Division of Allergy & Immunology

Allergy-Immunology Fellowship Adult Track

Program Tracks 
The Einstein/Montefiore Allergy-Immunology Fellowship Training Program is a joint effort of the individual Divisions of Allergy/Immunology of the Departments of Medicine and Pediatrics. 

The program consists of two tracks, Adult and Pediatric, each of which recruits fellows separately. The Medicine track usually selects fellows who have had three years of training in Internal medicine, and the Pediatric Track takes fellows trained in either Medicine or Pediatrics.

Training Objective 
Our program is designed to provide well-rounded training in all aspects of Allergy and Clinical Immunology. Through rotations at the Asthma Center, Drug Desensitization Program and Food Allergy Center fellows have focused exposures to Respiratory, Drug and Food Allergies. Fellows are required to cross train with the pediatric division in the immune deficiency clinics. Though we are part of Department of Medicine, our clinics are mix of both Pediatric and Internal Medicine patients. 

Outpatient Training
Internal Medicine track fellows tend to spend a little more time in the Internal Medicine Allergy Division clinical facilities and focus their research efforts on hypersensitivity diseases. Fellows evaluate new and follow-up patients and develop an assessment and plan. Cases are presented to and discussed with the appropriate attending and final plans are presented to the patients.
Montefiore offers a diverse patient population from Bronx and Southern Westchester, and a rich clinical experience in a wide variety of hypersensitivity disorders. Fellows will gain experience in respiratory allergies, skin disorders such as urticaria and contact dermatitis, drug allergies, food allergies and primary immune deficiency disorders. Fellows have the option to rotate through multidisciplinary clinics run jointly by Allergy and Pulmonary (for asthma) and Allergy and ENT (for Chronic Sinusitis).

Inpatient Training
In-patient consultations are shared between both Divisions, so fellows have the opportunity to consult on both children and adult inpatients. The Allergy/Immunology service sees 5-15 consults per week for problems of drug allergy and desensitization, aspirin desensitization, eosinophilia, poorly controlled asthma, immunodeficiency, food allergy, and the occasional patient that puzzles everyone else.
All consults are seen within 24 hours. Fellows first see in-patient consults alone and then discuss them with the appropriate attending. Recommendations are discussed with the team caring for the patient and a formal consult note is entered in the EMR system. Inpatient consults are rounded on with the attending at a later date. Our EMR systems (EPIC at Montefiore inpatient facilities and Quadramed at Jacobi and North Central Bronx Hospitals) are accessible from home through remote access.

Cross Training
Fellows cross-train extensively between the Internal Medicine and Pediatric divisions. Though each division caters to both adult and pediatric patients, there is are mandatory 6-month rotations pediatric allergy division in each of the two years. In addition, internal medicine track fellows have the opportunity to work in the faculty practices of the pediatric division attendings as part of their elective rotations. All fellows do inpatient consultations on both pediatric and adult patients that are then are discussed with one of the pediatric or medicine allergy attendings. All didactics sessions for fellows from both tracks are combined.

Allergy Extracts
Fellows are not responsible for mixing extracts or administering allergy shots on a regular basis. Fellows will learn how to prepare and administer allergy immunotherapy extracts by shadowing the research associate in charge of mixing allergen immunotherapy. If the fellows desire more intense exposure to the practice of allergy immunotherapy, there is also opportunity for hands-on practice.

On-Call Schedules
Consult call is taken in one-week blocks. Fellows are on call for inpatient consults at Montefiore and Weiler Hospitals on an average one week out of every five weeks. Adult and pediatric cases are precepted by medicine and pediatric allergy attendings
Fellows in the medicine track (but not pediatric track) cover adult inpatient consults for Jacobi and North Central Bronx Hospitals. Medicine track fellows are responsible for after-hours coverage on weekdays for the adult outpatient service and pediatric track fellows for the pediatric division. Medicine track fellows never have any weekend call responsibilities, while the Pediatric track fellows do take calls on weekends for the pediatric division attendings. The Pediatric track fellows handle almost all of the HIV-related consults.

Electives
Adult track fellows have the opportunity to design their own elective rotation schedules based on their educational needs and interests. These are usually taken as part-time participation in one-month blocks for some electives and as full-time, one-month blocks for others (e.g., Dermatology). The schedule is very flexible and can be adjusted based on the educational and research needs of the fellow as long as it meeds ACGME and ABAI requirements
Available blocks include:

  1. ENT: Opportunity to learn ENT approach to treatment of rhinitis, otitis and sinusitis, improve ability in reading sinus CT scans, and to master technique of fiberoptic rhinolaryngoscopy. Fellows can observe sinus surgery if interested and can have a virtual surgical experience using a computer controlled surgical dummy. 
  2. Dermatology: Fellows usually spend one full month in a full-time, formal dermatology rotation. 
  3. Pulmonary: Opportunity to learn Pulmonary approach to management of asthma, learn methacholine challenge technique, performance and interpretation of pulmonary function testing, improve ability in reading chest CT scans. Fellows can also rotate through the emergency department (ED) to learn management of acute asthma in the ED setting. 
  4. Primary Immunodeficiency: Fellows spend time in the faculty practice office of Dr. Arye Rubinstein who has a very large population of patients with primary immunodeficiency problems including SCID, Bruton’s agammaglobulinemia, DiGeorge syndrome, CVID, etc. 
  5. Rheumatology: Fellows who are interested may do a rotation with the Division of Rheumatology. .
  6. Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center.

