The broad objective of the fellowship is to teach physicians how to initiate, carry out and complete a meaningful clinical research study. The focus of the research will be to understand the consequences of hypertension as they relate to the genesis of cardiovascular, metabolic (diabetes) and renal disease. Moreover, the fellowship will focus on strategies that may prevent or delay the onset of these problems. To achieve this goal, we have formulated a curriculum that incorporates knowledge and skills from the areas of epidemiology. statistics, molecular biology, clinical pharmacology and internal medicine.

Five primary units comprise the annual curriculum of the fellowship program:

• Fellow initiated and completed grant proposal
  
• Lectures and workshops
  
• Active participation in ongoing clinical trials
  
• Active participation in the journal club and seminars
  
• Consultation on the Hypertension Service
  

Each of these is discussed in great detail below.

Specific Objectives
To provide fellows with the knowledge to design clinical research studies that test specific hypotheses. To achieve this objective the following curriculum is employed:

Didactic lectures. These interactive sessions deal with topics on study design, statistics, epidemiology and related areas. In addition, the following areas will be covered: How to design a study, comparisons between prospective versus retrospective studies, case-controlled studies, designing risk factor trials and use of appropriate statistical measurements to evaluate data. These lectures are held at various times throughout the year. They include participation in a semester course on epidemiology/biostatistics offered in the spring of each year. In addition, the weekly presentations in Preventive Medicine Grand Rounds provides a forum in which experimental design and data analysis and interpretation are discussed. Interactive workshops with faculty. Seminars are held biweekly at 4:30 p.m. on a designated weekday. During these seminars, a clinical study, published in a peer-reviewed journal, will be critically reviewed by the faculty. Emphasis on all relevant areas of study design, data analysis and interpretation will be discussed.

Drafting a research proposal. All fellows are expected to work with a faculty mentor to generate and complete an NIH or similar grant by the end of their first year. In the case of those already in a subspecialty program at Rush, mentors from the respective subspecialty and the clinical research program are accessible. This requirement serves as the mechanism by which individuals can apply and utilize the concepts they have learned. To achieve this goal, fellows are exposed to a variety of ongoing clinical studies in the department. They are asked to focus on one study while participating in various ways with other related studies. Their duties include assessment of patients for a chosen protocol as well as insuring all medications, calculations and data collection procedures are correct for that and related protocols. They are also required to generate a clinical proposal that tests a specific hypothesis. This may be a related question of an ongoing study or a new idea. Fellows are required not only to write the protocol but also to calculate a budget, write the consent form and prepare it for presentation to the department. If deemed appropriate it will be sent to appropriate funding agencies for consideration. A faculty member chosen by and agreed to by that person shall assist the fellow with this requirement.

To provide fellows with an in-depth review of the spectrum of hypertensive disorders. To achieve this objective the following curriculum will be employed:

• Didactic lectures. These lectures take place at weekly Preventive Medicine Grand Rounds as well as at special seminars sponsored by the department. Both "in house" and visiting faculty participate. Topics center on various aspects of hypertension and include the areas of molecular biology, pathophysiology, genetics, end organ injury and assessment of secondary causes (pheochromocytoma, primary aldosteronism, renal artery stenosis and other related diseases).
  
  
• Consultation service. Fellows are responsible for both inpatient and outpatient consultation of hypertensive patients throughout the year. Specifically, fellows assess and generate a diagnostic and therapeutic plan for each patient they evaluate. This plan is reviewed with a faculty member in the department. In this regard, fellows work with various faculty members in the Department of Preventive Medicine throughout the year.
  
  
• Journal Club. Each fellow presents four articles per month for the journal club. These articles are selected from a group of related journals on cardiovascular/renal diseases. In addition, fellows are given selected articles, submitted to various journals by outside authors, to review with a faculty member. They are also required to present a bimonthly talk (review) on a topic that deals directly with their research interest.
  
  
• Case conferences. A combined hypertension case conference occurs each month at Rush. It involves nephrology/hypertension fellows from the University of Illinois and Cook County. Each fellow is responsible for organizing and presenting a case during this time. In addition, cases from the University of Illinois and Cook County are presented and discussed.
  

Clinical Responsibilities
Fellows are typically exposed to an average of 40-50 hypertensive patients per week during the yearlong fellowship. Fellows are responsible for all aspects of diagnostic and therapeutic evaluation in these patients and are required to discuss any and all related issues with the corresponding attending. Fellows are also required to be on-call for any and all problems in these patients with an attending backup to discuss these issues. Fellows are responsible for the following clinical activities:

• Initial assessment and development of a plan for management of hypertension in all patients for whom we are consulted in both the inpatient and outpatient setting.
  
• Discussion of all patients seen with the corresponding attending physician, who evaluates the fellow's diagnostic and therapeutic plan.
  
• Spending a minimum of six hours each day on direct patient care in the outpatient or hospital consultation setting.
  
• Interacting with all primary care physicians involved in a case and discussing the final diagnosis and plan with them.
  
• Participating in weekly hospital teaching rounds, which involve bedside assessment of hypertensive patients, and discussing all attendant problems in the presence of an attending.
  
• Being first call for all clinic patients after clinic hours.
• Reading all ABPMs with the respective attending physician of the month.
  
• Coordinating all journal club and case conference activities.
  
• Participating in lectures and rounds to house staff at both Rush and Cook County Hospital. Fellows see outpatients at the Cook County Hypertension Clinic, which meets every Tuesday between 1:00 and 5:00 p.m. and are responsible for assessing at least seven to 10 patients per clinic visit. As previously noted, this is reviewed by the attending physician of that clinic.
  
• Attending the nephrology/hypertension clinic at the University of Illinois, which meets Wednesday afternoons between 1:00 and 5:00 p.m. During this time fellows are responsible for evaluating between seven and 10 patients, as at the Cook County Hypertension Clinic.
  
• Learning and becoming proficient in developing CRC consent forms and all other aspects of drug trials. Fellows are responsible for handling specific protocols and assisting, when needed, in seeing afternoon study patients as they relate to various ongoing studies. This is limited, however, to a maximum of two days per week.
  

The time remaining after clinical responsibilities are fulfilled should be dedicated to research activities. Research time includes protocol development, journal reading and manuscript writing. In addition, fellows should use this time to prepare for journal club and case conferences.

Patient Care
The Rush University Hypertension Center sees patients, primarily in consultation, typically for a second or third opinion, when blood pressure control is poor or cardiovascular risk high. However, a few physicians also do a small amount of primary care. Physicians, working predominantly in the research areas of cardiovascular or renal disease are available to see patients for consultation by appointment in their given areas of expertise. Patients with secondary hypertension (that is, due to a specific cause, like a blocked renal artery or a tumor) or those with diabetes and renal insufficiency are of special interest.

For questions about the fellowship program, send e-mail to William Elliott, MD, PhD, Program Director, at welliott@rush.edu.