Course/Rotation Title: RHEUMATOLOGY
Date of Last Review/Update: 3/07
Course/Rotation Director: Edmund Hornstein, DO
Location of clinical encounters:
Inpatient % time = <1%
(Check all that apply)
[X]
Wards
[X]
ICU/RCU
[X]
ED
[ ]
Other (please specify)
Outpatient% time = >99%
(Check all that apply)
[X]
Clinic
[ ]
Home
[ ]
Other (please specify)
Course/Rotation description with educational purpose/value
The goal of this rotation is to provide future general internists with the skills and knowledge
necessary to appropriately evaluate and treat patients with rheumatologic diseases. This includes
learning when to refer patients in a timely fashion for specialty consultative evaluation.
Types of Clinical Encounters: (PLEASE SPECIFY)
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Outpatient consults
Outpatient follow up visits
Outpatient infusions
Inpatient consults with subsequent follow up visits during hospitalization
Outpatient, office based and Inpatient bedside procedures including joint and soft tissue
injection and/or aspiration.
Exposure to laboratory testing, wet prep synovial fluid crystal analysis and radiologic
studies pertinent to the field of rheumatologic disease
Types of Patients: (PLEASE SPECIFY)
[X]
[X]
[X]
[X]
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Adults of all ages
Male
Female
Children < 18 years old
Other (please specify)
1
Mix of Diseases: (PLEASE SPECIFY ANY ADDITIONAL DISEASES)
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Inflammatory rheumatologic diseases such as RA, SLE, Inflammatory Myopathy,
Vasculitis, Spondyloarthropathy, Scleroderma, etc.
Soft tissue disorders including Fibromyalgia, hypermobility syndromes and regional
myofascial pain syndromes.
Degenerative arthritis and regional musculoskeletal disorders including compressive
neuropathy, tendonitis, bursitis, radiculopathy, RSD, etc.
Metabolic musculoskeletal disorders such as Osteoporosis, Rheumatic Manifestations of
Endocrinopathy, metabolic myopathy, Paget’s disease, etc.
Types of Procedures: (PLEASE SPECIFY):
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Aspirate and/or inject large, medium and small sized joints and bursa.
Inject local soft tissue sites including tendon sheaths (trigger finger, rotator cuff
syndrome, etc), trigger/tender points, sites of enthesitis (plantar fasciitis, epicondylitis,
etc.).
Describe the level of supervision by faculty:
[X]
[X]
[X]
[X]
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Attending staff will supervise and precept all patient care activity directly or indirectly.
Attending staff will provide mid rotation feedback
Attending staff will provide end-of-rotation feedback
Other:
All inpatient and outpatient, consults and follow up notes will be reviewed for accuracy,
corrected if necessary and co-signed by attending staff.
All procedures will be directly supervised by attending staff until competency to perform
independently has been achieved
Competency Based Objectives/Expectations. Please see Roman Numeral II with additional
items specific to this rotation as below:
Patient Care: PLEASE SPECIFY
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Obtain a focused history, review of system and physical exam in patients with
rheumatologic conditions
Perform a thorough musculoskeletal history and physical examination, including patients
with: low back pain, neck and shoulder pain, and hip and knee pain
See above under procedures
Present information and discuss with attending
Write appropriate subspecialty consult and follow up notes
Interpret and arrange treatment plan based on results of Bone Densitometry
Medical Knowledge: PLEASE SPECIFY
2
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Signs and symptoms of common musculoskeletal problems as well as their treatment
options.
Understand the approach to the diagnosis and the initial treatment of common patterns of
rheumatic diseases:
a)
mono or pauci-articular arthritis
b)
osteoarthritis
c)
polyarthritis
d)
systemic inflammatory diseases
e)
vasculitis
Learn to workup, diagnose, and treat common office-based musculoskeletal problems
(low back pain, neck and shoulder pain, and hip and knee pain, carpal tunnel,
radiculopathy).
Learn the uses and common side-effects of drugs used to treat musculoskeletal and
inflammatory problems.
