First Clinical Year
During the first clinical year, fellows are assigned to four monthly rotations on the Duke Hospital Rheumatology Consult Service, four on the Durham VA Medical Center (VAMC) Service, and three research/elective rotations. All fellows maintain their own continuity clinics both at Duke University Medical Center (DUMC) for one half-day per week and the VAMC 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 first year fellow clinic time. 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 joint injection clinic during elective time.
Each first-year fellow has 3 months during the first year available to get started on a research project, spend a few half days in the Clinical Immunology Laboratory, write a case report or review, and participate in elective clinical experiences.
Second Clinical Year
During the second clinical year, fellows complete 2-4 additional weeks on the Duke Hospital Consultation service with 2-4 weeks as the teaching fellow on this service. Clinical fellows in the second year maintain one half day continuity clinic at the Durham VAMC and one directly mentored half day of continuity clinic at Duke. The remainder of the training months can be spent in electives, learning musculoskeletal ultrasound, and for completing the mentored research project.
First-year fellows can arrange elective experiences during elective/research months. Second year clinical fellows have ample time for elective experiences. Elective clinics may include: 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 has a mentoring committee that meets three times per year to provide oversight. Fellows are also required to co-author a case report, review article or book chapter during training.