A. Background and Rationale:

In 1994 the Department of Medicine of the UMDNJ-Robert Wood Johnson Medical School introduced a program (i.e. the "Developmental Medicine Program") designed to improve health services for adults with severe Developmental Disabilities/Mental Retardation.

For the past 20-30 years, and until relatively recently, these individuals received health services out of the mainstream of usual clinical practice in various state operated institutions. With closure of these institutions, practitioners in the community are now being called upon to provide services.

Numerous studies have demonstrated lack of physician knowledge regarding the complex health conditions frequently encountered in this population of adults with severe mental retardation. Recent reports in the medical literature have called for more physician training in the primary care programs such as General Internal Medicine and Family Medicine.

Accordingly, the Department of Medicine/Developmental Medicine Program is now offering formal Fellowship/Residency training for post-graduate physicians in the field of adult developmental-disabilities diagnosis, treatment, and research.

The purpose of this Fellowship/Residency to produce primary care physicians who are competent managing those complex medical problems frequently encountered in adults with developmental disabilities and also to train "academic" physicians who will serve as consultants to other physicians, whether they be primary care or specialists.

Those Fellows who wish to pursue an "academic" career will therefore be trained in research methodology and teaching as well as clinical service.

Physicians who complete the Developmental Medicine Fellowship will serve as a resource to other physicians, provider agencies, government officials, and parents seeking a second opinion. These Developmental Medicine Specialists will perform much needed basic and/or clinical research designed to improve clinical outcome of treatments required by their patients with developmental disabilities. Developmental Medicine physicians will also train medical students and post-graduate physicians regarding diagnosis and management of disabilities-related health problems.

In summary, physicians who complete the Developmental Medicine Fellowship/Residency will be able to function as primary care providers, but will also be able to teach medical students and house officers, serve as consultants to other physicians, and perform relevant disabilities-related basic and clinical research. It is anticipated that these physicians will be a significant aid in the efforts of many to "mainstream" medical care for individuals with developmental-disabilities.

B. Description of the Fellowship(See Addendum below for Description of the Residency Program):

The Fellowship in Developmental Medicine offered by the Department of Medicine will have a one year duration, starting July 1 of each year. The Fellowship has the traditional educational, research, and patient care service components and is supported by the faculty of the UMDNJ/RWJ Medical School.

(1) Educational Responsibilities: Various teaching materials will be provided to the Fellow. This will include a Developmental Medicine Syllabus (attached), various published manuscripts and text material.

In addition, the Fellow will be instructed on methods to access Developmental Medicine resources on the internet, including "Medline" search, use of the "Developmental Medicine Forum" (http://www2.umdnj.edu/forumweb/foruml.htm) and Medical-DD listserve.

The Fellow will also be required to develop a website (using the UMDNJ server) which provides information on a selected topic regarding Developmental Medicine.

In addition to these activities the Fellow will be required to attend Grand Rounds in Medicine, Neurology and Psychiatry at RWJ Medical School as well as selected lectures and presentations held in New Brunswick and the Hunterdon Developmental Center.

Quarterly written tests will be required which document that the Fellow has mastered the required goals and objectives (see attached).

(2) Clinical Service Responsibilities: Training will occur at the Hunterdon Developmental Center in Clinton, NJ as well as Outpatient Clinics located at the RWJ Medical School and various community sites, under the supervision of the RWJ Medical School faculty. The Hunterdon Developmental Center is a State/Federal operated Intermediate Care Facility for the Mentally Retarded. It serves as the residence for 650 severely mentally retarded adults with complex medical, behavioral, and neurologic conditions. There is a high frequency of heart conditions (e.g., Down Syndrome), infectious disease, (e.g., hepatitis), gastrointestinal disease (e.g., GERD, H. Pylori, constipation), pulmonary disease (e.g., aspiration pneumonia), osteoporosis, drug toxicities and absence of an etiologic diagnosis for the underlying brain disorder.

The Fellow will be assigned a case load of 15-20 complex patients at Hunterdon Developmental Center and the community under the supervision of faculty. Those patients who develop acute problems will be evaluated by the Fellow and then presented to the Attending during daily Attending rounds. It is expected that the Fellow will be well- prepared when he presents a case to the Attending, including text book and literature review when appropriate.

In addition to his/her regular case load, the Fellow will perform "Comprehensive Developmental Medicine Consultations" for selected patients who reside at the Developmental Center in addition to other sites in the community, such as group homes, skill-development homes, or conventional parental residence. These latter patients will be encountered during "house calls" or in outpatient clinics supervised by the Developmental Medicine Program.

If it is decided during a "house call," or as the result of a consultation , that hospitalization is required, the patient will be transferred to the Robert Wood Johnson University Hospital in New Brunswick, NJ or an affiliated hospital, thus ensuring continuity of care and ongoing supervision by faculty.

(3) Research Activities: The faculty of the Department of Medicine's Developmental Medicine Program is actively involved in clinical research regarding various areas of Developmental Medicine. These include, immune dysfunction in Down Syndrome (see attached manuscript), osteoporosis in people with disabilities, hypothalamic-pituitary dysfunction in patients with Septo- Optic Dysplasia and other disorders of vision, duodeno-gastric reflux, and other mechanism of gastritis in patients with scoliosis, Q-T interval prolongation in patients with severe mental retardation, and medical mechanism of psychiatric diseases in patients with severe mental retardation.

