Director of the Adult Division: David Rosenstreich, MD
Director of the Pediatric Division and Training Director of the Combined Program: Arye Rubinstein, MD
The Allergy/Immunology Fellowship Training Program is a joint effort of the Divisions of Allergy/Immunology of the Departments of Medicine and Pediatrics.
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Program Tracks
The Einstein Allergy-Immunology Fellowship Training Program is a joint effort of the individual Divisions of Allergy/Immunology of the Departments of Medicine and Pediatrics.
The program consists of two tracks, Adult and Pediatric, each of which recruits fellows separately. The Medicine track usually selects fellows who have had three years of training in Internal medicine, and the Pediatric Track takes fellows trained in either Medicine or Pediatrics.
Cross Training
Fellows cross-train extensively between the Adult and Pediatric tracks.
- Both divisions see both children and adults in their faculty practice offices.
- Fellows do mandatory 6-month rotations through the pediatric and adult outpatient clinics in each of the two years.
- Adult track fellows have the opportunity to work in the faculty practices of the pediatric attendings as part of their elective rotations.
- All fellows do in-patient consultations on both pediatric and adult patients. For the adult patients, consults are discussed with one of the adult attendings. For the pediatric patients, consults are discussed with one of the pediatric attendings.
- All fellows and attendings from both divisions meet for about two hours at a lunch conference every Friday for case discusssions and a formal lecture.
Inpatient Activities
In-patient consultations are shared between both Divisions, so fellows have the opportunity to consult on both children and adult inpatients.
The Allergy/Immunology service sees 5-15 consults per week for problems of drug allergy and desensitization, aspirin desensitization, eosinophilia, poorly controlled asthma, immunodeficiency, food allergy, and the occasional odd patient that puzzles everyone else.
All consults are seen within 24 hours. Fellows first see in-patient consults alone and then discuss them with the appropriate attending. Recommendations are discussed with the team caring for the patient and a formal written consult is placed in the chart. Inpatient consults are rounded on with the attending at a later date. Interesting and challenging cases are discussed with all attendings and fellows on Friday before the formal clinical allergy or basic immunology lectures.
Outpatient Activities
Adult track fellows tend to spend a little more time in the Adult Allergy Division clinical facilities and focus their research efforts on hypersensitivity diseases. Pediatric track fellows spend a little more time in the Pediatric Allergy Division clinical facilities and tend to focus their research activities in the area of immunodeficiency.
Fellows evaluate new and follow-up patients and develops an assessment and plan. Cases are presented to and discussed with the appropriate attending and final plans are presented to the patients.
Most of the general clinical facilities of both Divisions see both children and adults. The outpatient facilities are extremely busy and see the whole range of hypersensitivity and immunologic disorders. The patient population is reflective of the New York City demographic and includes a large number of ethnicities and diverse socioeconomic backgrounds ranging from the poorest to some of the richest, and everyone in between.
Allergy Extracts
Fellows are not responsible for mixing extracts or administering allergy shots on a regular basis. There are ample opportunities to work with the research associate and clinic RN to learn the art of extract preparation and immunotherapy administration, respectively.
Drug Desensitization
All drug desensitization is administered by RNs or house staff taking care of the patient. Fellows are not responsible for staying in-house during the desensitization.
On-Call Schedules
Consult call is taken in one-week blocks. Depending on the number of fellows in the program, fellows take call one week out of every three or four weeks.
The only differences in the call schedules are that Adult track fellows perform consults in Jacobi and North Central Bronx Hospitals, while the Pediatric track fellows do not. In order to balance the workload, Adult track fellows never have any weekend call responsibilities, while the Pediatric track fellows do take call on weekends.
Fellows consult with Adult Division attendings for adult in-patients and with the Pediatric Division attendings on pediatric in-patients. The Pediatric track fellows handle almost all of the HIV-related consults. It is extremely rare for Adult track fellows to have to return to the hospital at night for consultations
Electives
Adult track fellows have the opportunity to design their own elective rotation schedules based on their educational needs and interests. These are usually taken as part-time participation in one-month blocks for some electives and as full-time, one-month blocks for others (e.g., Dermatology). The schedule is very flexible and can be adjusted based on the educational and research needs of the fellow.
Available blocks include:
- ENT: Opportunity to learn ENT approach to treatment of rhinitis, otitis and sinusitis, improve ability in reading sinus CT scans, and to master technique of fiberoptic rhinolaryngoscopy. Fellows can observe sinus surgery if interested and can have a virtual surgical experience using a computer controlled surgical dummy.
- Dermatology: Fellows usually spend one full month in a full-time, formal dermatology rotation.
