Rheumatology Service Rotation

Educational Purpose:

This rotation is designed to give residents background knowledge of rheumatic disease as well as practical application of that knowledge in direct patient care activities. This rotation is intended to teach the clinical skills necessary to evaluate the patient presenting with musculoskeletal problems, their initial diagnostic evaluation and general management. The rotation is designed to emphasize outpatient ambulatory care and consultative inpatient services. Residents have direct patient contact with close faculty supervision. This patient-oriented approach is supplemented by regular didactic lectures, conferences and journal club.

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

1. Take histories, complete a comprehensive review of systems related to rheumatologic conditions, and conduct physical examinations with additional focus on the musculoskeletal exam.
2. Appropriately use and interpret routine laboratory tests, specific rheumatologic serologies (eg. rheumatoid factor, antinuclear antibodies, complement determinations, sedimentation rate), perform analysis of synovial fluid.
3. Gain exposure to the radiologic evaluation of rheumatic disease (eg. x-rays, MRI, HRCT).

PGY 2 and 3

1. Take histories, complete a comprehensive review of systems related to rheumatologic conditions, and conduct physical examinations with additional focus on the musculoskeletal exam.
2. Appropriately use and interpret routine laboratory tests, specific rheumatologic serologies (eg. rheumatoid factor, antinuclear antibodies, complement determinations, sedimentation rate), perform analysis of synovial fluid.
3. Gain exposure to the radiologic evaluation of rheumatic disease (eg. x-rays, MRI, HRCT).
4. Develop accurate assessments and treatment plans for patients.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. Develop basic core knowledge of rheumatic diseases, differential diagnosis, pathophysiology, and management and therapeutics for rheumatologic conditions.

PGY 2 and 3

1. Develop basic core knowledge of rheumatic diseases, differential diagnosis, pathophysiology, and management and therapeutics for rheumatologic conditions.
    

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

1. Supervise PGY 1 as well as medical students on the rotation.
2. Develop short term as well as long term treatment plans for patients.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.

Residents are expected to:

PGY 1

1. Communicate a comprehensive assessment and treatment plan for patients with the healthcare team, patient and families.

PGY 2 and 3

1. Communicate a comprehensive assessment and treatment plan for patients with the healthcare team, patient and families.

Teaching Methods:

Didactic teaching materials (audio visual and printed) located in the Division of MUSC Rheumatology and on-line which provide basic core knowledge of differential diagnosis, pathophysiology, and therapy of rheumatic diseases. The resident should attempt to read most of The Primer of Rheumatic Diseases during the course of the rotation. In addition, chapters from recommended texts should be read on the more common rheumatic diseases, especially RA, SLE, SSC, OA, PMR and GCA, gout, spondyloarthropathies, vasculitis, myositis, regional disorders, and pharmacology of frequently used medications. These topics should also be covered in teaching rounds and during patient care encounters.

Mix of Diseases and Pathological Material:

Diseases include: rheumatoid arthritis, Spondyloarthropathies and seronegative arthritis, infectious arthritis, crystal-induced arthritis, connective tissue diseases, vasculitis, osteoarthritis, and heritable disorders of connective tissue.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. There is a broad mixture of patients including older adults, but there are significant numbers of adolescent and young adult patients with rheumatologic diseases. All have acute or chronic rheumatologic diseases including those that complicate general medical conditions.

Types of Clinical Encounters:

Encounters are primarily in the outpatient setting, though there will be occasional participation on inpatient consults.

Procedures and Services:

Procedures and services include physical examination of the joints, synovial fluid examination, radiologic examination, interpretation of synovial fluid analysis, and interpretation of laboratory testing.

Supervision:

All patient encounters during the rotation are presented to an attending physician. Residents are given the opportunity to develop a plan of care under the guidance of the Rheumatology attending.

Educational Resources to be Used and Reading Lists: 

Educational resources include The Primer of Rheumatic Diseases, Textbook of Rheumatology, ACR image bank and online teaching modules and cases, and audiovisual materials.

Pathological Material:  Participation in interdisciplinary pathology conference.

Method of Evaluation of Resident Competence:

The resident is evaluated using the standard Development Evaluation form for each competency. Patient Care is assessed based on direct observation and chart review. Medical Knowledge is assessed through direct questioning on rounds. Professionalism is assessed based on observation of the resident’s demeanor and behavior on this rotation. Interpersonal and Communication Skills are assessed by observing the resident’s interactions with patients, families, and staff. Systems-Based Practice is evaluated based on the resident’s ability to function in the team setting and to utilize interdisciplinary resources to care for Rheumatology patients in the ambulatory setting. Practice-Based Learning is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study, and literature review. The resident is also evaluated on his or her ability to cogently present a talk during the rotation. The resident evaluates the faculty and the rotation via the standard evaluation forms in E*Value.