Curriculum

PC1: Gathers and synthesizes essential and accurate information to define each patient’s clinical problems.

• Proficient in taking a complete history, performing a physical examination (particularly of the joints and musculoskeletal structures) and the use laboratory and imaging studies.
• Demonstrates expertise in the performance and interpretation of musculoskeletal examinations.

PC2: Develops and achieves a comprehensive management plan for each patient.

• Possesses the ability to analyze critically the clinical and laboratory data, integrate this with their basic foundation of medical knowledge, and formulate appropriate differential diagnoses and therapeutic plans.
• Prescribes and manages immunomodulatory therapy.
• Provides patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

PC3: Manages patients with progressive responsibility and independence.

• Manages the care of patients with acute and chronic, common, and complex rheumatologic diseases across multiple care settings.
• Advocates for individual patients.

PC4a/b: Demonstrates skills in performing and interpreting invasive & non-invasive procedures.

• Performs procedures including arthrocentesis and injections, compensated polarized microscopy, and interpretation of synovial fluid analysis.
• Demonstrates expertise in the performance and interpretation of musculoskeletal examinations.

PC5: Requests and provides consultative care.

• Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment.
• Models management of discordant recommendations from multiple consultants.
• Proficient in performing as a rheumatology consultant or health care team leader for patients with primary rheumatologic diagnoses.
• Provides rheumatology consultation to other specialties and providers.

MK1: Possesses Clinical Knowledge

• Possesses a basic core of knowledge of clinical features and presentations, pathophysiology, laboratory and imaging manifestations and comprehensive management of rheumatologic and musculoskeletal diseases. This includes arthritis in all its forms, both acute and chronic, as well as metabolic diseases of bone, osteoporosis and, musculoskeletal pain syndrome, and systemic diseases with rheumatic manifestations, particularly including the connective tissue diseases.
• Possesses a knowledge base that includes an appropriate content of anatomy, genetics, biochemistry, immunology, genetic basis, cell biology, physiology, pharmacology, epidemiology, statistics, ethics, and human/social behavior as needed for the Clinical practice of Rheumatology and evidence-based decision making.
• Possesses a core knowledge of treatment for both common and uncommon diseases found in Rheumatology. This includes understanding the principles, indications and contraindications, risks, complications (including adverse events interactions), techniques and interpretation of results of diagnostics, screening tests/procedures, pharmacokinetics, metabolism, cost, and utility of the various treatments. It also includes recognition of the need for appropriate consultation and of reasonable expectations from such a consultant.

MK2: Knowledge of Diagnostic Testings and Procedures

• Demonstrates expertise in the performance and/or interpretation of diagnostic, imaging studies, and therapeutic procedures common to the practice of Rheumatology, particularly arthrocentesis, and relevant to the evaluation of patients with suspected or established rheumatic and musculoskeletal disease. This includes understanding the principles, indications and contraindications, risks, cost, and utility of the procedures.

MK3: Scholarship

• Possess a level of skill and expertise in clinical and/or basic research defined as competence in understanding the quality of experimental and clinical trial design, implementation, data analysis, and interpretation of research studies. This includes research methodology, critical interpretation of data and of published research, and responsible use of informed consent.

SBP 1: Works effectively within an interprofessional team.

• Facilitates the learning of patients, families, and members of the interprofessional team.

SBP 2: Recognizes system errors and advocates for system improvement.

• Demonstrates competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, during health and all stages of illness, including their cost-effectiveness.
• Demonstrates an awareness of the larger content and system on health care delivery and the ability to effectively call on system resources to provide safe and quality care.
• Enhance and promote patient safety and the quality of health care at both the individual and system levels.

SBP 3: Identifies the forces that impact the cost of health care, and advocates for and practices cost-effective care.

• Shows increasing appreciation and understanding of cost-effectiveness in patient care and resource utilization.
• Demonstrates an understanding of managed care, federal versus private insurers, and the social consequences of the uninsured.
• Contributes to the fiscally sound and ethical management of a practice.

SBP 4: Transitions patients effectively within and across health delivery systems.

• Effectively communicates and manages the transition of care with other healthcare providers.

PBLI 1: Monitors practice with a goal for improvement.

• Systematically analyzes their practice using quality improvement methods and implements changes with the goals for improvement.
• Initiates their own self-review in the quality of the work that they do, including evaluating patient care experiences as well as the progressive acquisition of specialty knowledge.
• Engages in lifelong learning.

