• Introduction
• Clinical Component
• Formal Clinical Teaching
• Clinical Electives
• Research Component
• Formal Research Training Opportunities and Institutional Resources
• Faculty
• Applications

Introduction

The pediatric rheumatology fellowship at UCSF is committed to training future academic pediatric rheumatologists. Fellows are expected to complete one year of clinical training and two years of academic training to prepare for a career in either clinical/translational investigation or basic laboratory investigation. The fellowship is designed to meet the expectations of the ACGME and to prepare fellows for the Board Exam in Pediatric Rheumatology.

Clinical Component

Clinical training for the fellows occurs in the following three venues:

Out-patient clinic: trainees are expected to gain experience in the evaluation, differential diagnosis, and management of children and adolescents with the full spectrum of rheumatic conditions. Fellows attend UCSF and outreach clinics during their clinical year. They will learn how to field phone calls regarding these patients, determine urgency by phone, and perform appropriate physical examination, ordering of studies, interpretation of studies, and institution and management of therapy.

In-patient service: trainees are expected to learn how to manage acutely ill patients with rheumatic conditions, including those with life-threatening complications.

Procedures: trainees are expected to perform the following procedures before graduation: aspiration or intra-articular steroid injection of elbow, wrist, knee and ankle.

Rehabilitation: trainees are expected to observe PT and OT evaluations and to gain an understanding of the principles and techniques of rehabilitation.

Continuity: trainees are expected to conduct a continuity clinic during their research years in which they follow a cohort of patients over time to develop an appreciation for and competency in the management of chronic issues.

Learning Objectives for the clinical training include the following:

Diagnostic testing and procedures: Fellows are expected to learn the techniques of arthrocentesis, and how to interpret synovial fluid analysis, and common laboratory tests such as sedimentation rate; C-reactive protein; iron studies, including ferritin; rheumatoid factor; antinuclear antibodies; anti-ds-DNA; anti-SS-A/Ro; anti-SS-B/La; anti-U1-RNP; anti-Sm; anti-ribosomal P; anticentromere; antitopoisomerase 1; SCL-70; antineutrophil cytoplasmic antibodies; cryoglobulins; complement component levels; CH50; serum protein electrophoresis; serum immunoglobulin levels; LE cell preparation; RPR; lupus anticoagulant; anticardiolipin antibodies; HLA typing; antihistone antibodies; ASO and other streptococcal antibody tests; Lyme serologies; circulating immune complexes; lymphocyte subset and function data. Additionally they are instructed in the interpretation of diagnostic imaging studies such as plain radiographs, radionuclide scanning techniques, computed tomography, magnetic resonance imaging and arteriograms. Finally, they are instructed in the interpretation of biopsy specimens including histochemistry and immunofluorescence of tissues.

Therapeutic modalities and strategies: Instruction in the use of pharmacologic agents and rehabilitation is taught in the both the in-and out-pt setting. Methods of rehabilitation including range of motion, strengthening and stretching exercises, rest and splinting, thermal and spa therapy, aids and appliances are taught in collaboration with the PM&R staff.

Formal Clinical Teaching

The following teaching conferences provide formal instruction during the clinical year. The core clinical curriculum is provided through a shared seminar series with the Adult Rheumatology fellows in the Department of Rheumatology.

Clinical Electives

The following are required electives during the clinical year.

Research Component

Both clinical research and basic science research tracks are available to the fellows. The fellow is expected to participate in a research project, of either a clinical or basic science nature, during the last two years of the fellowship program. The program ensures a meaningful, supervised research experience based on early establishment of a mentor appropriate to the fellow's interests. The fellow is encouraged, although not required, to write a grant, in order to provide meaningful instruction in grant-writing. Trainees are encouraged to receive advanced training, either through formal curriculum or mentoring as appropriate. They are expected to prepare and submit a manuscript for publication.

Formal Research Training Opportunities and Institutional Resources

• Department of Pediatrics
• Adult Division of Rheumatology
• Department of Biostatistics and Epidermiology
• Biomedical Sciences Graduate Program
• Institute for Health Policy Studies
• UCSF Immunology Graduate Program
• UCSF Program in Biological Sciences
• University of California, Berkeley School of Public health
• Pediatric Clinical Research Center

Faculty

Diana Milojevic, MD. Dr. Milojevic is interested in chronic arthritis of childhood, particularly the early onset of specified and unspecified spondyloarthropathies and systemic-onset JIA. She conducts a clinical/translational research program which is exploring the pathogenesis of systemic-onset JIA and aims to better define risk factors, prognostic factors, outcome and effects of early treatment for these patients. Dr. Milojevic conducts a weekly specialty clinic for children with JIA.

Emily von Scheven, MD, MAS. Dr. von Scheven conducts clinical research in the areas of Lupus, anti-phospholipid antibody syndrome and osteoporosis. She serves as Director of Pediatric Rheumatology, Director of the Pediatric Rheumatology Fellowship, and UCSF Site Director for the Glaser Pediatric Research Network, a five- hospital collaborative program in the US. Dr. von Scheven conducts a monthly specialty clinic for children with Anti-phospholipid antibodies.

Diane Wara, MD. Dr. Wara is Chief of the Division of Pediatric Immunology and Rheumatology and Program Director of the Pediatric Clinical Research Center. Her clinical investigation involves the primary immunodeficiency patients as well as her role in the Pediatric AIDS Clinical Trials Group.

Applications

Application requires the submission of three letters of recommendation, curriculum vitae, and personal statement describing your career goals. Interview is by invitation.

Please submit your materials to:

Emily von Scheven, MD

533 Parnassus Ave. U127
Box 0107
San Francisco, CA 94143

Contact Information:

Emily von Scheven, M.D.

Program Director
Email: evonsche@peds.ucsf.edu
Phone: 415-476-2491
Fax: 415-502-7540