RHEUMATOLOGY FELLOWSHIP PROGRAM DESCRIPTION
A.
PROGRAM DEMOGRAPHICS
1. University of Tennessee Health Science Center
2. Rheumatology Department
3. 956 Court Avenue, G326
4. Memphis TN 38163
5. 901-448-5774
6. 901-448-7265 (Fax)
7. lcarbone@uthsc.edu
8. Dr. Laura Carbone, Program Director
9. Angela Augusta, Program Coordinator
B.
INTRODUCTION
1. History: The Rheumatology Fellowship program at the University of Tennessee Health Science Center
(formerly, UT Memphis) has been in existence since 1959 when it was established by Professor Glenn Clark,
one of the first full-time rheumatologists in the United States and the first rheumatologist in the Memphis area.
Since that time, the program has graduated 107 Fellows to be independently practicing rheumatologists. The
career paths of graduates has spanned a broad range, from academic teachers and researchers, directors in the
pharmaceutical industry, and clinical practitioners across the United States and the world.
2.
Duration: 2 years
3.
Prerequisite Training/Selection Criteria:
Medical Education:
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Graduates of Liaison Committee on Medical Education (LCME)-approved U.S. and Canadian Medical Schools
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International Medical Graduates who have valid Educational Commission for Foreign Medical Graduates
(ECFMG) certificates
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United States or Canadian medical schools must have completed at least three years of approved residency
training in internal medicine
Visa Status:
Visa status for International Medical Graduates must fall within the following categories:

Permanent Resident or Alien status (i.e., “Green Card”)
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Eligible to seek J-1 visa
Selection of Residents:
To be considered for Rheumatology Residency Program, a complete file must be on hand at the time of review.
A complete file consists of:
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ERAS Completed Application
CV
3 letters of recommendation
ECFMG Certificate (if applicable)
Transcript
Permanent Residency Card (if applicable)
USMLE sheets (all steps needed)
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4.
Goals & Objectives
Rheumatology Grand Rounds
Core Curriculum and Research Conferences
Competency
Objective
Patient Care

Know rationale, alternatives, indications, contraindications,
complications, risk, benefit, cost, expected outcome, & interpretation
Medical Knowledge
of results of diagnostic aspiration & therapeutic injection, EMG/NCT,
biopsy (to include skin, muscle, &artery), angiography, radiography
Practice-Based
(plain film, MRI, CT, DXA, & other scans), nailfold capillaroscopy,
Learning &
joint replacement, & arthroscopy.
Improvement

Know rationale, alternatives, indications, contraindications, risks, &
benefits of nonsteroidal anti-inflammatory drugs, disease-modifying
antirheumatic drugs, adrenal corticosteroids, biologic response
modifiers, anti-hyperuricemic drugs, cytotoxic drugs, & antibiotic
therapy for joint & soft tissue infections.

Know pathophysiology, diagnosis, & management of the
rheumatologic diseases listed in the core curriculum.
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Construct differential diagnoses for rheumatologic symptoms & signs.
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Critically analyze the rheumatologic literature, & understand statistical
analysis.
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Continue to expand knowledge base & skills via diverse educational
media.
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Attend, present at, & help organize local, regional, & national
conferences.
Evaluation/Outcome
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Satisfactory performance evaluations.
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Successful completion of the ABIM Rheumatology
Certification Exam.
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Successful completion of the RSAP
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Satisfactory performance evaluations.
Satisfactory participation in Journal Club.
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Satisfactory presentations at Rheumatology Grand Rounds,
Journal Club, & regional & national meetings.
Satisfactory organization of the Core Curriculum lecture
schedule.
Abstract presentation(s) at regional & national conferences.
Satisfactory teaching evaluations from trainees.
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Journal Club
Competency
Practice-Based
Learning &
Improvement
Objective
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Critically analyze the rheumatologic literature, & understand statistical
analysis.
Radiology Conference
Competency
Objective
Patient Care
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Interpret results of common rheumatic diseases seen on
angiography & diagnostic imaging studies related to the
Medical Knowledge
musculoskeletal system.
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Know the rationale, alternatives, indications, contraindications,
complications, risk, benefit, cost, expected outcome, &
interpretation of results of angiography & radiography (plain
film, MRI, CT, DXA, & other scans).

