Residents and Students,

Welcome to Rheumatology! We are glad you have chosen us for an elective or have been assigned to us. To orient you to this rotation see the following information.

NATURE OF THE ROTATION: Rheumatology is an outpatient elective. There is an inpatient consult service run by the fellows and you are invited to participate. A pediatric outpatient experience is available as well, for those interested, upon request. There are no clinics on Thursdays for trainees, instead this is an education day covering rheumatology MKSAP, located at HB2034 (students) and the VA (residents) starting at 8AM. Wednesday afternoon is our academic conference, located at 5080 or on Microsoft Teams starting at 1PM.

IM RESIDENTS PLEASE NOTE: WHENEVER THERE IS A VA CLINIC FOR RHEUMATOLOGY OCCURRING, YOU SHOULD BE THERE!If you have a sick day, please let the Medicine office and Alexzondria at our office know.

CLINICS: (2nd floor MOB in MED II for AU clinics and 4th floor (4D) for VA clinics)DAY OF THE WEEK TIME

MONDAY AMVAMC 4-D 8:00 AM – 12:00 PM Laura Carbone, MD

(Residents report here)

MONDAY AMAU-MOB 2nd floor 8:00 AM – 12:00 PM

Alyce Oliver, MDOmar Tolaymat, MD(Students report here)

MONDAY PMAU-MOB 2nd floor 12:00 PM-5:00 PM

Alyce Oliver, MDOmar Tolaymat, MD(Residents and students, report here)

TUESDAY AMAU-MOB 2nd floor 8:00 AM – 12:00 PM Sandeepkumar Gupta, MD

(Residents and students report here)TUESDAY PMVAMC 4-D 1:00 PM –5:00 PM Alyce Oliver, MD

(Residents report here)

WEDNESDAY AMAU-MOB 2nd floor 8:00 AM – 12:00 PM

Omar Tolaymat, MDSandeepkumar Gupta, MD(Residents and students report here)

WEDNESDAY PM AU-BI 5080 or Microsoft teams 1:00 PM-4:00 PM Rheumatology Conference

(Residents and students report here)THURSDAY AM/PM

Time Location8am-4pm HB2034

(Students report here)VA Room(Residents report here)

4pm-5pm HB2039(Residents and students report here)

8:00 AM-5:00 PMRheumatology Education & Review with Laura Carbone, MD(Residents and students report here)

FRIDAY AMAU-MOB 2nd Floor 8:00 AM – 12:00 PM Omar Tolaymat, MD

(Students report here)

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FRIDAY AMAU-MOB 2nd Floor 8:00 AM – 12:00 PM Sandeep Gupta, MD (LUPUS CLINIC)

(Residents report here)Friday AM (4th Friday of the month) Uveitis Clinic2nd floor of hospital

8:00 AM – 12:00 PMAlyce Oliver, MD(Students report here)

Friday PMAU-MOB 2nd floor 1:00-5:00 PM Hong Shi, MD

(Students report here)

Friday PMVAMC 2B107 1:00-5:00 PM Rheumatology Didactics

(Residents report here)

All AU residents on rotation are expected to be at the VA when available for clinics unless told otherwise

FACULTY: Drs. Laura Carbone, Walter Moore, Alyce Oliver, Omar Tolaymat, Hong Shi, and Sandeepkumar Gupta

FELLOWS: - Senior Fellows: Drs. Rachel Elam and Christopher Rice- Junior Fellows: Drs. Adam Meszaros and Irina Madera

FACULTY SUPPORT STAFF: Ms. Alexzondria Montgomery, Assistant 1, Fellowship Program Coordinator. Academic office phone number: 1-2981

CLINIC SUPPORT STAFF: Amy Perrine RN. Clinic phone numbers: Front Desk 1- 1477, Rheumatology Workroom 1-1401 and 1-1403

EXPECTATIONS: (Also, see and read the Goals and Objectives for the Internal Medicine Residency Curriculum at the end of this PDF)

1. Professionalism: Be in clinic on time. If you are going to be late or absent, students, please notify Liz Jones in the Clerkship Office (1-2055). Residents, please contact Michelle Torres (1-2423) in the Housestaff Office and Alex Montgomery (1-2981) in the Rheumatology Office, or one of the faculty