The Fellow will be required to either participate in an ongoing research project or to develop his/her own. All Fellows will be required to submit abstracts of their work to selected medical/scientific meetings.

Fellows will also be required to submit at least one case report or research finding to a peer-reviewed journal.

(4) Teaching Responsibilities: The Developmental Medicine Fellow will be required to organize a lecture with slides and handouts regarding a selected topic relevant to Developmental Medicine. Opportunities for presentation to the faculty/staff of the Robert Wood Johnson Medical School and Hunterdon Developmental Center will be available.

The Fellow will also assist faculty in teaching of medical students, residents, and other parties who may be interested in Developmental Medicine issues.

C. Requirements:

The applicant must be a graduate of an approved School of Medicine and have completed at least one year of post-graduate training in an accredited program. Priority will be given to those applicants who have completed post-graduate training in Family Medicine, Internal Medicine, Neurology or Psychiatry.

D. Stipend:

An annual stipend of $50,000 will be provided (contingent on funding).

ADDENDUM:

SPECIALIZED RESIDENCY TRAINING

It is anticipated that the NJ State Senate will soon appropriate funding for training in Developmental Medicine at both the Fellowship level and the Residency level (NJ Senate bill S1492). Therefore, in addition to the Fellowship Program described above, the Department of Medicine will offer Residents in Internal Medicine the opportunity to achieve specialized training in adult Developmental Medicine. The Department of Medicine's Developmental Medicine Residency Training Program will be individualized for each Resident who wishes to pursue training in this field, but will have many of the same educational, service, and research aspects of the Fellowship Program.

GOALS AND OBJECTIVES

ROBERT WOOD JOHNSON MEDICAL SCHOOL

Department of Medicine

Developmental Medicine Program

FELLOWSHIP and RESIDENT TEACHING GOALS AND OBJECTIVES

A. GOALS

1.The Developmental Medicine Fellow/Resident will be able to determine etiology of the disorder in adults with pediatric-onset chronic brain disorders.

2. The Developmental Medicine Fellow/Resident will be able to identify and manage those medical conditions which frequently occur in adults with pediatric-onset chronic brain disorders.

B. SPECIFIC OBJECTIVES

l. The Fellow/Resident will demonstrate competency in the diagnosis and management of adult patients with various "developmental-onset" conditions such as homocystinuria, metachromatic leukodystrophy, phenylketonuria, tuberous sclerosis, neurofibromatosis, fragile-X syndrome, myotonic dystrophy, William's syndrome, Prader-Willi syndrome, Angelman syndrome, Smith-Magenis Syndrome, Down Syndrome, Cornelia de Lange syndrome, Rett syndrome, and Septo-Optic Dysplasia.

2. The Fellow/Resident will demonstrate knowledge of the application of newer genetics tests(e.g. Fluorescent-in-situ hybridization, Southern blot, DNA polymerase) and the role of brain neuroimaging(eg MRI) in the determination of etiology of developmental-onset conditions.

3. The Fellow/Resident will demonstrate ability to evaluate and manage commonly occurring conditions in adults with pediatric-onset chronic brain disorders, such as osteoporosis, GERD, Barrett's esophagus, Helicobacter Pylori infection, constipation, muscle rigidity, contractures, severe abnormal behavior, recurrent pneumonia, seizures, and the Hepatitis-B Carrier State.

4.The Fellow/Resident will demonstrate knowledge of educational resources relevant to Developmental Medicine which are available on the internet; specifically, the Developmental Medicine Forum, and MEDICAL-DD listserve.

5. The Fellow/Resident will successfully complete a series of written examinations based on teaching materials provided by the Developmental Medicine Faculty.

Name_________________________________Social Security No._______________ Home Address_____________________________________Telephone__________ Hospital Address____________________________________Telephone__________ Date of Birth__________________Sex___________________Marital Status_______ College, Year and Degree________________________________________________ College, Honors and Activities_____________________________________________ Medical School, Location, Year of Graduation_________________________________ Intemship, Place and Dates_________________________________________________ Residency, Place and Dates_________________________________________________ Military Service and/or Military Status________________________________________ Beginning date of Appointment Sought____________________Best dates for interview___________ Physical or Medical Factors Influencing House Officer Performance_______________________________________ Previous Research Activities and Publications______________________________________________________________ _______________________________________________________________________ Other Pertinent Information Interests__________________________________________ Future Medical Goals and Plans_____________________________________________ NJ. State License No._____________________________________________________ DEA Federal Narcotics License______________________________________________ NJ. CDS No.____________________________________________________________ ECFMG Cert No & Grade__________________________________________________

Please supply: 1 ) Your CV, 2) Names of two persons whom you will ask to forward recommendations, 3) Personal statement (optional). 4) Recent photograph. Forward to:

Philip B.May, Jr.MD

Fellowship Program Director

Developmental Medicine Program

Department of Medicine

UMDNJ-Robert Wood Johnson Medical School

One Robert Wood Johnson Place-CN 19

New Brunswick, NJ 08903-0019