Construct differential diagnoses of radiologic findings seen in
common rheumatologic diseases.
Evaluation/Outcome
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Satisfactory participation in Journal Club.
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Optional: matriculation in epidemiology & statistics courses
through Department of Preventive Medicine
(http://www.utmem.edu/grad/COURSES/courses_epi.html)
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Evaluation/Outcome
Satisfactory performance evaluations.
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Satisfactory performance evaluations.
Successful completion of the ABIM Rheumatology Certification
Exam.
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2
Electives (Orthopedics, Neurology, Physical Medicine & Rehabilitation, Chronic Pain Management)
Competency
Objective
Evaluation/Outcome
Patient Care
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Perform proficiently a comprehensive history & physical
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Satisfactory performance evaluations.
examination tailored to orthopedics (including sports medicine),
Medical Knowledge
neurology, or rehabilitation, as they relate to rheumatologic
disorders, & the appropriate request of laboratory & imaging
studies.
Interpersonal &
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Know the pathophysiology, diagnosis, & management of the
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Satisfactory performance evaluations.
Communication
rheumatologic diseases listed in the core curriculum that pertain
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Successful completion of the ABIM Rheumatology Certification
Skills
to orthopedics, neurology, & rehabilitation.
Exam.
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Construct differential diagnoses for rheumatologic symptoms &
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Satisfactory performance evaluations.
signs related to orthopedics, neurology, & rehabilitation.
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Know the indications for referral of patients to specialists in
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Satisfactory performance evaluations from attendings &
orthopedics, neurology, & rehabilitation.
professional associates.
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Participate and/or lead a multidisciplinary team, i.e.,
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Satisfactory performance evaluations from attendings &
rehabilitation facilities, home health care, etc.
professional associates.
Rheumatology Ambulatory Clinics, Rheumatology Consult Service, Electives (Pediatrics, Metabolic Bone)
Competency
Objective
Evaluation/Outcome
Patient Care
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Perform proficiently a comprehensive history & physical
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Satisfactory performance evaluations.
examination tailored to rheumatology, especially the
Medical Knowledge
musculoskeletal system, & the appropriate request of
laboratory & imaging studies.
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Know the rationale, alternatives, indications,
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Satisfactory performance evaluations.
contraindications, complications, risk, benefit, cost,
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Successful completion of the ABIM Rheumatology Certification
expected outcome, & interpretation of results of diagnostic
Exam.
aspiration & therapeutic injection, EMG/NCT, biopsy (to

Successful completion of the CARE
include skin, muscle, & artery), angiography, radiography
(plain film, MRI, CT, DXA, & other scans), nailfold
capillaroscopy, joint replacement, & arthroscopy.

Know the rationale, alternatives, indications,
contraindications, risks, & benefits of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic
drugs, adrenal corticosteroids, biologic response modifiers,
anti-hyperuricemic drugs, cytotoxic drugs, & antibiotic
therapy for joint & soft tissue infections.

Know the pathophysiology, diagnosis, & management of
the rheumatologic diseases listed in the core curriculum.

