Rheumatology

Overview

Rheumatology is the branch of medicine concerned with the specialized assessment and care of patients with rheumatologic, autoimmune, and musculoskeletal-related health disorders. Traditionally, pediatric patients (usually under age 18) are attended to by pediatricians with subspecialty training in Pediatric Rheumatology.

The SickKids clinical program is one of the largest in North America and provides residents and fellows 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 develop an understanding of the natural history and long-term treatment of rheumatic diseases.

Objectives

On completion of the two-year Paediatric Rheumatology training program (core program), the resident and fellow will be effective in the assessment, investigation, management, and rehabilitation of patients with inflammatory arthritis, systemic autoimmune rheumatic diseases, vasculitis, autoinflammatory diseases, soft tissue rheumatic disorders, collagen-vascular diseases, spinal, and regional pain problems and the musculoskeletal manifestations of systemic disease.

Residents and fellows in Pediatric Rheumatology may plan a training program directed to an academic teaching and research career in the University setting or independent private practice in the community. Private practice Rheumatologists, and in particular those with university clinical appointments may also engage in teaching and research activities. Residents wishing to pursue a career in academic rheumatology are encouraged to take additional research training following completion of the core clinical Rheumatology Program.

Pediatric Lupus

At SickKids, Paediatric Lupus fellowship is offered by the Division of Rheumatology, Department of Paediatrics, University of Toronto. This is an advanced clinical research fellowship dedicated to state-of-the-art interdisciplinary clinical care and research for children and adolescents with lupus. This fellowship is one year in duration. Applicants must have prior experience in paediatric rheumatology.

Childhood Vasculitis

At SickKids, Childhood Vasculitis fellowship is offered by the Division of Rheumatology, Department of Paediatrics, University of Toronto. This is an advanced clinical research fellowship dedicated to state-of-the-art interdisciplinary clinical care and research for children and adolescents with vasculitis. This fellowship is one year in duration. Applicants must have prior experience in pediatric rheumatology.

Training Sites

The Hospital for Sick Children (SickKids) is the main training site for the Paediatric Rheumatology Program. There is also an opportunity to complete rotations at community paediatric rheumatology sites in the Greater Toronto Area (GTA), in addition to an outreach clinic in Sudbury, Ontario.

The adult rheumatology rotation is completed in the ambulatory clinics at the major adult rheumatology hospital sites (University Health Network, Mount Sinai Hospital, St Michael’s Hospital, Sunnybrook and Women’s College Health Sciences Centre).

SickKids is the main training site for the Paediatric Lupus and Childhood Vasculitis fellowships.

Program Content

The pediatric rheumatology core training program is comprised of:

  • 5 months inpatient ward and consultation service
  • 15 months ambulatory clinics (mixture of general, subspecialty and longitudinal clinics)
  • 4 month medical daycare – overlaps with ambulatory assignments
  • 1 month adult rheumatology
  • 1 month research
  • 2 months electives

The inpatient rotation includes the assessment and management of patients, as well as a consultation service that allows the trainees to see the many rheumatic manifestations of systemic disease.

Trainees also rotate through the medical daycare unit (4C) where they supervise infusions and perform intra-articular corticosteroid injections.

Trainees participate in the general rheumatology clinic and in each of the specialized disease clinics including:

  • systemic lupus erythematosus
  • neonatal lupus
  • systemic juvenile idiopathic arthritis
  • juvenile spondyloarthritis
  • juvenile dermatomyositis
  • systemic vasculitis
  • Kawasaki disease
  • autoinflammatory syndrome
  • morphea

Trainees also participate in their own longitudinal continuity clinic during the course of their fellowship. There is also exposure to community pediatric rheumatology clinics where trainees are able to learn a more community-based approach.

Residents and fellows are required to participate in a one-month adult rheumatology rotation.

Electives can be completed in a variety of disciplines including but not limited to paediatric immunology, orthopedics and radiology.

The residents and fellows have a close relationship with the teaching staff who ensure there is graded responsibility with greater independence of the residents and fellows expected as they gain experience.

Pediatric Lupus

Trainees will attend weekly lupus and neonatal lupus clinics. The remaining time will be focused on research and educational activities in pediatric lupus.

Childhood Vasculitis

Trainees will attend the weekly systemic vasculitis and Kawasaki disease clinics. The remaining time will be focused on research and educational activities in vasculitis.

Research Experience

The program has a strong focus on research which residents or fellows are expected to initiate a scholarly project beginning in the first year of their training and complete over the two-year program. 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 Pediatrics' Research Day and the Rheumatic Disease Unit Research Day (Rheumatology Ogryzlo Research Day) as well as to submit an abstract for presentation at the American College of Rheumatology Annual Meeting or Canadian Rheumatology Association Annual Meeting.

Trainees who wish to pursue independent, investigative research careers are encouraged to pursue an additional year or years of training.

Evaluation

Pediatric Rheumatology is a two-year program that follows the Royal College’s Competency By Design (CBD), Competency Based Medical Education (CBME) curriculum which was officially adopted as of July 2019. Under this curriculum, trainees will have the educational experiences structured into the following stages within the two-year period:

  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. The 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
  • 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.

Ways To Get Involved

Trainees are valued members in the Division of Rheumatology and can actively participate in trainee leadership/representative roles in various committees including but not limited to the Residency Training Program committee, Clinical Council. Education Council, Research Council, PR-COIN Quality Improvement Committee and Family Advisory Committee.

