the Children's Hospital. Additional weekly ambulatory experiences may be arranged at the BWH Asthma Center, which is jointly managed by the Pulmonary and the Allergy/Immunology Services, or at other specialty services of interest to the trainee.
During the initial rotations, patients with a variety of IgE and non IgE-mediated disorders ranging from anaphylaxis to urticaria, angioedema, adverse drug reactions, rhinitis, and asthma are assessed. Less common disorders such as systemic mastocytosis, eosinophilic diseases, complement deficiencies, immune deficiencies, and vasculitides are also evaluated. Pediatric patients are seen at BWH, and also evaluated at the Children's Hospital and the MassGeneral Hospital for Children. Inpatient experience is gained primarily through consultations and provides a unique opportunity to assess difficult and challenging cases, to maintain clinical skills, and to interact with the hospital staff. Fellows assist in evaluation and management of inpatients and outpatients with drug allergies requiring desensitization for therapy of underlying diseases such as infections, cancer, and autoimmune conditions. Ongoing clinical experience in the second and third years is provided at one or more of the sites involved in the initial rotations. The clinical program, the array of courses in preclinical and clinical immunology under the auspices of the Committee for Immunology of the Harvard Medical School, and the in-depth, intensely supervised individual laboratory programs provide the range of skills needed for an academic career in the evolving subspecialty of Allergy and Clinical Immunology. Further experience in Rheumatology adequate to qualify for the appropriate subspecialty boards would include two more years after completion of the allergy training. However, this additional program must be developed at the inception of the allergy program.
The laboratory research experience is central to the Allergy program. Most postdoctoral fellows participate in the laboratories focused on molecular and cellular processes directly pertinent to bronchial asthma and allergic diseases. These research programs are directed to the study of mast cells, eosinophils, neutrophils, and the 5-lipoxygenase pathway to leukotriene generation. The senior faculty includes both preclinical faculty and faculty with subspecialties in rheumatology or allergy.
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