Clinical competence in Rheumatology includes the following elements:
- American College of Rheumatology acquisition of the clinical skills of data collection including history-taking, physical examination, techniques of joint aspiration and soft tissue injection, and the appropriate use of laboratory and imaging studies.
This is achieved through precepted patient care in the inpatient and outpatient settings, didactic lectures, case presentations, journal clubs and formal teaching rounds. The ACR reading list consisting of a series of key journal articles covering most of the topics listed in the ACR curriculum is distributed to fellows to utilize as a primary reference resource. This is supplemented by the journals, reprint and slide collections available to the fellows in the rheumatology offices on each campus.
In addition, a course in epidemiology, statistics and ethics for all medicine residents and sub-specialty fellows is currently being given yearly.
- The ability to formulate appropriate differential diagnoses and therapeutic plans based on a critical analysis of the clinical data and integration of this analysis with the basic fund of medical knowledge.
This is achieved in the patient care setting by interaction with the attending staff and is supplemented by didactic lectures from and interdisciplinary conferences with members of other divisions as described below.
- The ability to perform as a consultant or a health-care team leader.
This is achieved by the fellow serving as a teacher and role model for internal medicine and primary care residents and for medical students, and includes delivery of didactic lectures as well as informal teaching in inpatient and outpatient setting. There is graded increase of responsibility through the course of the training program, with the fellows acting in attending capacity with the help of a designated faculty mentor in the last three months of the fellowship.
- The knowledge required to treat the common and uncommon diseases found in the practice of rheumatology, based on understanding of the principles, indications, contra-indications, risk, cost and expected outcome of the various possible treatments. The ability to recognize the need for appropriate consultation and the reasonable expectations from a consultant.
- Experience in the performance and/or interpretation of diagnostic and therapeutic procedures common in the practice of rheumatology. This skill should include the understanding of the principles, indications, contraindications, risk, cost and expected outcome of the procedures.
- Possession of the appropriate communication skills with patients, peer and paramedical personnel.
- Highly developed qualities of professionalism and humanistic skills including integrity, compassion, and respect for patients, peers and paramedical personnel.
These qualities are observed and evaluated in the patient care setting, in journal clubs, and in academic lectures to lay groups including senior citizen and Lupus Foundation meetings.
- The ability to critically evaluate published research reports. Fellows are trained in the understanding of the design, implementation and interpretation of research studies, specifically including research methodology, critical interpretation of data, critical interpretation of published research, and the responsibility for informed subject consent.
This is implemented through journal club discussions and by involvement in clinical research projects, in particular through the participation in recruitment of patients to clinical trials during the fellowship years. In addition, the second year of the training program is largely devoted to a clinical or basic research project intended to provide the fellow with an opportunity to explore a particular area of clinical or basic scientific interest in depth under the close supervision of a full-time faculty member.
At the end of our program our fellows should be prepared to serve in a variety of clinical roles including:
- As the primary health care provider in the acute inpatient setting, the ambulatory clinic, the emergency department, and the intensive care unit.
- As the consultant to other internists or non-internists in the acute inpatient setting, the ambulatory clinic, the emergency department, and the intensive care setting.
- As a participant in a multidisciplinary health care team.
- As the director of a clinical immunolgy laboratory In addition, some of our fellows will be prepared to pursue investigative careers in rheumatology
Life-long learning is an essential attribute of the clinically competent physicians and required for the acquisition, critical analysis, synthesis and reassessment of knowledge, skills and professionalism. Life-long learning requires:
- Independent study habits in the acquisition of clinical and research knowledge and skills.
- Attendance, presentation and participation in local educational conferences and professional organizations.
- Attendance and presentation at regional and national scientific conferences.
Life-long learning is encouraged by the expectation that the fellows research their own cases and present their findings to the attending of the month, by their presentation of topic reviews and by attendance at the NYU review course and the ACR meeting as well as at local New York Rheumatism Association meetings. Fellows are strongly encouraged to present their work at local forums; many present at the national meeting and publish their work in the rheumatologic literature.
The Rheumatologist should serve as an educational resource in their specialty for the rest of the medical community and the general public. Our fellows gain experience in this as they supervise and teach medical residents and medical students during their elective periods in the rheumatology service, in writing comprehensive consultation notes and in periodic lectures to lay groups through the Arthritis Foundation and the Lupus Foundation.