Welcome to your rotation in the Section of Rheumatology. We look forward to your participation in our clinical activities from _ _ _ _ _ _ _ _ _ _ . The faculty are enthusiastic and dedicated to your education. Drs. Sutej and O’Rourke will be your attendings during the month. In order to provide some structure to your experience, the following outline summarizes the goals of the rotation and your responsibilities.

1. effectively evaluate and treat (at a level appropriate for the general internist) patients with musculoskeletal syndromes and connective tissue diseases commonly seen in the outpatient setting;
2. identify those patients who would benefit from consultative care, including care from rheumatologists, surgeons, and physical and occupational therapists;
3. assess hospitalized patients with rheumatic disease and provide recommendations for preoperative care in the context of their underlying disease and antirheumatic medications.

2. Specific Learning Objectives

1. Rheumatology knowledge base: you should master the following content issues:
   
1. Musculoskeletal syndromes: differential diagnosis and approach to the patient with:
   
1. monoarticular complaints
2. polyarticular complaints
3. myalgias
4. low back pain
5. carpal tunnel syndrome
6. soft tissue rheumatism (including regional periarticular syndromes (e.g., bursitis, tendonitis) and fibromyalgia)

2. Connective tissue diseases: clinical findings (history, physical, lab) and treatment of:

1. common arthritides
   
   1. rheumatoid arthritis
   2. osteoarthritis
   3. spondyloarthropathies
   4. crystal-induced arthropathies

2. rheumatic diseases with multiple autoantibodies

1. systemic lupus erythematosus
2. inflammatory myopathies
3. systemic sclerosis and mixed connective tissue disease

3. vasculopathies

1. giant cell arteritis and polymyalgia rheumatica
2. differential diagnosis of vasculitis

2. Rheumatology practice skills: you should be able to perform the following skills:

1. Obtain a complete history and perform a thorough musculoskeletal examination on patients suspected of having a rheumatic disease
2. Appropriately order or perform commonly used diagnostic tests, and interpret laboratory data, including:
   
1. acute phase reactants
2. rheumatoid factor and autoantibodies
3. synovial fluid analysis, including polarized microscopy
4. imaging examinations, including plain radiographs and MR

3. Aspirate and/or inject the following:

1. joints: shoulder, elbow, wrist, knee, ankle, 1st MTP
2. soft tissue sites:

1. bursae: subacromial, olecranon, trochanteric, anserine
2. carpal tunnel

3. Attitudinal skills: the resident will be able to:

1. Define the practice of rheumatology as based on a unique core of knowledge and practice skills.
   
2. Understand that many of the rheumatic diseases develop over lengthy periods of time, and thus identify strategies for working with patients with incomplete or partially defined conditions.
   
3. Identify fibromyalgia as a unique syndrome with a defined set of signs, symptoms and treatment options.
   
4. Appreciate the chronic nature of many rheumatic diseases, and its impact on patient/family quality of life domains (e.g., work, leisure/social, psychologic, sexual).

3. Methodology to Achieve Objectives

1. Teaching methods

1. Patient care: The major venue for completing the above objectives will be in the outpatient rheumatology clinic, where you will be closely supervised in the evaluation and management of both new and returning patients by faculty rheumatologists. You are required to attend a minimum of four half-day clinics per week. Morning clinics, when assigned, start promptly at 7:45 (Mon, Fri) 8:30 (Wed) and 9:00 (Thu), afternoon clinics at 1:00. During the days of morning clinics, you should not go to Morning Report. You will be provided a schedule listing your clinic times and locations (WFUP clinic or CompRehab) for the month. In order to provide you with experience in the evaluation of rheumatic disease patients with urgent/emergent clinical problems, you will periodically evaluate such patients (new patients or patients known to our clinic) in the WFUP clinic outside of the normal Rheumatology clinic hours, under the supervision of your consult attending. These appointments will be made known to you by either the attending or our scheduler.
   
   You will also evaluate selected inpatients referred for rheumatology consultation. Opportunities for observation of physical and occupational therapists will be made available (at CompRehab).
   
2. Conferences: Attendance at regularly scheduled Sectional conferences is required. The general schedule is as follows:
   

3. Readings: The required text is the Primer on the Rheumatic Diseases, 11^th edition (1997), available in the Section for free. At a minimum you are responsible for reading those chapters that correspond to the topics in the Learning Objectives defined above. Adequate opportunities for learner-directed study will be made available during the rotation. Other optional readings include the Handbook of Rehabilitative Rheumatology, (available for $2.00), and the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism (free while supplies last).
   
4. Audio-visuals: A self-contained series of patient management problems with associated teaching slides is available for self-study in the Section in both hard copy and CD-ROM formats (the latter can be checked out from JoAnn Fahey).

1. Clinic and ward (consult) performance.
   
2. Case Conference (see above).
   
3. Evaluation form: A resident feedback form, to better assess the success in meeting the above objectives, is attached. Please complete this form and return to Dr. O’Rouke prior to finishing your rotation.

4. Rotation Logistics