Understand indications for Bone Density testing and types of treatment options
Practice-Based Learning: PLEASE SPECIFY
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Perform an in-depth analysis and report on a musculoskeletal topic using appropriate
literature review.
Interpersonal and Communication Skills: PLEASE SPECIFY
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Please see BMC general core competencies under Roman Numeral II
Professionalism: PLEASE SPECIFY
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Please see BMC general core competencies under Roman Numeral II
System-Based Practice: PLEASE SPECIFY
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Learn how and when to order appropriate and cost effective Rheumatologic testing and
imaging.
Develop an understanding of how and when to consult other neuromuscular and surgical
specialists and learn how to order physical therapy for common musculoskeletal
problems.
Check Any Methods Used For Teaching and Assessment:
[X] Ambulatory Clinic (feedback written & verbal)
[X] Annual In-service Exam (feedback written)
[X] Attending Rounds (feedback written & verbal)
[X] Board Review (feedback written examination)
[ ] Cancer Conference
[ ] Case Management Evaluation (360 degree written evaluation)
[X] Chart Stimulated Recall & Feedback (feedback verbal)
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[X] Direct Observation and Feedback (feedback written & verbal)
[ ] GME Core Curriculum
[ ] Interns Report (feedback written & verbal)
[ ] Journal Club (feedback written & verbal)
[X] Medical Record Review (feedback written & verbal)
[ ] Mentor Feedback (feedback written & verbal)
[X] Monthly End of Elective Exam (feedback written)
[X] Monthly Mini CEX (feedback written & verbal)
[X] Monthly Competency Based Written Evaluation
[ ] Morning Report (feedback written & verbal)
[ ] Multidisciplinary Rounds Feedback (feedback verbal)
[ ] Nursing Evaluation (360 degree written evaluation)
[ ] Patient Evaluation (360 degree written evaluation)
[ ] Patient Management Discussions (feedback written & verbal)
[ ] Procedure Logs
[ ] Performance improvement Multidisciplinary Morbidity and Mortality
(feedback written & verbal)
[ ] Semi Annual Program Director Feedback (feedback written & verbal)
[ ] Student Evaluation (feedback written & verbal)
[ ] Supervised Sign-In Rounds (feedback written & verbal)
[ ] Supervised Sign-Out Rounds (feedback verbal)
[ ] Other _______________________________
[ ] Other _______________________________
[ ] Other _______________________________
[ ] Other _______________________________
Other Policies:
The Course Director recognizes that the trainee is accountable to all BMC Residency and GME
Personnel Policies and Procedures. The Course Director recognizes that the residents are
expected to attend all continuity clinics and mandatory educational conferences unless excused
by the Program Director or Chief Medical Resident with advanced notice.
Check The Educational Materials Used (beyond direct patient care):
[X] Reading List (Please Specify):
The attending physician keeps files of review articles. They are used as the basis of discussion
of many diseases and of their treatment. We encourage residents to purchase a Primer on the
Rheumatic Diseases. This is a concise and useful resource. There are several textbooks and
illustrated books in the offices and these are available to the residents.
1.
2.
2.
W. Kelley et al: Textbook of Rheumatology, 6th Edition,W.B. Saunders, 2001.
Primer on the Rheumatic Diseases, 12th edition, 2001.
Hoppenfeld, S.: Physical Examination of the Spine and Extremities, AppletonCentury-Crofts, 1976.
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[X] Review of Appropriate Radiology Images (Please Specify):
1.
Brower, A.C.: Arthritis in Black and White, 2nd Edition, W.B. Saunders, 2007.
[X] Review of Appropriate Pathology (Please Specify):
1.
Primer on the Rheumatic Diseases, 12th edition, 2001.
[X ] Review of Appropriate Laboratory Data (Please Specify):
1.
Primer on the Rheumatic Diseases, 12th edition, 2001.
[X ] Articles from the Literature (Please Specify):
As provided during outpatient rotation
[ ] Other (Please Specify):
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