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Electives - Asthma, Allergy and Immunology

Asthma, Allergy and Immunology

Elective Number: 1631

Rotation Supervisors: Drs. Larry Borish

Coordinator: Linda Davis, MR4 room 5086; (434) 924-5917, lmr3g@virginia.edu

Available: All Rotations

Duration: 4 weeks ONLY

Report to: Dr. Borish

Time to Report: 8:00 am

Place to Report: Northridge 3rd Floor, Ste. 311 - Allergy/Asthma/Immunology Clinic

Typical days: 8:00 am - 5:00 pm

Attendance: Attendance at elective activities is mandatory.

  • Anyone who is ill or has a personal or family emergency must contact Student Affairs and the Attending on Service.
  • Students are allowed to take off up to 1 day per week to interview between November 1 and February 1.
    • Specific days missed must be approved by the Attending on Service.

Required reading: American Journal of Rhinology & Allergy (Supplement 1, May-June 2013). Understanding Sinonasal Disease: A Primer for Medical Students and Residents - www.ajra.com

Number of students per rotation: 1

Course Description: The Elective offers experience and instruction in the outpatient evaluation and management of both pediatric and adult asthma, allergic and immunologic diseases.

Disease Characteristics: Students who choose this rotation will become knowledgeable in the diagnosis and management of common allergic diseases including (but not necessarily limited to): asthma, allergic rhinitis, atopic dermititis, urticaia, drug reactions, immunodeficiency and anaphylaxis.

Clinical Procedures: Additionally they will be exposed to the common diagnostic and therapeutic modalities used in the practice of allergy (pulmonary function testing, peak flow monitoring, intravenous immunoglobulin administration, skin testing and immunotherapy).

Competencies:

  • Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
  • Medical knowledge about established and evolving biomedical, clinical and cognate sciences, as well as the application of this knowledge to patient care
  • Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence and improvements in patient care
  • Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and other health professionals; students may provide, under supervision, consultation to physicians in other specialties
  • Professionalism, as manifested through a commitment, carrying out professional responsibilities, adherence to ethical principles and sensitivity to patients of diverse backgrounds
  • Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Time will be divided between the adult and pediatric outpatient practice, as well as inpatient consultation. Students will be taught by required reading material, example and patient encounter through the attending, the fellows, the residents and the nursing staff. Students are expected to use all resources in clinic to learn allergy practice. Time for students to participate in hospital rounds on inpatients and on consult service will be arranged. Attendance at weekly fellow's conferences is expected. The divisional journal club is required from 12:00-noon on Fridays.

CLINICS: MONDAYS-FRIDAYS
Mondays: 8 am – 5 pm – A/A/I Clinic, Dr. Timothy Kyin – Northridge clinic (2955 Ivy Road), 3rd floor, Suite 311
Tuesdays: 8 am – 5 pm – A/A/I Clinic, Dr. Larry Borish (1st/3rd/5th Tuesday) / Dr. Anna Smith (2nd/4th Tuesday) – Northridge clinic
Wednesdays 8 am – 12:30 pm – Primary Immune Deficiency (PID) Clinic, Dr. Monica Lawrence (1st/3rd/5th Wednesday) / Dr. Larry Borish (2nd/4th Wednesday) – Northridge clinic
1 pm – 5 pm – A/A/I Clinic – Dr. Monica Lawrence – Northridge clinic
Thursdays: 8 am – 5 pm – A/A/I Clinic, Dr. Thomas AE Platts-Mills – Northridge clinic
Fridays: 1 pm – 5 pm – Combined allergy sinus clinic (CASC) Drs. Borish and Dr. Spencer Payne – 1-2 Fridays/month (please ask Dr. Borish)) – Fontaine Research Park (415 Ray C Hunt Drive) Suite 2200

CONFERENCE: FRIDAYS
Report to MR4 Building, 4th floor conference room (409 Lane Road – the building across the street and towards the left if you are coming out of the UVA Hospital loading dock; locked building, you will need to be buzzed in). Lectures and Journal Club are usually from 10 AM-noon, but please ask someone each week as it might change week to week.

RESPONSIBILITIES:
**On the first day of your rotation, please provide in writing (email is fine) a list of dates you will not be in clinic (e.g., for interviews). If you have an unexpected absence due to illness, contingency, or anything else it is your responsibility to notify the attending that day and Dr. Borish of your absence.

As a medical student rotating with us, we would like you to get as much exposure to what we do as possible. Please see patients on your own and present to the attending you are working with that day. You are expected to write your own clinic notes in EPIC (and receive appropriate feedback).

ADDITIONAL INFORMATION:
Attendings that see adults mostly: Drs. Platts-Mills, Borish, Kyin, and Smith
Attendings that see pediatrics mostly: Dr. Heymann (it may be possible to arrange to rotate through Battle Building Pediatrics clinic on Wednesday)

Current Fellows:
DeVon Preston / Bob Sullivan (2nd year), Julia Sohn/ Monica Gupta (1st year)

Useful reading list:

1. Northwestern University Allergy-Immunology Syllabus 2012: Residents and Students. Allergy & Asthma Proceedings 33(3; Suppl 1), May-June, 2012.
2. Numerous allergy/asthma/immunology “state of the art practice parameters” available including those on chronic sinusitis, anaphylaxis, allergic rhinitis, chronic urticaria online at this Link.
3. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. J Allergy Clin Immunol 2007 Nov;120(5 Suppl):S93-138. Link
This is the “gold standard” for the diagnosis and management of asthmatic patients.
4. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med 2008;358:1109-1117. Link
5. Park MA, Li JT, Hagan JB, Maddox DE, Abraham RS. Common variable immunodeficiency: a new look at an old disease. Lancet 2008;372:489-502. Link
6. Bird, JA, G Lack, TT Perry. 2015. Clinical management of food allergy. J Allergy Clin Immunol: In Practice 2015;3(1):1-11. http://www.jaci-inpractice.org/article/S2213-2198(14)00267-0/abstract
7. Wasserman, RL. The nuts and bolts of immunoglobulin treatment for antibody deficiency. J Allergy Clin Immunology: In Practice 2016;4(6):1076-1081. http://www.jaci-inpractice.org/article/S2213-2198(16)30407-X/abstract
8. Laidlaw, TM and KN Cahill. Current knowledge and management of hypersensitivity to aspirin and NSAIDS. J Allergy Clin Immunology: In Practice 2017;5(3):537-545. http://www.jaci-inpractice.org/article/S2213-2198(16)30559-1/abstract


Welcome, and we hope you have a great month rotating with us!