Rheumatology
I. Rationale
Today the outlook for the majority of arthritis patients, especially those with rheumatoid arthritis, is
considerably brighter than ever before. This is most likely the result of many co-existing factors, including
the appropriate use of NSAIDS, steroids and newer medications (DMARDs) that reduce pain and
inflammation, as well as judicious physical therapy and reconstructive surgery. This curriculum is
designed to teach the resident the fundamentals of rheumatic diseases. This will include both an
understanding of the differential diagnoses and active management, as well as appropriate adjunctive
care issues. This curriculum has two components: the focused Rheumatology rotation in the third year
and the longitudinal component which will be provided through a series of lectures within the Thursday
didactic sessions and patient care exposures in the FPC, sports medicine, and orthopedic rotations.
II. Competencies
Patient Care/Medical Knowledge
Goal: Provide evidence based care to patients with rheumatological conditions.
Objectives:
A. Learn how to perform a focused rheumatologic H & P, develop a differential diagnosis and initiate an
appropriate, cost-effective diagnostic work-up.
B. Understand the differences between an inflammatory vs. non-inflammatory arthritides (e.g. R.A. vs
DJD)
C. Develop an understanding of Rheumatoid Arthritis in both its active and nonactive state.
D. Acquire an understanding of R.A. disease management and monitoring.
E. Develop an understanding of the soft-tissue rheumatic diseases such as myofascial, psychogenic, and
fibromyalgia syndromes.
F. Understand the presentation, diagnostic criteria and initial work-up of the patient with Lupus and other
related connective tissue disorders.
G. Develop an understanding of the spondyloarthropathies including Ankylosing Spondylitis, Reiter’s
syndrome and Psoriatic arthritis.
H. Understand the presentation, diagnosis and treatment of the crystalline arthritides, gout and pseudogout.
I. Understand the evaluation, differential diagnosis and treatment of infectious disorders including Lyme
disease and septic, viral, mycobacterial, fungal, AIDS and parasitic arthritides.
J. Develop an understanding of vasculitis focusing upon the presentation, differential diagnosis and initial
treatment of Polymyalgia Rheumatica and Temporal/Giant Cell Arteritis.
K. Acquire an understanding of Osteoporosis including prevention, screening, diagnosis, monitoring and
treatment.
L. Understand the special considerations for pediatric, pregnant, geriatric, disabled and critical care
patients with active rheumatologic complaints.
M. Develop an understanding of the physical therapy and exercise prescriptions.
N. Develop a knowledge of patient education resources.
O. Know the indications for orthopedic referral.
P. Develop skill in arthrocentesis, trigger point injection, tendinitis and/or bursitis treatment.
Q. Understand the appropriate use, selection and/or contraindications/precautions regarding the injection
Last Updated March 7, 2013
of intra-articular corticosteroid and local anesthetics.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
X
Grand Rounds
Sub-Specialty Conference
X
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
X
360 ᵒ evaluation
Other
X
X
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Goal: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence
to ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the profession; and a
commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care,
confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at clinics in a timely fashion.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information about
patients.
G. Assist patients and their families in planning for future care needs and care decisions based on
prognosis for the disease.
H. Support the patient in their healthcare decisions.
I. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
J. Appear professionally dressed and well groomed.
K. Completes clinic notes in a timely fashion.
L. Attends required before clinic conference and morning report.
M. Responds to pages in a timely fashion.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Last Updated March 7, 2013
Research Conference
Ethics/Comm Conference
X
X
Outpatient Clinics
Direct Patient care
X
X
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
X
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
X
360 ᵒ evaluation
Other
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Resident Seminar
Journal Club
Readings
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Goal: Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices.
Objectives:
A.
B.
C.
D.
E.
F.
Identify resources for personal education and develop a plan for ongoing education in dermatology.
Identify Point of Care learning resources
Utilize Electronic Medical Records Decision aid tools and templates for patient care
Recognizes strengths and weaknesses of knowledge and skills in self and others.
Appropriately code for procedures done.
Document all procedures performed and the diagnoses of patients managed.
Learning Activities
X
Attending Rounds
X
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
X
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
X
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Goal: Residents must be able to demonstrate interpersonal and communication skills that result in
Last Updated March 7, 2013
effective information exchange and teaming with patients, their patients families and professional
associates.