Construct differential diagnoses for rheumatologic
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Satisfactory performance evaluations.
symptoms & signs.
Interpersonal &
Communication Skills
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Serve as the primary health care provider or consultant in
the inpatient setting, ambulatory clinic, emergency
department, & intensive care setting
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Satisfactory performance evaluations from attendings &
professional associates.
Satisfactory completion of consultation notes on inpatients &
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Participate and/or lead a multidisciplinary team, i.e.,
rehabilitation facilities, home health care, etc.
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GME Conferences
Competency
System-Based Practice
5.
Objective
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ambulatory new patient consultations
Satisfactory performance evaluations from attendings &
professional associates.
Satisfactory & timely referrals to rehabilitation specialists,
home health care agencies, etc.
Evaluation/Outcome
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Program Certifications: the program is accredited by the ACGME
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C.
RESOURCES
1. Teaching Staff
FULL TIME FACULTY
Carbone (Program Director)
Kang
Postlethwaite
Stuart
Menon
Pattanaik
VOLUNTEER FACULTY
Laura
Andrew
Arnold
John
Yamini
Debendra
Richardson
Tulio
David
Bertorini
Inpatient
Consultations
Longitudinal
Clinics
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Private
Office
Mentoring
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Basic
Research
Clinical
Research
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2. Facilities
Regional Medical Center (The MED) of Shelby County & City of Memphis & Veterans Affairs Medical Center (VAMC), both are within a 4-block area in downtown
Memphis, adjacent to or on the university campus.
D.
EDUCATIONAL PROGRAM – BASIC CURRICULUM
1. thru 4.
Residents gain experience in the diagnosis and management of the entire spectrum of rheumatic and musculoskeletal diseases, and diseases with rheumatologic
and musculoskeletal manifestations. University rheumatologists staff the inpatient consult service and ambulatory clinics. Consultations with all specialists and
allied health professionals are available. Residents experience pediatric consultative and continuity of care during the 6 mo. Ambulatory Pediatrics rotation with the
pediatric rheumatologist on faculty. The inpatient Pediatric Consult Service is available as an elective.
Ambulatory Medicine Experience
The PGY4 Resident attends five half-day clinics weekly. Continuity of care occurs in the VA Follow-up, UTMG, and Medplex Clinics. Consultative care for new
patients occurs in the VA Clinic, UTMG, and Medplex Clinics. The PGY4 Resident spends 6 mo. on Ambulatory Pediatrics, in which he/she provides both
continuity and consultative care to pediatric patients with rheumatologic complaints. The PGY5 Resident attends four half-day clinics weekly. Both the PGY4 and
the PGY 5 resident rotate in elective clinics in muscle and nerve biopsy interpretation and office orthopedics..
Consult http://www.rheumatology.org/training/readinglist/readinglist.html for a suggested reading list.
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Core Clinical Topics:
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Diffuse connective tissue disease (e.g., undifferentiated & mixed connective tissue disease,
overlap syndromes)
Rheumatoid arthritis, adult-onset Still disease
Systemic, discoid, subacute cutaneous, & drug-induced lupus erythematosus
Scleroderma (localized, systemic, CREST, induced) & eosinophilic syndromes (fasciitis,
myalgic syndrome)
Sjögren syndrome
Inflammatory myositis, including polymyositis, dermatomyositis, inclusion body myositis;
metabolic myopathies, including primary & secondary diseases
Spondyloarthropathies, ankylosing spondylitis, Reiter, psoriatic, inflammatory bowel disease,
acne-associated, SAPHO syndrome
Vasculitis, including polymyalgia rheumatica & temporal arteritis, systemic necrotizing,
Takayasu, Wegener & ANCA-associated, Churg-Strauss, Behcet, hypersensitivity,
cryoglobulinemia, Cogan
Crystal-induced arthritides, including monosodium urate, calcium pyrophosphate dihydrate,
basic calcium phosphate, calcium oxalate
Core Basic Science Topics:
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tissue cells & components, bone, muscle & blood vessels
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Nonarticular rheumatic diseases, including fibromyalgia, psychogenic rheumatism, chronic pain, &
axial & regional syndromes
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Nonsurgical, exercise-related (sports) injury
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Metabolic bone disease, including osteoporosis, osteomalacia, renal osteodystrophy, & Paget
disease
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Joint & soft tissue infections, including bacterial, mycobacterial, spirochetal, viral, fungal, parasitic
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Pain management
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Joint surgery, including arthroscopy, arthrodesis, joint replacement, synovectomy, osteotomy,
Immunology, including anatomy & cellular elements of the
lymphoid system, immune & inflammatory mechanisms
(including antigens, superantigens, MHC, B & T cell receptors,
complement & kinin systems), cellular interactions &
immunomodulation (activation, cytokines, inflammatory
