The A&I fellow is responsible for all consultations and is supervised closely by the A&I attending on service. The fellow is responsible for all follow-up and communication with other services for these inpatients. Inpatients are seen principally at the Hospital of the University of Pennsylvania and also at Penn-Presbyterian Medical Center. In addition, inpatients at CHOP are evaluated as detailed elsewhere.
When an A&I consult is requested, the fellow sees the patient initially, then presents the case to the faculty member who also examines the patient. The A&I resident writes a complete note, which includes the history, physical examination, differential diagnosis, and suggested approaches for diagnosis and treatment. The patient is examined by the faculty member and the A&I resident’s note is reviewed. After any appropriate changes are made, the fellow’s note is reviewed and the attending does an attestation note on the inpatient PennChart system. In occasional situations when an immediate consultative response is needed, the A&I resident may discuss the case on the telephone with the A&I attending and subsequently put a preliminary A&I note in the chart. This note is followed by a full report after the patient is seen with the A&I attending, within 12 to 24 hours of notification of the case.
Teaching other house staff and medical students is an integral part of our inpatient activities. Thus, after plans are recommended and discussed in detail with the house staff teams, these teams have primary responsibility for requesting studies and writing orders concerning inpatients. For patients on the consultation service, the fellow has first responsibility to communicate with house officers, the primary service, and other consulting services. He/She and the A&I attending examine the patient in follow-up as necessary – the A&I resident is responsible for following up laboratory studies requested by our team, including after the patient is discharged. If medical residents or house officers are rotating on the A&I service, our resident will provide the preliminary supervision of their activities that will then be additionally supervised by the attending.
There is a close working relationship between the A&I staff and the staff of the Intensive Care Units. On average there is at least one A&I consultation per week in the MICU. Consultations are handled in the same way as floor consultations except they are generally followed more closely as the patients are sicker.
A&I fellows evaluate a variety of inpatients at the Hospital of the University of Pennsylvania. The patients are 18 years and older, males and females, and include a wide range of racial/ethnic backgrounds. The fellow is exposed to patients that represent the spectrum of allergic/hypersensitivity/immunodeficiency disorders. The most common in-patient consultations include: Drug allergy evaluation, drug desensitization and challenges, angioedema, eosinophilia, unexplained immunologic abnormalities and immunodeficiency evaluation or management.
The fellow sees outpatients daily during the first year and during those days also performs the inpatient duties (rotating with other fellows). When there is a consult – the fellow leaves the clinic earlier between one and two pm, in order to evaluate the in-patient. The fellow sees on average one to two hospitalized patient per day
Other Teaching Activities
Pulmonary Function Lab – In addition to doing and interpreting their own spirometry, A&I fellows spend one week observing other techniques (e.g. lung volume, diffusion, plesythmography studies) in the hospital pulmonary function lab.
Allergy and Immunology Techniques – Fellows get "hands-on" experience doing skin testing, challenge techniques, immunotherapy and (where desired) immunoassays as part of our clinical activities.