Objectives:
A. Use effective listening skills and elicit and provide information using effective nonverbal,
explanatory, questioning, and writing skills.
B. Work effectively with others as a member or leader of a health care team or other professional
group.
C. Develop a pattern of cooperation and support within resident years, between years, between
residents and faculty, and between residents and family practice department and clinic staff.
D. Develop interviewing skills recognizing age, ethnic, gender, and cultural differences
E. Learn techniques for managing stress, prioritizing tasks, and balancing multiple demands.
F. Develop a pattern of cooperation and support within resident years, between years, between
residents and faculty, and between residents and family practice department and clinic staff.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
X
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
X
360 ᵒ evaluation
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-based Practice
Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and
system of health care and the ability to effectively call on system resources to provide care that is of
optimal value.
Objectives:
A. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization, and the larger society and how these elements of the
system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including
methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of care.
D. Advocate for quality patient care and assist patients in dealing with system complexities.
Last Updated March 7, 2013
E. Know how to partner with health care managers and health care providers to assess, coordinate,
and improve health care and know how these activities can affect system performance.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Dir
Review
360 ᵒ evaluation
Other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
A. Direct patient care along with the Rheumatology preceptor focusing upon ambulatory care issues as
seen in the private offices, Grady indigent clinics and VA clinics.
B. Core lecture series presented by within the Family Medicine Conference series.
C. Directed readings
D. Associated rotations: sports medicine and orthopedics
E. Reinforcement provided in continuity clinic setting
Evaluation Strategies (see above)
A. Observation of resident by Rheumatology faculty/fellow preceptor
Preceptor: Jonathan Waltuck, MD
Emory Clinic Bldg. A
1365 Clifton Road
Atlanta, GA 30322
Contact: Susan Anderson
Miato
(404) 778-5730
(404) 778-3127
B. End of rotation evaluation provided by Rheumatology preceptor
C. Procedure/Diagnosis documentation
D. Resident evaluation of rotation and preceptor
Implementation Methods
A. Clinical activities along with preceptor which may include:
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Private office clinic: hours dependent upon faculty preceptor
Grady clinics : all day Monday and Thursday am
VA clinics : Tuesday pm- NP clinic, Wednesday am general clinic and Friday am- R.A. monitoring
clinic
B. Rheumatology clinical time not less than 5 half-day sessions per week.
C. FPC clinics and /or didactic attendance not less than 4 half-day sessions per week
D. Complete reading list:
Mandatory Reading
AAFP Monograph #299: Rheumatic Disorders
AAFP Monograph #371: Arthritis Update
Read monograph and take post-test.
Suggested Reading
Primer on the Rheumatic Diseases, current edition
available through the Arthritis Foundation, 1-800-207-8633, or
Library, attention chapters: 7-19,23-24,45,48-57
Office Procedures by Thomas Zuber:
Chapter 21
Knee Joint Aspiration and Injection
Practice Tips by John Murtagh
Multiple chapters on Musculoskeletal exam, injection techniques, exercises for `
patients, etc.
American Family Physician - articles
2001: 03/01: Joint Injury and Subsequent Development of Osteoarthritis
2000: 04/20: Topical Treatment for Patients with Raynaud’s Syndrome
1999: 02/99: Gout and Hyperuricemia
10/99: An Approach to Diagnosis and Initial Management of Systemic Vasculitis
1998: 01/98: Commonly Missed Orthopedic Problems, p267
4/98: Lumbar Spine Stenosis, p1825
6/98: Lupus Erythematosus
12/98: Complex Regional Pain Syndrome
1997: 03/97: ACR Recommendations Target Prevention and Treatment of
Glucocorticoid-Induced Osteoporosis
08/97: Recognition and Management of Lyme Disease
11/97: Upper extremity Bursitis, p1797
1996: 2/96: A Practical Approach to the Patient with Low Back Pain, p670
3/96: A Rational Approach to the Diagnosis of Arthritis, p1295
4/96: Cutaneous Manifestations of Rheumatic Disease, p1625
AAFP Video CME program: Osteoporosis: Dx and Patient Management
Available through AAFP 1-800-274-2237
Patient Care
11/15/97 Entire issue focused on the Management of Acute Joint
Problems, including rehab exercises.
Last Updated March 7, 2013