VCU Internal Medicine Training Program
Rheumatology Curriculum

Revision Date: 8/11/08
Revised by: Tammy Copsey Spring, MD

 

Purpose
Learning Objectives
How Learning Objectives are Met
Required Reading/Resources
Expectations
Evaluation
Contact
Resident Schedule
Printable version of the curriculum (pdf)

Purpose

• To provide Internal Medicine residents with a basic rheumatology foundation applicable to both an inpatient and outpatient setting
• To improve skills such as gathering clinical data, understanding pathophysiology, and practicing clinical decision making
  

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Learning Objectives

At the end of the rotation, residents will be able to:

• Patient Care
  • Obtain a thorough, yet targeted, rheumatologic history and exam
  • Convey physical exam findings in a written and verbal format
  • Understand and utilize autoimmune tests and acute phase reactants, with particular emphasis on RF, ANA and it’s subsets, ANCA, anti-CCP, ESR, and CRP
  • Aspirate and therapeutically inject the knee using the medial and lateral approach (the lateral approach used to definitively rule out a septic joint), therapeutically inject the shoulder using the posterior approach, and therapeutically inject the greater trochanteric bursa
  • Interpret synovial fluid analysis and microscopy findings
  • Understand when to order imaging procedures when diagnosing and following different rheumatologic diseases, such as RA, OA, Gout, and Ankylosis Spondylitis
  • Develop a basic treatment plan for common diseases
    
• Medical Knowledge
  • In addition to the skills mentioned above the resident should be able to:
    • Develop a thorough differential diagnosis for common musculoskeletal presentations
    • Understand the basic clinical manifestations, diagnosis, and treatment of common or threatening rheumatologic disorders, such as rheumatoid arthritis, osteoarthritis, gout, pseudogout, seronegative spondyloarthropathies, connective tissue diseases, SLE, and vasculitides
    • Know the basic medications used in rheumatology (anti-TNF agents, methotrexate, hydroxychloroquine, mycophenolate, NSAIDS, and corticosteroids) with particular emphasis on their side-effects and when in the treatment process the side-effects are likely to occur
      
• Practice-Based Learning and Improvement

• Use available electronic resources to appropriately diagnose and treat rheumatology patients
• Interview and examine consult patients in a timely fashion
• Perform self-evaluations to target individual learning needs
  
  
• Interpersonal and Communication Skills
  • Communicate effectively with referring physicians, patients, families, staff, and colleagues using both a written and verbal format
  • Contact the fellow or attending in a timely fashion and summarize appropriate patient information
    
    
• Professionalism
  • Demonstrate compassion and respect towards patients and their families as well as all members of the health care system
  • Maintain the professional code of conduct
  • Provide informed consent for minor rheumatologic procedures
  • Maintain patient confidentiality at all times
    
• Systems-Based Practice
  • Understand the local medical system well enough to effectively treat patients while maintaining continuity of care
  • Understand the practice of rheumatology in both an inpatient and outpatient setting
  • Learn to work in a complex environment with multiple clinicians caring for a patient
  • Appreciate the role of a consultant in both the inpatient and outpatient environment
    

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How Learning Objectives are met

• Participation in three clinics a week
• Attendance at three rheumatology conferences a week
• Case-based learning sessions two half-days a week involving self-guided learning as well as lectures with the consult fellow. The cases can be found on rheumatology.org under professional education.
• Evaluating patients as part of the MCV Rheumatology consult service
• Self-guided reading based on patients seen and evaluated by the individual resident
  

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Required Reading/Resources

• Case-based readings and questions (to be provided at the beginning of the rotation)
• ACR Radiology CD
• Relevant sections in Up To Date following every consult
• Lieberman's Interactive Tutorials in Radiology
  
• Reading/Resources by Topic

Suggested Readings

• Essentials of Musculoskeletal Care. L Griffen ed.
• Up To Date (www.utdol.com)
• Practical Rheumatology. Hochberg, Weinblatt, et al.
• Primer on the Rheumatic Diseases. 12th ed. J Klippel ed.
  

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Expectations

• Attendance and punctuality at all learning conferences (see resident schedule)
• Attendance and punctuality at all required clinics (see resident schedule)
• Completion of the case-based learning objectives; failure to complete the assigned cases will result in an unsatisfactory evaluation in professionalism
• Professional behavior towards patients, staff, and fellow clinicians

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Evaluation

• Residents will be evaluated by the supervising consult attending(s) on www.newinnov.com

• Residents will evaluate the consult attending(s) and may elect to evaluate any clinic attending on www.newinnov.com

Contact

• Dr. Neal Roberts
  Pager: 3297
  Phone: 828-3352
  Email: wnrobert@mcvh-vcu.edu

• At the beginning of the rotation, please contact the MCV consult fellow via pager 9097

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Resident schedule

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Case-Based Learning (9-11) MCV Consults (page the fellow on consults at 9)	Clinic- Connective Tissue Disorders: 4th floor ACC 2	MCV Consults (VA Gold Clinic - 1 resident)	Journal Club/ Zebra Conference: 9-10:30 5th floor conference room-VA Case-Based Learning	MCV Consults¹
PM	MCV Consults (VA New patient clinic - 1 resident)	Post-Clinic Conference: 1-2pm 4th floor ACC MCV Consults	Clinic-Private Practice Tutorial: 4th floor ACC² MCV Consults	Rheumatology Follow-UP Clinic: Blue Clinic (VA)³	Grand Rounds: 1-2 pm Learning Center-1st floor Main Hospital MCV Consults

¹ Internal Medicine-Pediatric residents will go to Dr. Buckley’s clinic at Stoney Point on Friday morning

² Residents may be asked to see consults during certain clinics, depending on the number of residents and patients

³ The Thursday afternoon VA clinic typically allows residents to perform many therapeutic injections

Pediatric patients: Pediatric rheumatology is a new and developing field. Currently, however, the majority of pediatric rheumatology patients in the country are taken care of by adult rheumatologists. As part of consult duties, residents may be asked to see pediatric patients. Attending coverage is provided primarily by Dr. Lenore Buckley (pager 3544).  In the event that Dr. Buckley is not available, Dr. Harry Gewanter (794-2821) is available to assist.

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