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Overview

Program Duration and Size

Our formal program duration is 2 years to conform with the Accreditation Council for Graduate Medical Education Residency Review Committee in Internal Medicine / Rheumatology. All Fellows are fully Board-eligible after this time. However, we consider that having an adequate exposure to research and completing a research project will very often take longer and we offer all our Fellows the opportunity to extend their Fellowship to 3 years. Most of our Fellows do stay with us for at least 3 years but are under no obligation to do so. We recruit three Fellows yearly.

First Year Fellow Activities

The first year of Fellowship is fully committed to inpatient and outpatient clinical activities. During the first year Fellows choose a faculty research mentor and project and in the second year devote at least 80% of their time to their research project. This strong focus on clinical activities in the first year permits Fellows to fully commit themselves to research in their second year.

Outpatient: First year Fellows are assigned two half-day ambulatory clinics per week. We emphasize continuity of care and Fellows assigned to a patient will look after them for the duration of their training. All patients are staffed with an assigned faculty member and the same faculty member and Fellow will work together in a clinic for either one or two years (Fellows have one ambulatory clinic weekly in their second year). We believe this close and continuing interaction with specific faculty has a very positive impact on our Fellows clinical development and fosters excellence in patient care. Typically, Fellows evaluate 1-2 new patients and four established patients in each clinic.

In addition to the main ambulatory clinics, Fellows are assigned to the VA clinic once every month and to an Urgent New Patient clinic once every three weeks. We also arrange rotations through our very active Pediatric Rheumatology service (x3 clinics assigned over the two year Fellowship), Geriatric Rheumatology (x3), Scleroderma (x9) and Injection / Ultrasound (x9). We also offer elective rotations through Physical Medicine and Rehabilitation, Spine, Pain, and Sports Medicine clinics and through Musculoskeletal Radiology/Ultrasound; these are usually done in the second year of Fellowship and are especially valuable for Fellows planning a career in clinical practice.

Inpatient: We assign two first year Fellows to be on the inpatient consult service together and the usual rotation is 4 weeks on-service followed by 2 weeks off-service. Most consultations are for University of Michigan Hospital inpatients, but we also provide inpatient care at the Ann Arbor VA Hospital and travel there as needed (0.7 mile, 1 minute drive). Fellows get exposure to diagnosis and management of the full range of complex systemic diseases and their complications, as well as a range of acute joint-based diseases. One faculty member is assigned as consult service Attending Physician for a 2-4 week period and works closely with the on-service Fellows. Fellows are responsible for running a clinical unit that also consists of junior and senior house officers from the Core Internal Medicine program, fourth year medical students who have chosen a rotation in Rheumatology (acting as sub-interns), and house officers from Orthopedics, Physical Medicine and Rehabilitation and sometimes other services who have chosen a month of Rheumatology training.

Off-service time: First year Fellows when not assigned to the consult service are able to spend time preparing their contributions to our educational programs (Grand Rounds presentations etc.) and being involved in other forms of self-directed learning. Their only rostered clinical activity apart from ambulatory clinics is responsibility for evaluating referrals for urgent assessment of new patients. These referrals are initially vetted by the Division Chief and then given to the responsible Fellow who may contact the patient and referring physician before making a decision about level of urgency. Fellows have been given complete autonomy in scheduling and staffing an Urgent-New-Patient clinic that is held every second Friday that was established to evaluate and manage urgent referrals.

Call: First year Fellows are on-call for urgent inpatient consultations approximately one night in three. All call is from home; Fellows do not stay at the hospital when on-call.

Second and subsequent year Fellows activities.

In the second year the focus for our Fellows changes from clinical activities to research. Fellows reduce weekly half-day ambulatory clinics from two to one, reduce the frequency of their VA clinics from monthly to six-weekly, and spend only limited time on the consult service (usually 4-6 weeks), limited to covering first year Fellows on vacation and supporting first year Fellows in their first month. In the third year Fellows are appointed to the faculty as Fellow/Lecturers and are responsible for their own ambulatory clinic one day / week but do not have other clinical responsibilities.

Fellows choose a research mentor and project during their first year and in the second year are able to devote at least 80% of their time to their research project. The Division Chief and Program Director are eager to assist Fellows as they go through the process of choosing a mentor and project. Most of our Fellows choose a mentor from amongst Rheumatology faculty but are under no obligation to do so. The basic science faculty all have significant peer reviewed external funding, generally including at least one NIH RO1 or equivalent.  Areas of investigation include human immunology and immunopathology, mechanisms of inflammation, connective tissue biology and biochemistry, and molecular genetics. The research laboratories of the Division of Rheumatology occupy over 12,000 square feet of space. In addition to a strong focus on basic research, we recognize the need to train investigators in patient-oriented research.  Our clinical research faculty has undergone considerable expansion in recent years, targeting SLE, scleroderma, and the pathophysiology of pain. The primary areas of investigation for these faculty members include epidemiology, behavioral sciences, human physiology, therapeutics, and outcomes research.

Rheumatology faculty are familiar with other rheumatic-disease related research on campus through close active collaborations, inter-disciplinary graduate education programs, and the support we provide to a large number of other investigators through our NIH Rheumatic Diseases Core Center grant. We can and do assist Fellows find research mentors in other academic units if they wish. We recommend that potential applicants interested in the scope of available research opportunities access websites such as:

The University of Michigan Howard Hughes Medical Institute
Life Sciences Institute
The Biological Sciences Scholars Program
Program in Biomedical Sciences
Individual Departments
Inter-disciplinary programs
Michigan Institute for Clinical & Health Research

Fellows interested in pursuing a career in research are offered the opportunity to attend a 10 week full-time Postdoctoral Research Training Program at the beginning of their second year. The program is designed to introduce individuals with a strong interest in pursuing a career in academic medicine to new and emerging concepts in cell and molecular biology. The course is divided into two basic categories: 1) Cell biology and biochemistry and 2) Molecular biology and genetics. These two sections are introduced by a core of 10 faculty members who have been chosen from the Departments of Biochemistry, Human Genetics, Physiology, Pathology, Pharmacology, Biology, Internal Medicine, as well as the Howard Hughes Medical Institute. In part, the program is constructed to provide a basic framework of knowledge in a variety of disciplines. However, more importantly, the course is designed to introduce Fellows to the methods of scientific thought, inquiry and analysis via the presentation of specific research topics. The program does not emphasize techniques, but rather problem solving exercises.

Fellows interested in clinical/translational research are offered the opportunity to enroll in the Master of Science program in Clinical Research Design and Statistical Analysis offered by the School of Public Health. Coursework is usually completed over a 2 year period and is coordinated with the Fellows research project and other responsibilities.

Both the basic science research training program and MPH degree course have been very popular with previous Fellows and are highly recommended. The program pays all associated costs.