Methology for Teaching Rheumatology

In order to achieve the goals and objectives for the fellowship program the following experiences have been established for the purpose of teaching Rheumatology fellows. These include: A) the inpatient rheumatology experience, B) the ambulatory rheumatology experience, C) ambulatory rotations with other clinical subspecialties, D) didactic conferences, E) continuing medical education and society participation, F) a research experience, and G) development of teaching skills.

A) The inpatient rheumatology experience. The fellows assigned to this rotation we will be responsible for organizing the activities of this service. This primarily includes the supervised evaluation of inpatient consultations and patients admitted to the rheumatology service as well as the continued follow up of these patients during their hospitalization. Essential in this role is the development and refinement of clinical evaluation skills of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans. Essential in this rotation will be developing skills in providing consultation services, to include communicating with the referring physicians and ensuring support for continuing care of the patients' rheumatic condition. A fellow will be called upon to  perform literature research on topics appropriate to the case at hand. They will participate actively in the teaching activities of the consultation team (which normally includes a resident and/or a medical student). Through
this experience the fellow will also develop a comprehensive understanding of the indications, contraindications, techniques, complications of arthrocentesis as well as the interpretation of results from this procedure. The fellow will also acquire the knowledge of and skill in educating patients about the procedure and in obtaining informed consent While assigned to the inpatient service, the fellow is also responsible for urgent consultations from the Emergency Treatment Center at UIHC, the Urgent Care Clinic at the VAMC, other ambulatory clinics and from outside physicians. All patients seen by fellows will be staffed by a faculty physician.

B) The ambulatory rheumatology experience. All fellows will be required to maintain the equivalent of a full day clinic for the first 12 months and a half day clinic for the second 12 months for patients with rheumatic diseases. This experience will continue with progressive responsibility through the fellowship and will be appropriately supervised by dedicated attending faculty members. The goal of this experience will be for the fellows to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended  period of time.

C) Interdisciplinary interactions. The fellow will be provided an experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases: this includes: 1 ) orthopedic medicine, 2) rehabilitative medicine (physical and occupational therapy), 3) pediatric rheumatology, 4) musculoskeltal radiology, 5) dermatology and 6) ophthalmology. The goal of these experiences is for the fellow to appreciate the approach to the specific conditions that relate to rheumatic disorders within these subspecialties. This interdisciplinary interaction can occur in the form of a clinical rotation, multidisciplinary conference, etc. Clinical experiences should be under the direction of attending physicians in the respective subspecialty who participate fully in the educational goals of the rotation.

D) Didactic conferences. Conferences will be held on a regularly scheduled basis with attendance required of all fellows and divisional faculty. There will be one clinical conference every week (case management conference). In addition, there will be one literature review conference (journal club), a clinical conference, and two research conferences (where basic science research is reviewed) each month. Fellows will be required to attend these conferences.

E) Continuing medical education and society memberships. In addition to participating in the organized didactic conferences established within the fellowship program it is also strongly encouraged that all fellows become members of the American College of Rheumatology . The division will pay for trainee membership in the American College of Rheumatology. The division wants to encourage attendance at the national meeting of the American College of Rheumatology. The division will pay for each second year rheumatology fellow to attend the meeting and the review course. The division will also pay for any other fellow (i.e. first or third year fellow) who will be presenting original research (i.e. poster, podium presentation) at the meeting.

F) Scholarly Activity/Research experience.

1) For fellows planning a career as a physician-scientist, a meaningful, supervised research experience will be provided with appropriate protected time for each fellow. Exposure to divisional research programs will be initiated early in the fellowship to allow the fellow adequate insight into the areas of research in preparation for the ultimate selection of a faculty member to serve as a specific research mentor for the remainder of the fellowship training program. During this phase of training the fellow will work under close guidance of the research mentor.

2) All fellows will learn sound methodology in designing and performing research studies and the correct interpretation and synthesis of research data.

3) For fellows planning careeers as Clincian-Educators, experience in developing teaching skills will be emphasized. The program will provide an environment for the fellow which fosters and highly regards the activities of teaching. This includes the education of not only medical students, physicians, and other allied health personnel but also the education of the patients. Development of these skills requires the fellow to receive instruction  and feedback in counseling and communication techniques. Teaching opportunities include presentation at regular division conferences, resident/student scheduled conferences, as well as clinical teaching as part of the  rheumatology consult team and as an attending on general medicine at the VAMC.