Fellows assigned to inpatient rotations are responsible for the evaluation of inpatient and emergency room consultations and the continued follow up of these patients during their hospitalization. In this process they develop and refine clinical evaluation skills of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans.
In this rotation fellows also develop skills in providing consultation services, including communicating with patients and patients' families, the referring physicians and ensuring support for continuing care of the patient's rheumatic condition. Fellows are called upon to perform literature research on topics appropriate to the case at hand and they participate actively in the teaching activities of the consultation team. Through this experience the fellow will also develop a comprehensive understanding of the indications, contraindications, techniques, complications of arthrocentesis as well as the interpretation of results from this procedure. Fellows will also acquire the knowledge of and skill in educating patients about the procedure and in obtaining informed consent. Faculty supervision aids in developing these skills.
- East Campus (Jacobi Medical Center, Weiler Hospital)
The Jacobi Medical Center, formerly the Bronx Municipal Hospital Center, is owned and operated by the New York City Health and Hospitals Corporation. Jacobi has 775 acute patient beds, as well as an active Emergency Room and a large out-patient department.
The Division of Rheumatology provides consultative services in Rheumatology for in-patients hospitalized at Jacobi Medical Center and for patients referred by the Urgent Care Department. In general there are 4-6 consults each week. The Rheumatology fellow assigned to the East Campus is the primary consultant, under the supervision of a full time or voluntary faculty member in the Division of Rheumatology serving as Attending of the Month on a rotating basis. The Fellows are responsible for writing an initial complete consultation in the clinical record, discussing the patient with the appropriate house staff and attending physicians, ordering and evaluating diagnostic testing on these patients, following the patients as frequently as indicated, performing or supervising joint aspirations and synovial fluid analysis, and participating in discharge planning.
The Weiler Hospital is a 431 bed hospital owned by the College of Medicine and operated as a division of Montefiore Hospital and Medical Center. All in-patients have private attending physicians who are full-time or voluntary faculty members of the College of Medicine. All admissions and consultations of the full-time Division of Rheumatology faculty are seen first and followed by the Rheumatology Fellow assigned to the East Campus. Voluntary faculty members in the division regularly invite the fellow to see their hospitalized patients and discuss their management with them. In all, the fellow sees 2-4 new patients weekly at Weiler.
- West Campus (Montefiore Medical Center, North Central Bronx Hospital)
The Rheumatology fellow provides consultative services for all in-patients in the Moses Division of the Montefiore Medical Center which is a 745 bed full service hospital with 28000 admissions annually. The fellows consult on an average of 31 new patients each month and in addition they evaluate 20 patients per month in the Emergency Department. Patients are seen on all of the adult medical services and on the pediatric, surgical and psychiatric services. The duties of the fellows with respect to in-patients are identical to those performed on the East Campus as outlined above. On average there are 2-3 medical residents on this elective each month and for four months of each year there is a medical student as well.
Fellows receive teaching and supervision continually during their in-patient experience at the Moses Division of Montefiore Medical Center. The attending of the month makes rounds with the fellows and the house staff and students on elective two or three times a week when all new consults are presented, examined and discussed.
North Central Bronx Hospital is a municipal hospital serving the north Bronx, which is physically connected to Montefiore Medical Center. There is a small full time medical staff in medicine, including representatives of most subspecialties; the remaining subspecialties ones are covered by staff based at Montefiore. NCB currently has about 90 medical beds, including an ICU and stepdown unit. There is a small surgical unit, and active pediatric service, a busy OB/GYN service, including a high risk clinic, and an in-patient rehabilitation unit. The rheumatology fellow rotating on the west campus is responsible for in-patient consultations at NCB and for covering the NCB emergency room. In-patient consults are seen and followed by the fellow, generally with a resident on rotation. An attending for the East Campus supervises the patients at NCB.