PBLI 2: Learns and Improves via performance audit.

• Understands the limits of their knowledge and experience and asks for help when needed. Self-improvement comes from: regular assessments of all competencies; setting learning and improvement goals; identifying and performing appropriate learning activities; and receiving balanced and honest feedback from the fellowship program.

PBLI 3: Learns and improves via feedback.

• Continues to improve in their ability to receive feedback in identifying strengths and deficiencies. They use this knowledge to translate into better patient care.

PBLI 4: Learns and improves at the point of care.

• Demonstrates competence in information technology and the ability to find answers to clinical questions that are asked. As fellow progresses through their training, there should be increasing evidence that scientific literature is being used to guide clinical decision-making.
• Participate in the education of patients, families, students, fellows, and other health professionals.

ICS 1: Communicates effectively with patients and caregivers.

• Development of excellent oral, written, and electronic communication skills with patients, peers, and paramedical personnel across a broad range of socioeconomic and cultural backgrounds.
• Obtain procedure-specific informed consent by competently educating patients about the rationale, technique, and complications of procedures.

ICS 2: Communicates effectively in interprofessional teams.

• Consistently and actively engages in collaborative communications with all team members and leaders.

ICS 3: Appropriate utilization and completion of health records.

• Maintains comprehensive, timely, and legible medical records and communicates clinical reasoning.

Prof 1: Has professional and respectful interactions with patients, caregivers, and members of interprofessional teams.

• Develops qualities of professionalism and humanistic skills, including integrity, compassion and respect for patients, peers, and paramedical personnel.

Prof 2: Accepts responsibility and follows through on tasks.

• Are responsive to patient needs that supersede self-interest, respect patient privacy and autonomy, accountable to patients, society, and the profession.

Prof 3: Responds to each patient’s unique characteristics and needs.

• Sensitive and responsive to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

Prof 4: Exhibits integrity and ethical behavior in professional conduct.

The program enables the trainee with the skill set to acquire, critically analyze, synthesize, and reassess their knowledge, skills and professionalism. This is achieved through the development of independent study habits for acquiring clinical and research knowledge and skills, and attendance, presentation, and participation in the organization of local, regional and national educational and scientific conferences.

Fellows are strongly encouraged to become members of the American College of Rheumatology and the American College of Physicians. Their participation in the CME activities of these organizations is important to promote their standards of professionalism and the process of life-long learning. The department of medicine will pay for one membership in a major subspecialty society per fellow.

All fellows will be assigned a faculty mentor who will support them in their clinical and scholarly activity. The mentor will work with the fellow in helping to guide them in their research and case study reports by helping them identify cases, collect data, and point out significant findings. At the beginning of the academic year, the fellow is assigned to the preceptor of their continuity clinic as their mentor. The assignment can change based upon the availability of the faculty member.

Note writing is essential in the comprehension and the development of critical thinking skills for the fellows. The fellows' notes will be monitored closely by the attending and encouraged to use note writing in practice and or develop their own style of which does not include copying and pasting. All fellows will be required to sign an attestation stating that they have read and understood the institution’s policy on copying and pasting EMR notes.

Each fellow will perform a monthly clinical case study. The fellows can choose the topic and patient for the study and the attending that they will present to. The presentation will occur either at the Friday Didactic sessions or independently with the attending, and the fellow can use write it in EPIC. The clinical case study will include differential diagnosis, diagnostics, and clinical research. The fellows will be required to track their cases and/or report them to the fellowship coordinator.

The program provides an environment for promoting active teaching of medical students, residents, and other allied health personnel, as well as education of patients by the fellows. Fellows receive instruction and feedback in counseling and communication techniques. This includes cultural, social, behavioral, and economic issues such as confidentiality of information and indications for life-support systems. Fellows learn about cultural, social, and other issues by their clinical inpatients and outpatient experience under the close supervision and teaching of the Attending. These topics are also discussed during clinical management of the patients by the Attending and in conferences.

Fellows are responsible for teaching and supervising medical students and internal and PM&R residents while on the Inpatient Consult Rotation, in conjunction with the attending. They have a lesser role in outpatient teaching, as this is handled almost exclusively by the attending. The fellows have a major role in teaching and supervising the other trainees to prepare topics for the various conferences, particularly the weekly Rheumatology Grand Rounds. Fellows are strongly encouraged by the attending to develop effective teaching and communication skills.