Research Opportunities 
All fellows are encouraged to participate in some meaningful scholarly activity. Depending on their interest, experience and abilities, this can be laboratory-based research, clinical research or combined research. Fellows have the opportunity to pick their own research subjects. They can work with Division of Allergy/Immunology faculty members or with anyone else in the Montefiore/Einstein system.   

Current research projects/interests of the Division of Allergy/Immunology include: 

  1. Role of early childhood immunotherapy in the prevention of asthma in inner city children. (Dr. De Vos) 
  2. Intensive allergen elimination in the management of chronic urticaria. (Drs. Hudes and Rosenstreich). 
  3. Industry-sponsored trials of new drugs. (Dr. Hudes) 
  4. Role of food and non-food ingestants in the etiology of eosinophilic esophagitis (Dr. Rosenstreich) 
  5. Drug and NSAID allergy (Dr. Jerschow) 

Evaluation and Feedback 
In addition to the informal feedback that occurs throughout the year, there are regularly scheduled, biannual evaluation sessions. All attendings submit written evaluations of each fellow and the fellows submit written evaluations of the attendings and the program. Medicine Track fellows meet individually with two attendings (one from each track) to review the evaluations, discuss their performance and plan improvements if necessary.   

Lectures and Conferences 

  1. All fellows meet for two hours every Friday for lectures or invited presentations in basic immunology and clinical allergy and immunology,,
  2. Fellows from both tracks attend a one to two hour precepted Board Review session every Monday
  3. In addition, medicine track fellows attend an one hour journal club/literature review every Wednesday. 
  4. Department of Medicine Grand Rounds every Thursday. 
  5. Research methods course on Wednesday afternoons. 
  6. Fellows are encouraged to participate in the AAAAI board review course 
  7. Fellows are encouraged to present original research and cases at national meetings of the American Academy of Allergy, Asthma and Immunology (AAAAI) and American College of Allergy, Asthma and Immunology (ACAAI) 
  8. Fellows are encouraged to be members of the New York Allergy and Asthma Society (NYAAS), attend its meetings and Teaching Day.
  9. Fellows can choose to attend immunology courses offered in the graduate and medical schools.

Career Guidance
Fellows are encouraged to participate in NY Allergy Society evening meetings four times per year. Fellows are also strongly encouraged to attend and present their research at the annual meetings of the American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Asthma, Allergy and Immunology (AAAAI). 

During these meetings, there are plenty of opportunities for networking and exposure to job fairs. Attendings are always available to offer advice and guidance about post-fellowship life.

Fellows Office
Medicine track fellows have dedicated office space at: 
1776 Eastchester Rd
Bronx, NY 10461 

Faculty Offices
Rooms 217-225, The Atrium
1776 Eastchester Rd
Bronx, NY 10461

Outpatient Facilities 
Hutchinson Metro Center 

1250 Water’s Place, Tower II, 12th floor
Bronx, NY 10461

Medical Arts Pavilion
3400 Bainbridge Avenue, 2nd floor
Bronx, NY 10467

Pediatric Allergy Clinic at the Children’s Hospital (CHAM)
3415 Bainbridge Avenue
Bronx, NY 10467

Cross County Office
1010 Central Park Avenue
Yonkers, NY

Westchester Medical Specialists
495 Central Park Ave
Scarsdale NY 10583

Jacobi Medical Center
Bldg 5, 3rd floor
Bronx, NY 10461

North Central Bronx Hospital
Bronx, NY 10467

 

In-Patient Facilities
Montefiore Medical Center – Weiler Division 

1825 Eastchester Road
Bronx, NY 10461

Montefiore Medical Center – Moses Division
East 210th Street
Bronx, NY 10467

Jacobi Medical Center
1400 Pelham Parkway
Bronx, NY 10461

North Central Bronx Hospital
Kossuth Avenue
Bronx, NY 10467 
 

Housing and Transportation 
Fellows live in Manhattan, the Bronx or Westchester. Fellows are not guaranteed housing through the house staff office, although there is limited housing available to fellows.  

A variety of subway lines/buses offer convenient access from Manhattan to the Bronx, and there are many beautiful neighborhoods to live in the Bronx within walking or driving distance or accessible by public transportation. Shuttle buses travel between the various hospitals and clinics.

 

Contact Information 
Dr. David Rosenstreich, MD
Director, Adult Division
1250 Waters Place
Tower II 12th floor
Bronx, NY 10461
drosenst@montefiore.org  


Dr. Arye Rubinstein, MD
Director, Pediatric Division
Montefiore Medical Park
1525 Blondell Avenue, Room 100
Bronx, NY 10461
(718) 405-8530
rubinste@aecom.yu.edu  

 

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