Educational Purpose:

This rotation is designed to give residents background knowledge of rheumatic disease as well as practical application of that knowledge in direct patient care activities. This rotation is intended to teach the clinical skills necessary to evaluate the patient presenting with muscu1oskeletal problems, their initial diagnostic evaluation and general management. The rotation is designed to emphasize outpatient ambulatory care and consultative inpatient services.  Residents have direct patient contact with close faculty supervision. This patient-oriented approach is supplemented by regular didactic lectures, conferences and journal clubs.

Goals and Objectives:

PGY-1:

1.  Develop basic core knowledge of rheumatic diseases, differential diagnosis, pathophysiology, and therapy

2.  Take histories and conduct physical examinations related to rheumatic disease, Synovial fluid examination, and interpretation

3.  Appropriately use and interpret routine laboratory tests, rheumatoid factors, antinuclear antibodies, complement determinations, sedimentation rate

4.  Conduct x-ray examination of the joints

PGY-2 and 3

1.  Develop basic core knowledge of rheumatic diseases, differential diagnosis, pathophysiology, and therapy

2.  Take histories and conduct physical examinations related to rheumatic disease, Synovial fluid examination, and interpretation

3.  Appropriately use and interpret routine laboratory tests, rheumatoid factors, antinuclear antibodies, complement determinations, sedimentation rate

4.  Conduct x-ray examination of the joints

5. Supervise PGY-I and as well as medical students on the rotation

6. Develop short term as well as long term treatment plans for patients.

Teaching Methods:

Didactic teaching materials (audio visual and printed) located in the MUSC and Rheumatology libraries provide basic core knowledge of differential diagnosis, pathophysiology, and therapy of rheumatic diseases.  The resident should attempt to read most of The Primer of Rheumatic Diseases during the course of the rotation.  In addition, chapters from tile standard texts should be read on the more common rheumatic diseases, especially RA, SLE, SSC, OA, PMR and GCA, gout, spondyloarthropathies, vasculitis, myositis, regional disorders, and pharmacology of frequently used medications.  These topics should also be covered on rounds.

Mix of Diseases and Pathological Material:

Diseases include:  Rheumatoid Arthritis, Spondyloarthropathies and Seronegative Arthritis,  Infectious Arthritis, Crystal-Induced Arthritis, connective tissue diseases, Vasculitis, Osteoarthritis,  heritable disorders of connective tissue.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender.  There is a mixture of patients including older adults, but there are significant numbers of adolescent and young adult patients with rheumatologic diseases.  All have acute or chronic rheumatologic diseases including complicating general medical conditions.

Types of Clinical Encounters:

Encounters are primarily in the outpatient setting, though there will be occasional participation on inpatient consults.

Procedures and Services:

Procedures and services include physical examination of the joints, Synovial fluid examination, X-ray examination of the joints, interpretation of Synovial fluid analysis, running laboratory tests and laboratory diagnosis.

Supervision:

All patient encounters during the rotation are presented to an attending physician.  Residents are given the opportunity to develop a plan of care under the guidance of the Rheumatology attending.

Educational Resources to be Used and Reading Lists: 

Educational resources include The Primer of Rheumatic Diseases, Arthritis and Allied Conditions, Textbook of Rheumatology, ACR slide collection and teaching cases, and audiovisual materials.  

Method of Evaluation of Resident Competence:

The resident is evaluated using the standard Development Evaluation form for each competency.  Patient Care is assessed based on direct observation and chart review.  Medical Knowledge is assessed through direct questioning on rounds.  Professionalism is assessed based on observation of the resident’s demeanor and behavior on this rotation.  Interpersonal and Communication Skills are assessed by observing the resident’s interactions with patients, families, and staff.  Systems-Based Practice is evaluated based on the resident’s ability to function in the team setting and to utilize interdisciplinary resources to care for Rheumatology patients in the ambulatory setting.  Practice-Based Learning is evaluated based on the resident’s ability to learn and improve his or her skills based on feedback, study, and literature review.  The resident is also evaluated on his or her ability to cogently present a talk during the rotation.  The resident evaluates the faculty and the rotation via the standard evaluation forms in E*Value.