Rheumatology/Dermatology

Introduction

Rheumatology and dermatology are two subspecialties that often intersect in the care of patients with autoimmune, inflammatory, and connective tissue diseases. Conditions such as systemic lupus erythematosus (SLE), psoriasis, and vasculitis require both dermatologic and rheumatologic expertise for optimal patient care. Given the growing recognition of the need for multidisciplinary care in these complex diseases, we propose the establishment of a Combined Rheumatology and Dermatology Fellowship Program.

This innovative fellowship would offer advanced training in both specialties, preparing future clinicians to address the unique challenges that arise in patients with dermatologic manifestations of rheumatologic diseases, and vice versa. The program would bridge the gap between two traditionally distinct fields, enhancing collaboration and improving patient outcomes.

Program Objectives

The primary objectives of the Combined Rheumatology and Dermatology Fellowship Program are:

Comprehensive Clinical Training: To provide fellows with a thorough understanding of the clinical presentations, pathophysiology, and management of conditions that span both specialties, including but not limited to lupus erythematosus, psoriasis, scleroderma, dermatomyositis, vasculitis, and other autoimmune connective tissue diseases with cutaneous involvement.
Enhanced Collaborative Care: To foster collaboration between rheumatology and dermatology specialists, allowing fellows to develop the skills necessary for interdisciplinary care and patient management.
Research Opportunities: To train fellows in conducting research that bridges dermatology and rheumatology, contributing to the development of novel therapeutic approaches and improving understanding of the pathophysiology of diseases with both dermatologic and rheumatologic manifestations.
Educational Excellence: To provide fellows with a rich educational experience through structured rotations, didactic sessions, and mentorship, preparing them for careers as leaders in both fields.

Program Structure

The fellowship will be a one-year program that combines both clinical and research training. The structure will be as follows:

1. Clinical Rotations (12 months)

Rheumatology: Fellows will spend six months rotating through the rheumatology department, where they will gain in-depth knowledge and experience in managing systemic autoimmune and inflammatory diseases. Key conditions include systemic lupus erythematosus, rheumatoid arthritis, vasculitis, and spondyloarthritis. Dermatology: Fellows will spend six months rotating through the dermatology department, focusing on skin diseases with rheumatologic implications, including autoimmune blistering diseases, cutaneous vasculitis, psoriasis, and other connective tissue diseases with dermatologic manifestations. Joint Specialty Clinics: The program will include interdisciplinary clinics where fellows will have the opportunity to manage complex patients under the supervision of both dermatology and rheumatology faculty, learning to address both the skin and systemic aspects of care. Sub-specialty Clinics: The program will also include elective rotations through pulmonology, ophthalmology, musculoskeletal radiology, nephrology, and maternal fetal medicine sub-specialty clinics to allow a robust educational experience to matriculated fellows. By observing these other subspecialties, the fellow will gain specific training in disorders in which coordinated care is needed with these other specialities.

2. Research

Fellows will engage in clinical or translational research focused on conditions that affect both the skin and connective tissues. Research may involve novel diagnostic techniques, treatment protocols, or the pathophysiology of autoimmune diseases with cutaneous manifestations.
Opportunities for collaboration with researchers in both dermatology and rheumatology will be encouraged, fostering a multidisciplinary approach to research.

3. Didactic Education

Fellows will attend weekly educational sessions that cover the overlap between dermatology and rheumatology, including lectures on immunology, pharmacology, and the treatment of diseases like lupus, vasculitis, and psoriasis.
Case-based discussions, journal clubs, and multidisciplinary rounds will be integral to the educational experience.
Fellows will be encouraged to present at national and international conferences, sharing their research findings and clinical insights.

Mentorship

Each fellow will be paired with faculty mentors from both dermatology and rheumatology, providing guidance in clinical decision-making, research, and career development.
Mentors will provide individualized feedback and support to ensure the fellow’s academic and professional growth.

Eligibility Criteria

Applicants for the Combined Rheumatology and Dermatology Fellowship Program must meet the following criteria:

Completion of an accredited residency program in dermatology or accredited fellowship in Rheumatology.
Demonstrated interest in autoimmune diseases and multidisciplinary care.
Strong academic record and commitment to research.
Excellent communication and interpersonal skills, with the ability to work in an interdisciplinary team.

Program Benefits

Unique Training Experience: Fellows will gain expertise in both dermatology and rheumatology, making them highly competitive for academic, clinical, or leadership positions in either or both fields.
Interdisciplinary Collaboration: Fellows will be trained to work in a collaborative environment, developing skills that will help them lead multidisciplinary teams in patient care.
Research Development: Fellows will have the opportunity to pursue groundbreaking research in autoimmune and inflammatory diseases, contributing to the advancement of knowledge in both fields.
Enhanced Patient Care: Fellows will be well-equipped to treat patients with complex, multisystem diseases, improving outcomes through integrated care.

Institutional Support and Resources

Our institution is well-positioned to support this fellowship, offering:

Expert Faculty: Renowned experts in both dermatology and rheumatology with active research programs.
Clinical Facilities: Access to specialized clinics, including an interdisciplinary autoimmune and inflammatory disease clinic.
Research Infrastructure: State-of-the-art research labs, with ongoing studies in immunology and clinical trials in both dermatology and rheumatology.

Conclusion

The Combined Rheumatology/Dermatology Fellowship Program represents an innovative and forward-thinking approach to training physicians in two fields that are increasingly interconnected. By combining clinical expertise with cutting-edge research, this program will create a new generation of specialists who are well-equipped to manage the complex needs of patients with autoimmune and inflammatory diseases. The program will not only enhance patient care but also foster new discoveries that will benefit both dermatology and rheumatology communities.

We look forward to implementing this program and contributing to the advancement of integrated care in rheumatology and dermatology.

Dr. James E. Roberts
Assistant Professor
Department of Internal Medicine
Division of Rheumatic Diseases
University of Texas Southwestern