mediators), immune responses, & immunoregulation
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Purine & pyrimidine metabolism, including uric
acid, purine pathway enzymes
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Osteoarthritis (primary & secondary), DISH
Regional musculoskeletal pain syndromes, & acute & chronic musculoskeletal pain
syndromes, including entrapment neuropathies, & reflex sympathetic dystrophy
Anatomy & biology of joints, tendons, ligaments, connective
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Test-performance characteristics, including sensitivity,
specificity, & predictive value
Biomechanics of bones, joints, & muscles
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Research principles in basic & clinical investigation,
including epidemiology, controlled trials, outcomes research,
health status, disease activity, quality of life assessment, &
bioethics
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Research techniques, including ELISA, RIA, immunoblots,
immunofluorescence, PCR, genetic mapping, gene sequencing,
hybridoma & monoclonal antibodies, transgenic & knockout
animals, & gene therapy
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Data analysis, biostatistics, meta-analysis,
medical informatics, & critical literature review
spine
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Rehabilitation therapy as it relates to rheumatology, including modalities, assistive devices,
exercise, footwear & orthotics
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Pediatric rheumatology, including JRA, Kawasaki, infantile PAN, neonatal lupus, dermatomyositis,
acute rheumatic fever, bone & joint dysplasias
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Systemic diseases with rheumatic manifestations, including endocrine- & hematologic-associated
diseases.
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Miscellaneous syndromes, including relapsing polychondritis, panniculitis, erythema nodosum,
primary antiphospholipid syndrome, avascular necrosis, transient osteoporosis, hypertrophic
osteoarthropathy, benign & malignant tumors of muscle & bone
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Inherited disorders, including Marfan, osteogenesis imperfecta, Ehlers-Danlos, hypermobility,
osteochondrodysplasias, homocystinuria, ochronosis, immunodeficiency
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Geriatrics & aging influences
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Laboratory tests: synovial analysis, acute phase reactants, autoantibodies, cryoglobulins,
complement, SPEP, immunoglobulins, antibodies to coagulation components; therapeutic
monitoring for drugs; diagnostic imaging (plain film, arthrography, ultrasound, CT, MRI,
radionuclide, bone densitometry, arteriography); EMG, NCV;
biopsies; nailfold capillaroscopy, Schirmer & rose bengal tests
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5. Trainee advancement and promotion: as deemed appropriate by the Program Director based on ongoing performance evaluations, trainees will be promoted to
the next PGY level at the beginning of the next 12 month cycle of their program. With promotion, trainees will acquire more responsibility, mainly in the form of
greater independence in clinical decision-making and in bedside procedures. Furthermore, advancing trainees will be given increased opportunity for the teaching
of students and residents in medical and other allied health professions in the form of bedside rounds, seminars, and didactic lectures.
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E.
EVALUATION
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Evaluation methods and frequency of evaluations and feedback are listed in the table on ACGME Core Competencies
(Appendix 1).
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The Evaluation Committee meets at least semiannually, and the Program Director subsequently meets with each
trainee to discuss evaluations and progress. The Program Director reviews evaluation forms promptly, and
summarizes the Resident’s evaluation forms at least semi-annually. Comments containing praise or concern are
shared with the Resident immediately. Residents may review their file in the office upon request.
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Academic due process is ensured through the resident’s ability to meet with an independent clinical competence
committee formed in the event of an adverse annual evaluation. Performance and competence are reported to the
ABIM annually.
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Residents maintain a Procedure Log through New Innovations. The Program Director reviews these data to ensure
that the Resident is on target to meet the requirements of the ACR and ABIM. This information is also used to respond
to credentialing requests to grant privileges to graduates of the program.
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Successful completion of the RheumatologyCertification Exam (ABIM) is expected. Subspecialty board passage rate
is checked on the ABIM website. The ACR currently provides the Rheumatology Self-Assessment Program (RSAP) as
an evaluative tool that serves as an in-service training exam.
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Residents evaluate faculty at least annually, using the ABIM Evaluation of Attending Physician. Residents also provide
feedback at the monthly Division Meeting, and informally through discussions with the faculty, particularly the Training
Program Director.
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