Pediatric Rheumatology Fellowship

  • About the program

    The Fellowship Program in Pediatric Rheumatology is a three-year program designed for physicians trained in pediatrics and selected on the basis of excellence in their credentials and training programs.

    Our program combines a one-year clinical experience followed by at least two years of advanced training in basic, translational or clinical research, while continuing a longitudinal patient care experience. The program is led by a broadly experienced faculty who will train physicians to be pediatric rheumatologists and leaders in pediatric rheumatology.

    Fellowship training program director

    Jon (Sandy) Burnham, MD, MSCE
    Children's Hospital of Philadelphia
    Leonard and Madlyn Abramson Pediatric Research Center
    Division of Rheumatology
    3615 Civic Center Boulevard - Room #1102
    Philadelphia, PA 19104-4399
    215-590-7180
    burnhams@email.chop.edu

  • Fellowship goals

    The key goals of the fellowship program are to:

    Develop collaborative clinical care expertise

    • To lead the comprehensive care of children with rheumatic diseases.
    • To incorporate the role of medical and allied healthcare professionals in patient care.
    • To understand the role of community resources in the care of children with rheumatic diseases.

    Foster independent basic science, translational and clinical investigation

    • To offer formal post-doctoral course work in basic science, translational and clinical research.
    • To provide mentoring to develop and complete innovative and feasible research projects.
    • To ensure academic achievement by rigorously supervising academic progress.

    Invest in the future of pediatric rheumatology

    • To promote management skills for independent direction of a rheumatology team, including formal participation in divisional quality and patient safety initiatives.
    • To solidify research skills to further independent research careers.
    • To foster mentoring skills to educate subsequent trainees.
    • To cultivate leadership skills to advance the field of pediatric rheumatology.
  • Unique information about the program

    An independent Division of Rheumatology was established in 1999 within the Department of Pediatrics. In 2000, the American College of Graduate Medical Education (ACGME) accredited the Rheumatology Fellowship Program. We have six pediatric rheumatology faculty members and two fellowship slots available each year. Our faculty are actively engaged in both basic and clinical investigation, and have a longstanding commitment to Children’s Arthritis and Rheumatology Research Alliance's (CARRA) efforts. Additionally, CHOP Rheumatology recently joined the Pediatric Rheumatology Care & Outcomes Improvement Network (PR-COIN) Network.

    Pediatric rheumatology has a strong relationship with adult rheumatology. We have shared conferences, and pediatric fellows attend adult clinics periodically. Importantly, we have a shared NIH fellowship training grant.

  • Specific information by years and/or rotation

    First year 

    Fellows become proficient in the history, physical exam, differential diagnosis, diagnostic evaluation, and treatment of pediatric rheumatic diseases. Sensitivity to psychosocial aspects of chronic illness is emphasized.

    First year fellows spend five months each on inpatient and outpatient services, and spend one month on elective or research rotations. Elective rotations will be set up from a variety of outpatient clinics, depending on the fellow's needs (such as sports medicine, immunology, or our multidisciplinary uveitis clinic).

    The fellow will share night and weekend care with the pediatric rheumatology attending. Additionally, the fellow will prepare conferences and help teach residents and students rotating through the service.

    During the first six months, the fellow considers available research training opportunities. In the second half of the first year, the fellow develops an appropriate research training plan and identifies a research mentor.

    Second and third year

    Clinical responsibilities during the second and third years consist of a longitudinal patient care experience in continuity clinic and one month of inpatient service.

    The majority of time in the second and third years is devoted to research training — a critical component of the fellowship program. Fellows interested in basic science may enroll in courses offered through the UPENN Graduate Program in Immunology and work as a post-doctoral fellow in their mentor’s laboratory. Fellows interested in clinical research typically enroll in the two-year Master of Science in Clinical Epidemiology (MSCE) Program at the UPENN Center for Clinical Epidemiology and Biostatistics (CCEB). Those seeking formal training in translational research may enroll in the two-year Masters in Translational Research (MTR) Program.

  • General information on outcomes of fellows

    The CHOP Pediatric Rheumatology Fellowship is designed to allow graduates the flexibility to seek the career of their choice. Most graduates seek academic positions at tertiary care centers.

