Residents and Students,
Welcome to Rheumatology! We are glad you have chosen us for an elective or have been assigned to us for
Med 5078/5010. To orient you to this rotation see the following information.
Nature of the rotation: Rheumatology is an outpatient elective. There is an inpatient consult service run by the
fellows and you are invited to participate, but not expected. A pediatric outpatient experience is available as
well, for those interested, upon request. Clinic is held Monday – Friday. PLEASE REPORT TO GRU
CLINIC AT ONSET. Wednesday afternoon is our academic conference.
Clinics: (2nd floor MOB in MED II for GRU clinics and 4th floor 4D for VA clinics)
DAY OF THE WEEK
TIME
MONDAY AM
8:00 AM – 12:00 PM
Alyce Oliver, MD
GRU-MOB 2nd Floor
Marcie Alisangco, MD
VAMC 4-D
8:00 AM-12:00 PM
Laura Carbone, MD
MONDAY PM
Alyce Oliver, MD
GRU-MOB 2nd Floor
12:00 PM-5:00 PM
Walter Moore, MD
TUESDAY AM
VAMC 4-D
8:30 AM – 12:00 PM
Walter Moore, MD
Specialty Care Clinic
Rheumatology fellows
TUESDAY AM
Alyce Oliver, MD
nd
GRU-MOB 2 floor
8:00 AM – 12:00 PM
Marcie Alisangco, MD
TUESDAY PM
VAMC 4-D
1:00 PM –4:30 PM
Alyce Oliver, MD
Specialty Care Clinic
Rheumatology Fellows
TUESDAY PM
Walter Moore, MD
GRU-MOB 2nd Floor
1:00 PM –4:30 PM
Marcie Alisangco, MD
WEDNESDAY AM
Marcie Alisangco, DO
GRU-MOB 2nd Floor
8:00 AM – 12:00 PM
Alyce Oliver, MD
WEDNESDAY PM
1:00 PM-3:00 PM
Rheumatology Conference
GRU-BI 5086
THURSDAY (3rd Thur. of each month)
Shared between Rheumatology,
Lupus Multi-Specialty Clinic
Nephrology, and Dermatology
DOM Library
12:00 PM-1:00 PM
Fellows and Residents
THURSDAY AM
Fellow’s clinic
nd
GRU-MOB 2 Floor
8:00 AM – 12:00 PM
Drs. Oliver and Alisangco
THURSDAY PM
Pediatric Clinic-Rita Jerath, MD
GRU-MOB 2nd Floor /CMC-3rd Floor
1:00 PM –4:30 PM
FRIDAY AM (3rd Friday of each month)
GRU-MOB 2nd Floor
8:00 AM-12:00 PM
Walter Moore, MD
FRIDAY AM (4th Friday of each month)
Ophthalmology clinic 2nd floor hospital
8:00 AM-12:00 PM
Alyce Oliver, MD
* All GRU residents on rotation are expected to be at the VA when available for clinics unless told otherwise
*****Friday clinics change periodically, please check with coordinator Shawnda Claxton at ext 2981.
Faculty: Drs. Laura Carbone, Chief, Section of Rheumatology, Walter Moore (Associate Dean for
GME), Alyce Oliver (Program Director for Rheumatology Fellowship), Marcie Alisangco, Joseph
Bailey, Rita Jerath (Chief of Pediatric Rheumatology)
Fellows: Drs. Kristin Etzkorn (senior fellow, pager 5934) and Wambui Machua (junior fellow, pager
6275)
Administrative Assistant: Ms. Shawnda Claxton - Phone 1-2981/2982.
Clinic Support Staff: Deirdre Bush, LPN and Ive Banks, nursing assistant. Clinic phone numbers:
1-1399, 1-1401 and 1-1403.
Expectations:
1.
Professionalism: Be in clinic on time. If you are going to be late or absent students, please
notify Liz Jones in the clerkship office (1-2055), and residents please contact Michelle Torres in the
housestaff office (1-2423), and Shawnda Claxton (1-2981/2982) in the Rheumatology office, or one of
the faculty. All absences will need to be excused through the clerkship office/housestaff office.
2.
