Rheumatology Hybrid

This rotation will take place in various outpatient clinics and/or rheumatology inpatient consult services. Residents will interact with both fellows and attendings. Making use of these settings has afforded us the opportunity to expose house staff to diverse patient populations, pathologies, diagnostic and interventional modalities, and practice settings.

Residents will participate in attending rounds and small group lectures/discussions. The rotation will provide either an inpatient component or an ambulatory component. All aspects of rheumatology will be covered including but not limited to collagen vascular disease, immunosuppressive therapy, and autoimmune disease. The rotation can be repeated for residents who want an enhanced rheumatology exposure.

This rotation is a one to four (4) week structured clinical experience under direct supervision designed to provide the resident experience diagnosing, treating and caring for patients with rheumatologic and endocrine disorders. There is no call or weekend duty on this rotation.

Subspecialty Consults and Clinics Expectations

Goals and Objectives for Rheumatology Inpatient

Develop an understanding of the rheumatology disorders seen in hospitalized patients

PGY-1: Understand the basic principles of assessing and managing common presentations of rheumatology and endocrine in hospitalized patients.

PGY-2: Understand the principles of assessing and managing both common and complex presentations of rheumatology and endocrinology disorders in hospitalized patients

PGY-3: Develop advanced processes to recognize and treat complications of rheumatologic disorders and complications of endocrine disorders in hospitalized patients with multiple medical problems

Competency: Patient care, Medical knowledge

Developing diagnosis skills

PGY-1: Learn how to use the bedside clinical examination in patients with common rheumatology and endocrine disorders

PGY-2: Effectively use the bedside clinical examination and demonstrate subtle clinical findings in patients with rheumatology and endocrine disorders

PGY-3: Learn how to correlate bedside clinical findings with imaging and other data in patients with rheumatology and endocrine disorders

Competency: Patient care, Medical knowledge

Understand the differential diagnosis of common rheumatologic and endocrine disorders

PGY-1: Develop a basic differential diagnosis for common clinical scenarios in patients with suspected rheumatologic and endocrine disorders

PGY-2: Develop a differential diagnosis for common clinical scenarios in patients with rheumatologic and endocrine disorders

PGY-3: Recognize unusual presentations of common clinical situations in patients with rheumatologic and endocrine disorders

Competency: Medical knowledge

Learn pharmacological management of common rheumatologic and endocrine disorders

PGY-1: Learn the common medications utilized for the management of rheumatology and endocrine disorders

PGY-2: Learn the medications used in management of rheumatologic and endocrine diseases, understand how to manage complicated clinical problems, and develop specific therapeutic strategies in patients with rheumatologic and endocrine diseases

PGY-3: Learn how to develop personalized care plans for patients with rheumatologic and endocrine diseases and intersecting clinical problems

Competency: Medical knowledge

Effectively consult on inpatients, develop, and execute assessment and management plans.

PGY-1: Learn the steps required to be an effective rheumatology and endocrinology consultant.

PGY-2: Learn to be effective rheumatology and endocrinology consultants. Recognize how to prioritize patient problems. Develop management plans for inpatients with rheumatologic and endocrine diseases.

PGY-3: Understand interactions between patient rheumatology and endocrine disorders and other medical issues and develop advanced strategies to prioritize management

Competency: Patient care

Effectively executes day-to-day management of patients

PGY-1: Learn to manage patients with rheumatologic and endocrine diseases on a daily basis including a daily assessment and determining progress in clinical problems

PGY-2: Understand how to adjust patient treatment plans based on patient progress and determine the need for additional assistance such as subspecialty consultation

PGY-3: Recognize how to manage complex rheumatologic and endocrine diseases and manage both expected and unexpected complications.

Competency: Patient care

Interdisciplinary care and discharge planning

PGY-1: Learn how to communicate effectively with the interdisciplinary care team and anticipate patient needs for discharge and effective follow-up

PGY-2: Recognize the unique needs of patients with rheumatologic and endocrine disorders and help integrate patient needs with available resources

PGY-3: Learn how to manage advanced situations such as complex transitions of care and advocate for patients when resources are limited

Competency: Patient care, System-based practice

Rational ordering of lab tests and imaging studies

PGY-1: Learn the indications for basic laboratory investigations and imaging in patients with rheumatologic and endocrine diseases

PGY-2: Learn how to interpret laboratory findings and imaging seen in patients with rheumatologic and endocrine diseases

PGY-3: Gain advanced knowledge of high value principles in the ordering of laboratory studies and imaging for evaluation of rheumatologic and endocrine disorders

Competency: Practice-based learning and improvement, Medical knowledge

Familiarity with the electronic health record and optimization of its use

PGY-1: Develop a basic understanding of The EHR and its core components and how it can be used to care for patients with rheumatologic and endocrine disorders

PGY-2: Understand how to effectively use the electronic health record in the care of patients with rheumatologic and endocrine disorders

