Areas of Concentration

• Basic Biomedical Research Training Program
• Clinical Research Training Program
• Clinical Training Program

Basic Biomedical Research

The goal of the biomedical research track of the Fellowship Program is to provide a rigorous, exciting, and productive training experience for those individuals interested in developing careers as independent physician-scientists. This requires at least a three year commitment to the study of molecular and cellular mechanisms of arthritis, autoimmune, and musculoskeletal diseases, or to the development of novel therapeutic agents or vaccines targeted at these conditions. During the first year of the program, each fellow will have the opportunity to meet with principal investigators as well as other trainees, to discuss specific projects, interests, and plans for career development, which will be tailored to each candidate's interests, abilities, and goals. Prior to the start of the second year, each fellow is expected to identify a mentor, who will usually be a member of one or more of the six specific Research Programs described below.

An extensive biomedical research program is available to Rheumatology fellows at the University of Pittsburgh. The biomedical research base, defined as independently funded research projects related to arthritis and musculoskeletal diseases (and the related basic sciences such as Immunology, Molecular Genetics and Biomechanics) currently consists of 60 projects from 26 Principal Investigators representing 12 Departments in 3 Schools of the University. In addition, this base is only a subset of more than 100 investigators working in related fields that may be of interest to Rheumatology fellows seeking to become independent physician-scientists. Members of this biomedical research base have an outstanding record of established extramural funding.

The following descriptions of current biomedical research activities at the University of Pittsburgh has been organized into Research Programs which define groups of investigators with common research interests. All faculty within these Programs are Principal Investigators of independently funded basic and/or clinical scientific projects with specific aims that focus directly upon molecular and cellular mechanisms of arthritis, autoimmune, and musculoskeletal diseases, their treatment, or their prevention. It should be noted that there is extensive collaboration among members of many program areas and that these collaborations extend across the boundaries of basic science and clinical medicine. In fact, one of the strengths of the research base at the University of Pittsburgh is the close working relationships among basic science and clinical faculty.

Clinical Research Training Program

The goals of the Clinical Research Training Program are to provide fellows with the skills needed to become well-trained, productive and independent clinical investigators. These goals are optimally met in a three-year program (optional third year available).

The first year focuses on clinical training in the diagnosis and management of patients with rheumatic diseases. In years two and three, fellows are encouraged to participate in the graduate training program in Epidemiology at the Graduate School of Public Health, University of Pittsburgh. Course work includes introduction to study design, methodology and biostatistics and an opportunity to obtain a Masters in Public Health Degree (MPH). The Epidemiology of Women's Health Program at the Graduate School of Public Health focuses on promoting the health and well-being of women through teaching and research in Epidemiology. Faculty members from the Division of Rheumatology actively participate in the Women's Health Program curriculum. The particular course work of study is developed collaboratively by the fellow and major advisor based on academic and professional background, area of concentration and degree program.

Additional educational and research opportunities for second and third year fellows are available through the Center for Research on Health Care at the University of Pittsburgh Medical Center. This nationally recognized program provides expertise in conducting health services and outcomes research. Activities of the Center include research seminar and lecture series and collaborative endeavors on outcomes research.

The Clinical Research Program provides opportunities to interact with not only faculty from the Division of Rheumatology, but also nationally recognized clinical researchers in both the University of Pittsburgh's Department of Epidemiology at the Graduate School of Public Health and the Department of General Medicine including:

• Lewis Kuller, M.D., Dr.P.H., Professor and Department Chairman, Department of Epidemiology
• Roberta Ness, M.D., M.P.H., Associate Professor, Department of Epidemiology, Director of Epidemiology of Women's Health Program
• Jane A. Cauley, Dr.P.H., M.P.H., Associate Professor, Department of Epidemiology
• Wishwa Kapoor, M.D., M.P.H., Associate Professor, Department of Medicine, Chief, Division of General Internal Medicine

All clinical research fellows are required to formulate and conduct a research project during the fellowship under the supervision of one or more full-time faculty members with faculty collaborators. Fellows will initiate a literature review, design a protocol, conduct their research, analysis and summarize their results, prepare them for presentation at regional and/or national meetings and submit a manuscript for publication. In addition, fellows are encouraged to write up interesting or unusual cases as brief reports.

At the completion of this three-year program, fellows will be well trained in designing and conducting clinical epidemiologic research in the area of rheumatic diseases.

The following descriptions of current clinical research activities at the University of Pittsburgh has been organized into Research Programs which define groups of investigators with common research interests. All faculty within these Programs are Principal Investigators of independently funded clinical scientific projects with specific aims that focus directly upon arthritis, autoimmune, and musculoskeletal diseases. It should be noted that there is extensive collaboration among members of many program areas and that these collaborations extend across the boundaries of basic science and clinical medicine. In fact, one of the strengths of the research base at the University of Pittsburgh is the close working relationships among basic science and clinical faculty.

Clinical Training Program

The clinical training component of our Fellowship Training Program is designed to provide a strong foundation for those individuals interested in the practice of rheumatology and for those interested in a research career. There is a heavy emphasis on outpatient clinical experience with exposure to a broad spectrum of rheumatic diseases. The fellow is an active member of a health care team and is responsible for longitudinal patient management with primary decision-making responsibilities under faculty supervision. This is complemented by training in the inpatient setting that consists of evaluation and management of patients who are hospitalized under the direct care of faculty rheumatologists and approximately 40 inpatient consultations per month.

Each fellow attends three to six outpatient rheumatology sessions per week, depending on other (e.g. inpatient, research) concurrent training activities. Fellows perform complete initial evaluations, correspond with the patient's referring physician, and function as the patient's primary rheumatologist for longitudinal care under the supervision of a faculty member. The outpatient rheumatology experience involves participation in disease-specific sessions (one to four times monthly) staffed by faculty with clinical expertise and research interest in these diseases, as well as general rheumatology sessions. These disease-specific sessions include:

• Pediatric and Adolescent Rheumatic Disease
• Polymyositis/Dermatomyositis
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Systemic Sclerosis

The fellow spends approximately nine months on the inpatient consultation service over the course of the two-year fellowship. This service provides inpatient consults for the hospitals that comprise the UPMC Oakland campus and include Presbyterian University Hospital, the Eye and Ear Hospital of Pittsburgh, Children's Hospital, Magee-Women's Hospital, UPMC-Southside Hospital, and the VA Medical Center-Oakland. The fellow is a member of a team (faculty, fellow, resident, nurse practitioner) which is responsible for initial evaluation and follow up of inpatient consults as well as inpatients who are under the primary care of the rheumatology faculty.

The practical outpatient and inpatient rheumatology training is supplemented by formal didactic sessions throughout the fellowship training period. These are comprised of rotations in specific areas, scheduled conferences, and courses.