2. Patient Care, Practice-Based Learning and Improvement, Systems Based Practice, and Communication Skills: Provide pertinent patient presentations. The nature of outpatient medicine does not always afford the luxury of lengthy patient encounters and thus not every patient encounter you have while in Rheumatology will result in as comprehensive a presentation as inpatient medicine. This does not mean that your presentations are not to be pertinent to the chief complaint or reason for follow up. Before you enter a patient’s room to begin your encounter, review the EHR (Powerchart or CPRS) and determine what occurred at the time of the last outpatient visit, including tests and therapeutic interventions, and discuss with the patient the result of such interventions, along with exploring any new concerns. When presenting to an attending or fellow, be prepared. One should know the reason for follow up, results of tests and interventions and have explored the chief complaint. For patients new to the clinic, a full History

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and Physical will be conducted and results presented. Following the clinic visit, a complete note will be generated in the EHR and forwarded to the appropriate attending for review

3. Medical Knowledge: Read. You are expected to spend time reading about the cases you encountered during clinic. Reading and studying materials can be found under education resources below. You should also read MKSAP rheumatology section.

4. Med 5077: Senior students on outpatient medicine ½ day per week often ask how we decide whether they are meeting or exceeding expectations (B versus A level performance) when completing their clinic evaluation form. Unfortunately, assignment of a particular grade can be rather subjective. To assist the senior student in achieving as high a grade as possible during the ½ day with us we have elaborated, in addition to what is already on the Med 5077 evaluation form, the following expectations in each of the four competencies that we feel differentiates the A from the B performance

a. Patient care: the student performing at an A level will have performed a complete (pertinent to the problem requiring referral) history and physical exam with a complete medication list (name, does and frequency) on all new patients and will have reviewed the record and know all labs, imaging results and medications germane to the previous and current visits on all returning patients.

b. Medical Knowledge: knowing the answer to basic questions regarding rheumatology and its more common diseases and showing evidence that the senior student is reading in the area of rheumatology prior to and during clinic will constitute an A level performance.

c. Professionalism: coming to clinic on time and showing an interest in learning as well as showing respect to your patients, peers and faculty on a consistent basis constitutes an A level performance.

d. Communication Skills: in addition to what is already listed on the Med 5077 evaluation form, it is expected that the A level student will consistently have an organized and accurate presentation and will be able to articulate a reasonable assessment and plan for each of their patients.

LEARNING OBJECTIVES:

During your time on Rheumatology Elective, you will see many examples of the most common rheumatic diseases seen in the private practice of rheumatology as well as examples of less frequently seen diseases, unique to a tertiary care center. It is expected that you will develop a working knowledge of the classic presentations of the most common rheumatic diseases and a passing familiarity with the less common ones. This includes understanding the appropriate use of immunologic labs such as ANA, anti-CCP Ab, RF, ANCA, etc. (See and read the attached PDF below on the approach to MSK disorders and indications for testing). Examples of diseases you can expect to see include but are not limited to osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, osteoporosis, sjogren’s syndrome and systemic sclerosis. In addition, you will see plenty of the common pain syndromes including fibromyalgia and chronic low back pain. Additionally, there will be the opportunity to learn to assist in procedures such as arthrocentesis.

EDUCATIONAL RESOURCES:

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In the rheumatology office, you will find a copy of Kelly’s Textbook of Rheumatology and Klippel’s Primer on the Rheumatic Diseases. A collection of rheumatology case studies is available online through the American College of Rheumatology at www.rheumatology.org/education/training/Rheum2Learn.asp. Follow the link for professional education to online curriculum cases. Additionally, similar cases in print form (CARE, MKSAP, PowerPoint presentations) may be utilized and are located in the Rheumatology offices.

RHEUMATOLOGY FELLOWSHIP OPPORTUNITIES:

Inquiries to applying for and completing a rheumatology fellowship at AU can be made to Dr. Carbone Program Director for Fellowship or to any one of the rheumatology faculty members.

(Right click, Document acrobat objects)

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drug therapy.pdf

Rheum handout.pdf