- Pulmonary: Opportunity to learn Pulmonary approach to management of asthma, learn methacholine challenge technique, performance and interpretation of pulmonary function testing, improve ability in reading chest CT scans. Fellows can also rotate through the emergency department (ED) to learn management of acute asthma in the ED setting.
- Primary Immunodeficiency: Fellows spend time in the faculty practice office of Dr. Arye Rubinstein who has a very large population of patients with primary immunodeficiency problems including SCID, Bruton’s agammaglobulinemia, DiGeorge syndrome, CVID, etc.
- Rheumatology: Fellows who are interested may do a rotation with the Division of Rheumatology.
Research Opportunities
All fellows are encouraged to participate in some meaningful scholarly activity. Depending on their interest, experience and abilities, this can be laboratory-based research, clinical research or combined research. Fellows have the opportunity to pick their own research subjects. They can work with Division of Allergy/Immunology faculty members or with anyone else in the Montefiore/Einstein system.
Current research projects/interests of the Division of Allergy/Immunology include:
- Role of early childhood immunotherapy in the prevention of asthma in inner city children. (Dr. De Vos)
- Mugwort and spice allergy in chronic urticaria. (Dr. De Vos)
- Intensive allergen elimination in the management of chronic urticaria. (Drs. Hudes and Rosenstreich).
- Industry-sponsored trials of new drugs. (Dr. Hudes)
- Role of environmental contaminants like mercury and plastics in the promotion of allergy. (Dr. Rosenstreich)
- Role of food and non-food ingestants in the etiology of eosinophilic esophagitis (Dr. Rosenstreich)
- Drug and NSAID allergy (Dr. Jerschow)
Evaluation and Feedback
In addition to the informal feedback that occurs throughout the year, there are regularly scheduled, biannual evaluation sessions. All attendings submit written evaluations of each fellow and the fellows submit written evaluations of the attendings and the program. Fellows meet individually with two attendings (one from each track) to review the evaluations, discuss their performance and plan improvements if necessary.
Lectures and Conferences
- All fellows and attendings from both divisions meet for two hours every Friday for a formal clinical allergy or basic immunology lectures.
- 1-2 hour journal club/literature review every Monday for 12 months.
- Department of Medicine Grand Rounds every Thursday for 10 months.
- Attendance at the Medical school basic immunology course every fall semester.
- Attendance at the Graduate School Advance Immunology course every other Spring semester
- All other Medical school lectures are open to fellows. There are usually several relevant immunology lectures scheduled every week.
Career Guidance
Fellows are encouraged to participate in NY Allergy Society evening meetings four times per year. Fellows are also strongly encouraged to attend and present their research at the annual meetings of the American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Asthma, Allergy and Immunology (AAAAI).
During these meetings, there are plenty of opportunities for networking and exposure to job fairs. Attendings are always available to offer advice and guidance about post-fellowship life.
Outpatient Facilities
Montefiore Medical Park
1515 Blondell Avenue, 2nd floor
Bronx, NY 10461
Medical Arts Pavilion
3400 Bainbridge Avenue, 2nd floor
Bronx, NY 10467
Pediatric Allergy Clinic at the Children’s Hospital (CHAM)
3415 Bainbridge Avenue
Bronx, NY 10467
Cross County Office
1010 Central Park Avenue
Yonkers, NY
Jacobi Medical Center
Bldg 5, 3rd floor
Bronx, NY 10461
North Central Bronx Hospital
Bronx, NY 10467
In-Patient Facilities
Montefiore Medical Center – Weiler Division
Eastchester Road
Bronx, NY 10461
Montefiore Medical Center – Moses Division
East 210th Street
Bronx, NY 10467
Jacobi Medical Center
Pelham Parkway
Bronx, NY 10461
North Central Bronx Hospital
Kossuth Avenue
Bronx, NY 10467
Housing and Transportation
Fellows live in Manhattan and the Bronx.
Fellows are not guaranteed housing through the house staff office, although there is limited housing available to fellows.
A variety of subway lines/buses offer convenient access from Manhattan to the Bronx, and there are many beautiful neighborhoods to live in the Bronx within walking or driving distance or accessible by public transportation.
Shuttle buses travel between the various hospitals and clinics. Fellows do not need a car to get from clinic to inpatient evaluations.
Contact Information
Dr. David Rosenstreich, MD
Director, Adult Division
Montefiore Medical Group
1515 Blondell Avenue, Room 220
Bronx, NY 10461
(718) 405-8300
drosenst@montefiore.org
Dr. Arye Rubinstein, MD
Director, Pediatric Division
Montefiore Medical Park
1525 Blondell Avenue, Room 100
Bronx, NY 10461
(718) 405-8530
rubinste@aecom.yu.edu