    In addition to the five graduates who currently hold faculty positions at CHOP, recent graduates have positions at the Cincinnati Children’s Medical Center, Children’s Hospital of Alabama at UAB, Nationwide Children’s Hospital, Seattle Children’s Hospital, University of California San Francisco Benioff Children’s Hospital, the National Institutes of Health, University of Texas Southwestern Medical Center, Children’s Hospital at Montefiore, Golisano Children’s Hospital at the University of Rochester, Children’s Mercy Kansas City, and the University of Iowa Children’s Hospital.

  • Related programs
  • Research expectations and opportunities

    Both clinical research and basic science research tracks are available to the fellow. The fellow is expected to participate in a research project, of either a clinical or basic science nature, during the last two years of the fellowship program.

    The program ensures a meaningful, supervised research experience based on early establishment of a mentor appropriate for the fellow's interests. The fellow is guided into appropriate training in order to successfully complete a research project over the course of the three-year program. Opportunities for attending University of Pennsylvania (Penn)-based courses in statistics and immunology are reviewed. The fellow may choose a clinically-based research project for which several mentors are available through the Divisions of Rheumatology at Penn or Children's Hospital, or the fellow may choose a basic research laboratory-based project. The fellow has the opportunity to work within the laboratories of Drs. Finkel, Behrens, Sullivan or Orange, or within the laboratories of other appropriate researchers at Children's Hospital, Penn or the Wistar Institute.

    Areas of laboratory research interest include immune cell (T-, B-, NK-cell) signal transduction and cytoskeletal dynamics, dendritic cells and immune tolerance, infectious causes of autoimmune disease, Toll-like receptor signaling, and animal models of Macrophage Activation Syndrome.

    The fellow is required to submit a research proposal to the chosen mentor and fellowship director prior to the end of the first year of training. This proposal is reviewed by the fellowship director and division faculty. The fellow and mentor are required to meet every three months during the first year and at least monthly thereafter to review progress in the research project, as well as any problems that may have arisen. The fellowship director meets with the fellow every three months during the second and third years of training to review progress and plans.

    The fellow is encouraged, though not required, to write a fellowship grant by the end of the second year of training. The primary goal of this exercise is to mentor the fellow through the difficult, but necessary and instructive task of writing grants.

  • Curriculum

    Clinical and technical skills

    First year

    • Rheumatologic history
    • Physical examination

    Diagnostic testing and procedures

    • Arthrocentesis
    • Synovial fluid analysis
    • Interpretation of results of disease-specific laboratory tests
    • Plain radiographs
    • Joint ultrasound including ultrasound guided joint aspiration and injection
    • Interpretation of results from the following tests:
      • Diagnostic imaging techniques
      • Radionuclide scanning techniques
      • Arteriograms in the vasculitides
      • Electromyograms and nerve conduction studies
      • Biopsy specimens including histochemistry and immunofluorescence of tissues
    • Others: nailfold capillary examination, ischemic forearm muscle test, Schirmer’s and rose bengal tests, closed needle synovial biopsy and arthroscopy
    • Demonstrate the ability to construct a differential diagnosis in children presenting with signs and symptoms related to rheumatologic diseases and to outline further testing necessary to establish the correct diagnosis
    • Using the basic principles of decision analysis, understand the indications for and costs of ordering laboratory tests and procedures to establish a diagnosis of a rheumatologic disease

    Therapeutic modalities and strategies

    • Therapeutic aspiration and injection
    • Pharmacology:
      • Nonsteroidal anti-inflammatory drugs
      • Glucocorticoids: topical, intraarticular, systemic
      • Systemic artirheumatic drugs: antimalarials, sulfasalazine, gold compounds, methotrexate, D-penicillamine
      • Cytotoxic drugs: allopurinol, sulfinpyrazone, probenecid
      • Antibiotic therapy for septic joints
      • Narcotic and non-narcotic analgesics
      • Others: apheresis, ionizing radiation

    Rehabilitation, disability and pain management issues

    • Multidisciplinary team concept
    • Methods of rehabilitation
      • Exercise: range of motion, strengthening and stretching
      • Rest and splinting
      • Aids and appliances
      • Shoes and orthotics
      • Nutritional issues
    • Specific rehabilitative techniques and modalities:
      • Psychosocial aspects — psychologic and emotional factors
      • Economic, educational and vocational issues
      • Compliance issues
    • Rehabilitation of the rheumatic disease patient after a surgical or orthopedic procedure

    Surgical management

    • Understand indications for surgical and orthopedic consultation in acute and chronic rheumatic diseases
    • For each procedure, the fellow should possess a working knowledge of indications, preoperative evaluation and medical adjustments, contraindications, complications, postoperative management and expected outcome:
      • Arthroscopy
      • Synovectomy of tendons and joints
      • Spine surgery: radiculopathy, stenosis and instability
      • Reconstructive surgery of hand and foot
      • Total joint replacement: hip, knee, shoulder, other
    • Infected joint
      • Infected joint management principles
      • Infected prosthetic joint
    • Non-allopathic medical practices: diet, nutritional supplements, antimicrobials, acupuncture, topicals, homeopathic remedies, venoms and others
    • Using the basic principles of decision analysis, understand the indications for and cost of different therapies used in the management of pediatric rheumatic diseases.