PGY-3: Develop an understanding of advanced medical informatics in the care of patients with rheumatologic and endocrine diseases by utilizing additional resources in the EHR

Competency: Systems-based practice

Communication and teamwork

PGY-1: Recognize the core members of the patient care team involved in care of patients with infectious diseases, to include nurses, patient technicians, pharmacists, case managers, social workers, and hospital administration personnel

PGY-2: Develop effective and timely communication strategies with the interdisciplinary care team for patients with rheumatologic and endocrine diseases

PGY-3: Use advanced communication methods to engage and coordinate care with the interdisciplinary care team for patients with rheumatologic and endocrine diseases

Competency: Professionalism, Interpersonal and communication skills

Goals and Objectives for Rheum Outpatient

Assess acute and chronic rheumatologic and endocrine diseases in the outpatient setting

PGY-1: Learn the initial assessment of acute and chronic rheumatologic and endocrine diseases in the outpatient setting

PGY-2: Learn to assess acute and chronic rheumatologic and endocrine disorders and develop an advanced understanding of these disorders in the outpatient setting

PGY-3: Understand the intersections between acute and chronic rheumatologic and endocrine diseases and subtle variations in presentation

Competency: patient care, medical knowledge

Understand the principles of chronic rheumatologic and endocrine disease management

PGY-1: Learn the principles of management for rheumatology and endocrine disorders, including the development of problem lists and preventive care principles

PGY-2: Understand the principles of chronic management of rheumatology and endocrine disorders, including problem lists and preventive care, and factors that create competing priorities with chronic rheumatologic and endocrine diseases.

PGY-3: Develop and utilize advanced care processes including consultation and interdisciplinary management of chronic rheumatologic and endocrine diseases

Competency: Patient care

Learn pharmacological management of common rheumatologic and endocrine diseases

PGY-1: Learn the common medications utilized for the management of rheumatology and endocrine disorders.

PGY-2: Understand the medications used for rheumatologic and endocrine diseases and how to manage complicated health problems and develop specific therapeutic strategies

PGY-3: Learn how to develop personalized care plans for rheumatology and endocrinology patients with intersecting clinical problems

Competency: medical knowledge

Understand the differential diagnosis of common clinical rheumatologic and endocrinology disease scenarios

PGY-1: Develop a basic differential diagnosis for common rheumatology and endocrine clinical

PGY-2: Develop an expanded differential diagnosis for common rheumatologic and endocrine disease clinical scenarios

PGY-3: Recognize unusual presentations of common rheumatologic and endocrine disease clinical situations

Competency: medical knowledge

Develop and utilize patient dashboards to engage in population management

PGY-1: Learn how to interpret patient dashboards in the HER for outpatient with rheumatologic or endocrine disorders

PGY-2: Identify noncompliance or patients who are outliers in the patient dashboards

PGY-3: Develop advanced care plans with the interdisciplinary care team to manage patients with endocrine or rheumatology disorders not meeting parameters in the patient dashboards

Competency: Systems-based practice, Practice based learning and improvement

Understand the unique outpatient needs of rheumatology and endocrine patients

PGY-1: Recognize the unique outpatient needs of infectious disease patients

PGY-2: Recognize and understand the outpatient needs and community resources available to rheumatology and endocrinology patients

PGY-3: Learn how to work with an interdisciplinary care team to optimize the availability and utilization of community resources available to rheumatology and endocrinology patients

Competency: Patient care, systems-based practice

Parkland Rheumatology Consults

Parkland Rheumatology Consults

Location: New Parkland Hospital (NPH). No set rounding room, contact the fellow on call (via paging system)

Hours: Starts at 8 AM. Monday through Friday.

This rotation is in person. Please contact the Rheumatology consult fellow at 8am for instructions on new patients and staffing.

Service Description Team Composition: Attending staff, rheumatology fellow, 1 resident

Functions as a consultant service for inpatient services and the Emergency Department. The resident participates in the evaluation and management of inpatients requiring rheumatology consultation at Parkland Memorial Hospital Conference. During this rotation you are expected to attend both morning report (9 am - 10 am) and noon conference (12 pm - 1 pm).

CUH Rheumatology Consults

CUH Rheumatology Consults

Location: CUH. No assigned room for rheumatology service. Please page the on-call fellow on the morning of your first day.

Hours: 8:00 am to 5:00 pm weekdays.

Team composition: 1-2 residents, fellow, medical student and attending rheumatologist.

Functions as a consultant service for inpatient services and the Emergency Department.
The resident participates in the evaluation and management of inpatients rheumatology consultation at Clements University Hospital. This experience will teach the resident a wide variety of rheumatological disorders (identification of rash, MSK examination, Interpretation of antibodies and other serological work up).
Additional instructions for residents: Reading recommendations: SLE and vasculitis.

Resources

Rheumatology Hybrid

Parkland Rheumatology Consults

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