Fellowship Program

i. Pediatric Rheumatology and Sports Medicine
An emphasis will be put on obtaining more experience in the diversity of pathologies in Pediatric Rheumatology. The trainee will increase their experience in Sports Medicine to become more familiar with non-inflammatory musculoskeletal problems that are a common reason for consultation.

ii. Advanced training in adolescents with chronic diseases and transition
Adolescents are exposed to many chronic rheumatic diseases. Dealing with a chronic disease during this period of life can be challenging. This fellowship will allow the trainee to obtain further training in order to be able to offer optimal care to this vulnerable population.

iii. Advanced training in Medical Education
The trainee may choose to get advanced training in medical education with a focus on Pediatric Rheumatology. The trainee will have to register to a postgraduate fellowship in Health Sciences Education at McGill University (http://www.mcgill.ca/centreformeded/educationalopps/fellowship) or at University of Montreal as well as to the Pediatric Rheumatology Fellowship Program. This is a one-year program with mandatory courses in the Center for Medical Education. The trainee may also choose to start a Masters in Medical Education, which is a two-year program. The trainee will also be encouraged to participate in teaching workshops given by the Royal College.

During any one of these fellowships, the trainee will have to undertake a research project related to a question based on the Pediatric Rheumatology program option chosen. Completion of the project is expected by the end of the fellowship, therefore a preliminary project should be drafted prior to starting to ensure its completion.

Attend 1-2 clinics per week: the choice and number of clinics depends on the Pediatric Rheumatology program option selected.

• For option i: Pediatric Rheumatology clinics at the Montreal Children's Hospital (MCH); Sports Medicine clinics with Dr. Claire LeBlanc; other Sports Medicine clinics in Montreal; clinics in Physiatry, Orthopedics, Plastic surgery; possibility of a one month elective in a Sports medicine clinic outside of Montreal.
• For option ii: Exposure to patients with juvenile arthritis, connective tissue disease and other chronic rheumatic diseases in the Rheumatology clinics at the MCH; YARD (young adult rheumatic diseases clinic) with Dr. Elizabeth Hazel at the Montreal General Hospital (MGH); Transition clinics at the MGH; Adolescent Medicine clinics at the MCH; possibility of a one month elective in the transition clinic in Vancouver.
• For option iii: choice of clinics depends on the research question.

For all three options, the trainee will have a continuity clinic every two weeks in which they will be following their own patients. The trainee will have minimal supervision to allow for more independence in decision making. However, the staff will always be available for questions or concerns. New referrals as well as follow-ups will be seen in this clinic. The trainee will also have the opportunity to discuss his/her patients during the multidisciplinary rounds to get further input from staff and allied health professionals.

Rounds

Multdisciplinary rounds every week: discussion of patients with the allied health professionals, trainees and physicians.

Call duties

• The trainee will be expected to do one weekend per month of home call. This will allow ongoing clinical exposure to general pediatric rheumatology.
• There is no expectation for the trainee to take calls during the weekdays.

• The trainee will have increased teaching responsibilities and will be expected to teach trainees rotating through the program with formal teaching sessions.
• The trainee will attend the Academic Half-Days and will contribute formally on topics based on their fellowship option.
• Additional undergraduate and postgraduate teaching is also encouraged

The trainee will have to obtain funding for the following courses:

Mandatory courses:

• Canadian Rheumatology Ultrasound Society (CRUS): This society is responsible for training Canadian rheumatologists who want to learn musculoskeletal (MSK) ultrasound. A course is offered every year, which consists of three weekends during which formal teaching and practice occurs. There is also a requirement to practice MSK ultrasound on patients locally and to send in ultrasound images for feedback. This course should be completed prior to the commencement of the fellowship.
• Preceptorship with Dr. Bruns: Dr. Bruns is a rheumatologist working in Sherbrooke with expertise in MSK ultrasound. Dr. Bruns offers a preceptorship for trainees to further enhance their ultrasound techniques. The duration of this preceptorship is usually from 3-6 months. There is also classroom teaching that occurs three weekends over one year that the trainee will also have to attend.

Optional courses:

• EULAR Pediatric Course: This course is over one weekend and is offered annually. It consists of lectures and practice of MSK ultrasound on children.
• ACR Ultrasound Course: This course is offered annually over one weekend. There is a basic and intermediate course consisting of lectures and practice of MSK ultrasound on patients.
• Other training: There will be the possibility of doing an elective with a rheumatologist who is an expert in MSK ultrasound outside of Canada, specifically in Europe. This elective is a maximum of one month.

The trainee is expected to complete a research project during the fellowship. A preliminary project should be drafted prior to starting to ensure its completion. It should address a specific question in relation to the use of MSK ultrasound in Pediatric Rheumatology.

Attend two clinics per week:

• Pediatric Rheumatology clinics with a focus on patients with juvenile arthritis. At the time of the trainee's encounter with patients, they will have the opportunity to practice MSK ultrasound.
• Trainee’s Ultrasound Clinic: Patients requiring MSK ultrasound will be booked into this clinic for a clinical and ultrasound evaluation. The trainee will be supervised by Dr. Chédeville.
• Ultrasound clinics with Dr. Bruns at the MCH. During this clinic, selected patients will be evaluated by Dr. Bruns by ultrasound to answer a specific question and possibly proceed with a joint injection.
• Joint injection clinics with Dr. LeBlanc. During this clinic, children who require joint injections are evaluated and MSK ultrasound is used to decide on the best management for these patients.
• Additional clinics (electives): Attendance at ultrasound clinics with other rheumatologists in the Montreal region can be arranged and these include clinics with Dr. Stein (RVH) and Dr. Yuen (HMR) – both adult rheumatologists with an expertise in MSK ultrasonography.

Procedures:

• The trainee will attend image guided joint injections sessions with interventional radiology supervised by Dr. LeBlanc.

Call duties:

• The trainee will be expected to do one weekend per month of home call when at the MCH. This will allow for ongoing clinical exposure to general Pediatric Rheumatology.
• There is no expectation for the trainee to take calls during the weekdays.

• The trainee will attend the Academic Half-Days and will contribute formally to at least one topic related to MSK ultrasound or a related topic.

Attend 3-4 clinics per week:

• Pediatric Rheumatology clinics
• Specialty clinics: combined clinics with Orthopedics, Dermatology, Nephrology
• Trainee’s continuity clinic every two weeks. One of the four pediatric rheumatologists will supervise this clinic. As the trainee gains expertise, there will be an increase in independence and a decrease in direct supervision.