    Laboratory and diagnostic tests

    • Understand the biology and principles/methodology of the laboratory techniques:
      • Erythrocyte sedimentation rate, C-reactive protein and acute phase reactants
      • Rheumatoid factors
      • Antinuclear/Anticytoplasmic antibodies: screening test, specific autoantibody tests, and LE cell preparation
      • Antineutrophil antibodies: membrane and cytoplasmic
      • Antiphospholipid antibodies including RPR, lupus anticoagulant and anticardiolipin antibodies
      • Others: total serum complement activity, complement proteins, histocompatibility markers, cryoglobulins, immunoglobulin levels
    • Synovial fluid analysis
    • Radiographic imaging and other diagnostic procedures:
      • Plain radiographs of bone and joints
      • Bone densitometry
      • Nuclear medicine scintigraphy
      • Ultrasonography
      • Computed tomography
      • Magnetic resonance imaging
      • Electromyography and nerve conduction velocities
    • Test-performance characteristics: principles of sensitivity, specificity and predictive value
    • Biomechanics of joints

    Research principles in basic and clinical investigation

    • Health status measurements and quality-of-life assessments
    • Bioethics of basic research and clinical trials
    • Critical literature review
  • Conference schedules

    Daily

    • Resident morning report

    Weekly

    • Cassidy and Petty Text Review*
    • Medical Grand Rounds
    • Morbidity and Mortality Conference*
    • Pediatric Rheumatology Fellow Journal Club
    • Pediatric Grand Rounds*
    • Pediatric Rheumatology Grand Rounds*
    • Rheumatology Research in Progress
    • Rheumatology Clinic Conference
    • Topics in rheumatology
    • University of Pennsylvania Immunology Colloquium
    • Wistar Institute Immunology Lecture Series

    Monthly

    • Fellows Association
    • Molecular and Cellular Immunology Course (every other month)
    • Rheumatology/Radiology Rounds*

    Quarterly

    • Rheumatology/Dermatology Rounds*
    • Rheumatology/Pathology Rounds*
    • Cytoxan Rounds*

    *Attendance at conference is mandatory

    The Pediatric Rheumatology Fellow will attend selected Adult Rheumatology clinics and conferences at the Hospital of the University of Pennsylvania.

  • How to apply

    Our three-year fellowship seeks physicians who will have completed two to three years of training in an accredited residency program in order to sit for the American Board of Pediatrics certifying examination. Our fellowship program participates in the ERAS universal application process. Please visit their Web site at www.aamc.org/eras for application information about this program.

    The following information should be uploaded into this program:

    1. Completed application
    2. At least three letters of reference, including one from your residency program director
    3. Dean's letter and medical school transcript
    4. An updated Curriculum Vitae with publication references included
    5. A personal statement describing career goals and reasons for continuing training in pediatric rheumatology
    6. A recent photograph (optional)
    7. Parts 1, 2 and 3 of the USMLE taken within the seven year time frame as required by the Commonwealth of Pennsylvania or equivalent scores
    8. If a graduate of a medical school outside the United States, Canada or Puerto Rico, valid ECFMG certificate or one that does not expire prior to the start of the fellowship
    9. If not a citizen of the United States, copy of permanent resident card or copy of current, appropriate visa

    National resident matching program (NRMP)

    The Pediatric Rheumatology Fellowship program participates in the National Resident Matching Program (http://www.nrmp.org).

    Tobacco-free hiring policy

    To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

    Job applicants who apply after July 1, 2014, will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

    Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.

    Contact

    Lisa Sudell
    Fellowship Administrator
    The Children's Hospital of Philadelphia
    Pediatric Rheumatology Fellowship
    3615 Civic Center Blvd., 1102 ARC
    Philadelphia PA 19104-4318
    215-590-7180
    sudell@email.chop.edu

Reviewed on April 07, 2014