First Clinical Year
During the first clinical year, fellows are assigned to rotations on the Duke Hospital Rheumatology Consult Service, the Durham VA Medical Center Rheumatology Service, and research/elective time. Fellows spend approximately one-third of the year on each of these activities.
First year fellows also maintain their own continuity clinics at Duke University for one half-day per week and the Durham VA for two half-day sessions per week. All first year clinics are directly supervised by faculty members who do not have other patient care responsibilities during clinic time. In clinic, fellows routinely see new patient consultations, provide ongoing care for patients with the full diversity of rheumatologic illnesses and provide ongoing continuity care for patients they have seen in the inpatient setting.
Each first year fellow gains community rheumatology experience either through participating in a community outreach clinic off-site one day each month with a rheumatology faculty member, or through participating in the Division's off-site rheumatology clinic one day each month with a faculty member. These experiences afford an opportunity to provide care in either a rural community or in a community-based rheumatology practice with one-on-one teaching. Fellows have the opportunity to participate in the pediatric rheumatology clinic during elective time.
Each first year fellow has approximately 3 months during the first year available to get started on a research project, spend time in the Clinical Immunology Laboratory, write a case report or review, and participate in elective clinical experiences.
During the second year, clinical fellows complete 3 additional weeks on the Duke Hospital Consultation service and 4 weeks as the teaching fellow on this service. Clinical fellows in the second year maintain one half day continuity clinic at the Durham VA and one at Duke. The remainder of the training months can be spent in electives, learning musculoskeletal ultrasound, and completing a mentored research project.
For fellows on the research track, clinical responsibilities include one half day of continuity clinic per week and adequate time on the inpatient service to allow them to effectively supervise fellows in the inpatient setting upon graduation. The remainder of the research fellow's time is protected to conduct research with the goal of obtaining external funding upon graduation.
First year fellows can arrange elective experiences during elective/research months. Second year clinical fellows rotate through the Duke Lupus Clinic and the Duke Autoimmunity in Pregnancy Clinic (one half day per week for four months each). Fellows also have the opportunity to spend time in other Duke Rheumatology subspecialty clinics such as inflammatory eye disease, scleroderma, myositis, gout, and MSKUS. Elective clinics outside of Rheumatology may include: interstitial lung disease, osteoporosis/metabolic bone disease, musculoskeletal radiology, sports medicine, hand surgery, dermatology, neurology and others depending on fellows' personal interests.
Didactics and Quality Improvement
Didactic conferences are designed by upper level fellows in consultation with a supervising faculty member. Conferences depend on fellow involvement and preparation prior to meetings. Fellows discuss the relevant scientific literature on consult rounds and in clinic, lead journal clubs, and deliver oral presentations at weekly conferences. Didactic time includes education in quality improvement science. Every year all fellows work together to lead the Division in a single quality improvement project mentored by faculty members.
All fellows develop and conduct an independent research project during their training. These projects are tailored to fellows' interests, keeping in mind the feasibility of suitable projects and availability of faculty mentors. Fellows are provided guidance to complete all necessary research certifications during the first year, along with training in research methodology. The research project begins during the first year and continues through the second year, with the goal of submitting an original research manuscript before graduation. Every fellow works closely with a mentor to provide guidance and oversight. Typically these projects result in publication and presentation at national or regional scientific meetings. Fellows also are required to co-author a case report, review article or book chapter during training.