Additional Educational Opportunities

There is a comprehensive academic program that has recently been consolidated into an academic half-day. This half-day includes Paediatric Rheumatology teaching sessions (core curriculum and subspecialty rounds), disease-specific study groups, research rounds (where division members and fellow present research projects or projects in evolution), journal club/clinical epidemiology rounds, pathology rounds, immunology rounds, radiology rounds, morbidity and mortality rounds, bioethics seminars and clinical research tools course. Clinical dilemmas or clinical cases of interest are presented by the fellow or resident on a regular basis (fellows’ rounds). In addition, there are weekly radiology reading rounds.

Residents and Fellows are encouraged to attend many of the national and international rheumatology conferences such as the:

Application Process

Paediatric Rheumatology Clinical Subspecialty Residency Training

Clinical subspecialty training is an opportunity for a physician to obtain advanced training and/or to acquire more specialized expertise that complements their residency training. Training may involve both clinical and research activities. We provide Royal College accredited pediatric rheumatology training over a 24 month period. The academic start date for the program begins July 1.

If you are a PGY-2 or PGY-3 year in Pediatrics at a Canadian University or in an RCPSC-accredited U.S. Pediatrics program - submit your application/documentation through CaRMS.

Candidates from Canadian or US programs must have successfully completed at least three years of training in core Pediatrics prior to the start of the core paediatric rheumatology training program. For applicants from non-Canadian programs, completion of core Pediatric training with appropriate certification is required.

The deadline for applications is August 1st of the year preceding the start of the clinical training year. For example: Apply by August 1st 2020 - Successful candidate starts July 01, 2021.

International (including non-accredited US pediatric programs) applicants interested in a Pediatric Rheumatology Clinical fellowship (core program)

Email: rheumatology.trainingprogram@sickkids.ca with their request.

Fellowship Applications Candidates will be required to upload the following documents to the Paediatric Rheumatology Application Site:

Letter of Intent:

Please state the reason(s) for applying to the fellowship; as well as, your goals and objectives.

Curriculum Vitae (CV):

Please attach the most up-to-date version of your curriculum vitae which includes clinical, teaching, research, leadership and any rheumatology-related experiences. We ask that you ensure your email address is included at the top of your curriculum vitae and that all publications listed must be in PubMed citation format.

Medical Degree:

A copy of your Medical Degree with English translation if applicable.

Specialty Certificate in Paediatric:

A Copy of your Specialty Certificate with English translation if applicable.

Three (3) Letters of Reference:

Three letters of reference are required. They must appear on official letterhead.

English Proficiency:

Please indicate if English is not your native language and upload the appropriate test results. TOEFL Score of 615, IELTS score of 7.0 minimum recommended.

The deadline for applications is March 1st of the year preceding the start of the clinical training year.

For example: Apply by March 1st, 2020 - Successful candidate starts July 01, 2021.

Paediatric Lupus Clinical Research Fellowship (1 year)

Email: rheumatology.trainingprogram@sickkids.ca with their request.

Candidates will be asked to provide:

  • Proof and description of prior paediatric rheumatology training or clinical experiences
  • Letter of intent, stating the applicant's reasons for applying to the fellowship, as well as their academic goals.
  • A complete up-to-date curriculum vitae which includes clinical, teaching, research, leadership and rheumatology-related experiences as well as an email address. All publications must be in PubMed citation format.
  • At least 3 reference letters
  • Funding source to support 1-year fellowship as applicable

Childhood Vasculitis Clinical Research Fellowship (1 year)

Email: rheumatology.trainingprogram@sickkids.ca with their request.

Candidates will be asked to provide:

  • Proof and description of prior paediatric rheumatology training or clinical experiences
  • Letter of intent, stating the applicant's reasons for applying to the fellowship, as well as their academic goals.
  • A complete up-to-date curriculum vitae which includes clinical, teaching, research, leadership and rheumatology-related experiences as well as an email address. All publications must be in PubMed citation format.
  • At least 3 reference letters
  • Funding source to support 1-year fellowship as applicable

Observership Opportunities

We provide observership opportunities (maximum 1-2 months) for all trainees currently enrolled in an academic program in medicine (undergraduate, postgraduate, fellowship).

For more information please contact us directly at rheumatology.trainingprogram@sickkids.ca

If you are an international applicant, please contact Mrs. Haya Al Husseini who is the Program Coordinator for the International Office at the Learning Institute: haya.al-husseini@sickkids.ca

Funding

Ministry of Health funding is provided for those qualified trainees who are eligible for licensure on the educational register of the Province of Ontario. This requires that the applicant be a Canadian citizen or permanent resident of Canada and have completed the Medical Council of Canada Qualifying Examination and may apply through CaRMS.

Non-ministry funding may be available for certain highly qualified applicants who fail to meet these criteria for provincial funding. The applications of outstanding individuals for whom funding is provided by a foreign government or institution will be seriously considered.

Please contact the program directly for more information: rheumatology.trainingprogram@sickkids.ca

Qualified residents may also apply for research training positions funded by the Royal College Clinical Investigator Program. Successful candidates will be expected to obtain a graduate degree in a research field during the course of extended training.

Contact

Training Program Director

Dr. Shirley Tse

Phone: 416-813-5828

E-mail: shirley.tse@sickkids.ca

Education Administrative Coordinator

Kamela Ramlackhan

Phone: 416-813-5828

E-mail: rheumatology.trainingprogram@sickkids.ca