Allergy-Clinical Immunology Learning Objectives For Medical Students

Introduction

Allergy/Clinical Immunology Learning Objectives for Medical Students has been published by the American College of Allergy, Asthma & Immunology (ACAAI) to promote the education of medical students in a clinical setting.  The learning objectives are available online.

Many medical schools do not have departments of allergy/clinical immunology that contribute to education of medical students in these common and important diseases. For this reason, these Learning Objectives have been developed to encourage greater appreciation of areas within the field of allergy and clinical immunology that are relevant for primary care practice.

The ACAAI encourages the utilization of board-certified allergists/clinical immunologists in communities where no university faculty in our field is available. As many social and economic pressures change the availability of funding for graduate education, clinical training in practice settings will become even more important.

Allergy/Clinical Immunology Learning Objectives for Medical Students was first published in 1982 by the American Association of Certified Allergists, edited by Drs. Robert M. Miles and Edward J. O’Connell. The 1996 revision was produced by the College’s Family Practice Training Programs Committee: Drs. Jean Chapman and Jay Portnoy, co-chairs; and Drs. Lawrence Chiaramonte, Richard Lavy, Myron Lipkowitz, Allan T. Luskin, Lyndon Mansfield, Edward O’Connell, John O’Loughlin, Richard Weber, and Robert Zuckerman. This current 2005 revision was produced by Drs. Marianne Frieri, David Lang, D. Betty Lew, Allan Luskin, and Jay Portnoy.

Allergy-Clinical Immunology Elective For Medical Students

This is a clinical rotation about common, chronic diseases affecting both children and adults. This elective should be most helpful for medical students who are in third or fourth year.

Students should be introduced to allergy, asthma & clinical immunology and become familiar with the skills of history taking, examination of patients, laboratory techniques, and interpretation of the results as they relate to the specialty. There should be involvement in inpatient and outpatient management of conditions such as asthma, rhinitis, atopic dermatitis, anaphylaxis, drug reactions, food reactions, and urticaria/angioedema. Students should learn how to approach problems associated with immunodeficiency and autoimmune states. They should become familiar with immediate hypersensitivity skin testing, pulmonary function testing, and the indications for allergen immunotherapy.

A typical week of activities could include hospital rounds, departmental conferences, learning of ongoing clinical or basic science research and informal discussions with the allergy/immunology consultant as well as evaluation of the patients. Students should observe the administration of immunotherapy, immediate hypersensitivity skin testing and pulmonary function testing procedures, and should be given time to do detailed new and follow-up examinations of the patients.

Informal discussion sessions with the allergist/clinical immunologist may include the following subjects:

1. Asthma & other reversible lung disorders - diagnosis, differential diagnosis, pathophysiology and categorization of severity, goal development, treatment and development of a self-management action plan.
2. Status asthmaticus - diagnosis and treatment.
3. Non-asthmatic immunological lung disease (i.e. Hypersensitivity Pneumonitis).
4. Rhinitis - classification, diagnosis and treatment.
5. Care of patients with asthma and or/allergic rhinitis during pregnancy and other special populations such as infants and the elderly - changes in pulmonary physiology, use of drug therapy, and/or use of immunotherapy.
6. Drug reactions - diagnosis and treatment.
7. Food reactions - diagnosis and treatment.
8. Contact dermatitis - diagnosis and treatment.
9. Atopic dermatitis - diagnosis and treatment.
10. Stinging insect reactions - diagnosis and treatment.
11. Anaphylaxis - diagnosis and treatment.
12. Urticaria/Angioedema - diagnosis and treatment.
13. Vasculitis and other systemic inflammatory disorders.
14. Use and interpretation of diagnostic tests using Evidence-Based Medicine
    Indications for performance of:
    a) Pulmonary function tests
    b) Immediate hypersensitivity skin testing
    c) In vitro serum IgE allergen specific assays
    d) Optional: Clinical laboratory immunologic techniques for HIV, immunoglobulin and rheumatologic assays.
15. Clinical immunology - components of the immune system, immunological reactions, and the more common immunodeficiency states.

Sample Goals and Objectives

Example: Asthma

1. Gain familiarity with diagnosis, differential diagnosis (vascular ring, foreign body aspiration, cystic fibrosis, bronchiolitis, etc.) and current and novel treatment of asthma.
2. Display proficiency with history taking and examination of patients.
3. Become familiar with immediate hypersensitivity skin testing, office pulmonary function testing and the indications for immunotherapy in diagnosis and management of asthmatic patients.
4. Appreciate the utility of the allergist/immunologist for cost-effective care of the asthmatic patient in the ambulatory setting.
5. Understand the role of allergy as a provoking or perpetuating factor for asthma.
6. Learn the indications for hospitalization of acute exacerbation of asthma, status asthmaticus, and appropriate care of asthmatic patients under-going surgery or birthing.
7. Learn when to refer a patient to allergy/immunology service.

1. Examine patients with allergic diseases under the supervision of a consultant.
2. Participate in allergy/clinical immunology consultations.
3. Observe immediate hypersensitivity skin testing.
4. Observe pulmonary function testing and understand methacholine testing
5. Observe administration of immunotherapy. 

1. Make hospital rounds with the allergist/clinical immunologist.
2. Observe care of asthmatic patients with acute exacerbations of status asthmaticus.
3. Observe pre- and post-operative care of controlled asthmatics undergoing surgery or birthing.