Patient Care, Practice-Based Learning and Improvement, Systems Based Practice, and
Communication Skills: Provide pertinent patient presentations. The nature of outpatient medicine
does not always afford the luxury of lengthy patient encounters and thus not every patient encounter you
have while on Rheumatology will result in as comprehensive a presentation as inpatient medicine. This
does not mean that your presentations are not to be pertinent to the chief complaint or reason for follow
up. Before you enter a patient’s room to begin your encounter, review the EHR (Powerchart or CPRS)
and determine what occurred at the time of the last outpatient visit, including tests and therapeutic
interventions, and discuss with the patient the result of such interventions, along with exploring any new
concerns. When presenting to an attending or a fellow, be prepared. One should know the reason for
follow up, results of tests and interventions and have explored the chief complaint. For patients new to
the clinic, a full History and Physical will be conducted and results presented. Following the clinic visit,
a complete note will be generated in the EHR and forwarded to the appropriate attending for review.
3.
Medical Knowledge: Read: If you have spare time before presenting your patient read on your
patient’s diagnosis or complaint in any our several textbooks or on-line sources (see Educational
Resources below). In addition, it is expected you will read about your patient’s diseases after hours. If
you are completing a one month rotation, you will be asked to give an informal discussion on a topic to
your peers.
4.
Med 5077: Senior students on outpatient medicine ½ day per week often ask how we decide
whether they are meeting or exceeding expectations (B versus A level performance) when completing
their clinic evaluation form. Unfortunately assignment of a particular grade can be rather subjective. To
assist the senior student in achieving as high a grade as possible during their ½ day with us we have
elaborated, in addition to what is already on the Med 5077 evaluation form, the following expectations
in each of the four competencies that we feel differentiates the A from the B performance.
a. Patient care: the student performing at an A level will have performed a complete (pertinent
to the problem requiring referral) history and physical exam with a complete medication list
(name, dose and frequency) on all new patients and will have reviewed the record and know
all labs, imaging results and medications germane to the previous and current visits on all
returning patients.
b. Medical knowledge: knowing the answer to basic questions regarding rheumatology and its
more common diseases and showing evidence that the senior student is reading in the area of
rheumatology prior to and during clinic will constitute an A level performance.
c. Professionalism: coming to clinic on time and showing an interest in learning as well as
showing respect to your patients, peers and faculty on a consistent basis constitutes an A
level performance.
d. Communication skills: in addition to what is already listed on the Med 5077 evaluation form
it is expected that the A level student will consistently have an organized and accurate
presentation and will be able to articulate a reasonable assessment and plan for each of their
patients.
Learning objectives:
During your time on Rheumatology Elective you will see many examples of the most common rheumatic
diseases seen in the private practice of rheumatology as well as examples of less frequently seen diseases,
unique to a tertiary care center. It is expected that you will develop a working knowledge of the classic
presentations of the most common rheumatic diseases and a passing familiarity with the less common ones.
This includes understanding the appropriate use of immunologic labs such as ANA, anti-CCP Ab, RF, ANCA,
etc. Examples of diseases you can expect to see include but are not limited to osteoarthritis, rheumatoid
arthritis, systemic lupus erythematosus, osteoporosis, Sjogren’s syndrome and systemic sclerosis. In addition
you will see plenty of the common pain syndromes including fibromyalgia and chronic low back pain.
Additionally, there will be the opportunity to learn and assist in procedures such as arthrocentesis.
Educational resources:
In the clinic you will find a copy of Harrison’s Rheumatology, Kelly’s Textbook of Rheumatology and
Klippel’s Primer on the Rheumatic Diseases. A collection of rheumatology case studies is available on line
through the American College of Rheumatology at www.rheumatology.org. Follow the link for professional
education to online curriculum cases. Additionally, similar cases in print form (CARE, MKSAP, PowerPoint
presentations) may be utilized and are located in the Rheumatology offices (BI5086).
Rheumatology Fellowship opportunities:
Travel scholarships to attend the annual national meeting are available from the American College of
Rheumatology to students and residents interested in the field of Rheumatology. Inquiries to applying for and
completing a rheumatology fellowship at GRU or abroad can be made to Dr. Oliver the Program Director for
the Fellowship or to Dr. Walter Moore.