Clinical Training

Clinical training occurs at the North Carolina Baptist Hospital complex with 806 hospital beds distributed within several interconnecting buildings.  Within the main hospita,l are the general medicine and general pediatrics units as well as intensive care units (Neonatal Intensive Care Unit, Pediatric Intensive Care Unit, Medical Intensive Care Unit, Cardiac Intensive Unit, etc) and various specialty units.

The First-Year Fellow

The first-year fellow will be exposed to the entire spectrum of allergic and immunologic diseases by spending time both on the inpatient consultation service, as well as in the Adult and Pediatric Allergy Clinics and Immunodeficiency Clinic.  During the first and second year, each fellow spends time in the Pediatric Immunodeficiency Clinic, the Pediatric Allergy Clinic and in the Adult Allergy/Immunology Clinic, according to rotation schedule.  Responsibilities also include the on-call/consultation service in Adult and Pediatric Allergy/Immunology which is rotated among the various fellows.  This environment assures the fellow of a broad knowledge base encompassing a wide spectrum of allergic and immunologic diseases and provides the opportunity to manage both acute and chronically-ill patients on an inpatient and outpatient basis.

While in the Adult and Pediatric Allergy Clinics, the fellow will be trained in all aspects of allergic disorders as well as in the conduct and interpretation of prick and intradermal skin testing to aeroallergens, foods, drugs, vaccines and other biologicals.  During this training, fellows will be responsible for:

• writing individual patient prescriptions for allergy immunotherapy and for preparing these vaccines in the Allergy Laboratory
• administering allergy immunotherapy and for monitoring and managing any adverse reactions that might occur allowing them to acquire competence in the conduct of food challenges and other allergen challenge protocols, as well as various drug desensitizations
• developing and communicating individual treatment plans for allergic disorders and asthma and for the monitoring of the success of these treatment plans 

Furthermore, the fellow will spend time learning clinical pulmonary physiology by interpreting pulmonary function tests, exercise tests, and inhalation challenge studies. This is then further enhanced during a second year elective month on Pediatric Pulmonary. 

First and Second Years

During the first and second years of training the Allergy and Immunology fellow will spend one half-day per week in the Pediatric Immunodeficiency Clinic.  The Adult Immunodeficient patients are seen within the Adult Allergy clinic experience.  While in the Immunology Clinic, the fellow will:

• develop expertise in all aspects of immunodeficiency disorders including, but not limited to, the evaluation of a child or adult with recurrent, severe or unusual infections, or other history that might suggest a primary or secondary immune deficiency disorder
• learn how to perform and interpret various tests used to evaluate different aspects of the immune system
• be required to observe the conduct of many of these tests performed in the Diagnostic Immunology Lab at Wake Forest Baptist Medical Center

At the beginning of the first year of training, the fellow is assigned a panel of established adult and pediatric patients with antibody deficiency states who are admitted to the Day Hospital of North Carolina Baptist Hospital for regular infusions of intravenous immunoglobulin (IVIG).  The fellow follows these immunodeficiency patients throughout his/her entire training and is responsible for the supervision of their immunoglobulin infusions.  The trainee will acquire not only technical proficiency necessary for these procedures but also the judgmental skills essential to their appropriate use.