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Rheumatology
Rheumatology

Paediatric Rheumatology Residency/Fellowship Program

The Division of Rheumatology offers a two-year clinical fellowship program in paediatric rheumatology. The fellowship program is accredited by the Royal College of Canada. The overall mission of the Paediatric Rheumatology Program at the University of Toronto is to produce graduates who have all the skills and competencies required to function as consultants in paediatric rheumatology and have the ability to readily embark on further postgraduate fellowship training if they wish to pursue this.

As of July 2019, the Paediatric Rheumatology Subspecialty Training Program will be adopting the Royal College's Competence By Design (CBD) curriculum. Under this new curriculum, trainees will have their educational experiences structured within a two year time period by stages:

1.    Transition to Discipline - 2 months
2.    Foundations of Discipline - 4 months
3.    Core of Discipline - 16 months
4.    Transition to Practice - 2 months

Promotion from one stage of training to another will be based on successful completion of a designated number of observations as related to specific Entrustable Professional Activities (EPAs), e.g., recognizing rheumatic emergencies and following up appropriately. Promotion will be a decision made by a Competency Committee as a collective. This committee will consist of members including a Chair, program director and clinicians from the specialty of training within and outside of the training program, at a minimum.

Trainees are additionally expected to acquire and demonstrate competencies in all the CanMEDS (Canadian Medical Education for Specialists) roles developed and endorsed by the Royal College of Physicians and Surgeons of Canada, recently revised in 2015. The CanMEDS framework includes the following physician roles: Medical expert, communicator, collaborator, leader, health advocate, scholar and professional.

Trainees must demonstrate the knowledge, skills, and attitudes related to gender, culture, and ethnicity pertinent to rheumatology. In addition, trainees must demonstrate an ability to incorporate gender, cultural and ethnic perspectives into research methodology, data presentation, and analysis.

The overall goals will be accomplished by establishing the relevant inpatient and ambulatory clinical experiences in addition to a complementary academic program that will facilitate the successful achievement of the competencies required. There will be a graded escalation of responsibility commensurate with the clinical resident/fellow's level of training and competence.

The training program comprises of 13 blocks each year with specific rotations at The Hospital for Sick Children (SickKids) as well as a rotation in the ambulatory clinics at the major adult rheumatology hospital sites (University Health Network, St Michael's Hospital, and Sunnybrook and Women's College Health Sciences Centre).

It is anticipated that training experiences within the CBD curriculum will be as follows:

First year:

  • 7 clinical outpatient blocks
  • 3 clinical inpatient/consult blocks
  • 2 infusion and joint injection blocks
  • 1 elective block
  • 4 weeks vacation

Second year:

  • 6 clinical outpatient blocks
  • 2 clinical inpatient/consult blocks
  • 2 infusion and joint injection blocks
  • 1 elective block
  • 1 research block
  • 1 adult rheumatology block
  • 4 weeks vacation

There is an experienced and dedicated teaching faculty of ten full-time and part-time rheumatologists with diverse clinical and research interests. The clinical program is one of the largest in North America and provides fellows and residents with an extremely rich clinical experience and the opportunity to assess and manage the full spectrum of pediatric rheumatic diseases. The trainee has the opportunity to see patients from admission to discharge and follow-up in the ambulatory clinics, ensuring that he or she is able to to develop an understanding of the natural history and long-term treatment of rheumatic diseases.

The inpatient rotation includes the assessment and management of patients on the rheumatology unit, as well as a consultation service which allows the trainee to see the many rheumatic manifestations of systemic disease. Trainees are also responsible for emergency room consultations. Trainees also rotate through the medical day care unit where they have the opportunity to assess and manage patients admitted for investigations, infusions, or intraarticular corticosteroid injections. The ambulatory program has approximately 5,000 patients visits per year. Trainees have the opportunity to spend four to six-month rotations in general rheumatology clinics and in each of the subspecialty clinics for systemic lupus erythematosus, neonatal lupus, systemic juvenile idiopathic arthritis, juvenile spondyloarthritis, juvenile dermatomysositis, systemic vasculitis, Kawasaki disease, autoinflammatory syndromes, and morphea. Residents and fellow  also participate in their own longitudinal continuity clinic during the course of their fellowship. 

There is also exposure to community paediatric rheumatology clinics where trainees are able to learn a more community-based approach. Electives are required in adult rheumatology (one-month) and elective time is also available which can be taken in a variety of disciplines including paediatric immunology, orthopedics and radiology. The residents and fellows have a close relationship with the teaching staff who ensure there is a graded responsibility with greater independence of the residents and fellows expected as they gain experience.

There is a comprehensive academic program which has recently been consolidated into an academic half day. This half day includes paediatric rheumatology teaching sessions (core curriculum and subspecialty rounds), research rounds (where division members and fellow present research projects or projects in evolution), journal club/clinical epidemiology rounds, pathology rounds, and morbidity and mortality rounds and ethics seminars and clinical research tools course. Clinical dilemmas or clinical cases of interest are presented by the fellow or resident on service each week. In addition, there are weekly radiology rounds and a weekly basic immunology seminar series.

The program has a strong focus on research which residents or fellows are expected to initiate during the first year of their training. Trainees are encouraged and supported to pursue a scholarly project either in basic science, clinical, translational, educational, or quality research and to present their research both locally at the Department of Paediatrics' Research Day and the Rheumatic Disease Unit research day (Rheumatology Ogryzlo Research Day) and to submit an abstract for presentation at the American College of Rheumatology Annual Meeting. Trainees who wish to pursue independent, investigative research careers are encouraged to pursue an additional year or years of training.

For more information, please contact:
Kamela Ramlackhan
Administrative Assistant, Rheumatology Education Program and to Dr. Shirley Tse
Rheumatology
The Hospital for Sick Children
Phone: 416-813-5828
Fax: 416-813-4989
rheumatology.trainingprogram@sickkids.ca