MEDU-4014 - Clinical Rheumatology

MEDU-4014 - Clinical Rheumatology

Elective Title: Clinical Rheumatology
Course Number: MEDU-4014
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: n/a
Responsible Faculty Director: Vijaya Murthy, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Victoria Garcia & Kiki Baldwin Other Faculty: Vijaya Murthy, M.D., Raymond Pertusi, M.D.
Location to Report on First Day:
Contact Dr. Murthy or the rheumatology fellow assigned to the consult service

The student will participate under the guidance of Rheumatology faculty and fellows in learning to collect historical information and perform a relevant physical examination with respect to a variety of rheumatic diseases. Attention will be given toward appropriate differential diagnosis, therapy and follow-up of these cases. The student will become familiar with the application of immunological principles to rheumatic diseases, the use of radiology and histopathology as it relates to the rheumatic diseases, and the selection of appropriate therapies, including oral DMARDS and the newer biological agents currently used in the treatment of rheumatoid arthritis, for example.

At the completion of a 4-week elective, the student should be able to:
1. Obtain a meaningful history from patients with rheumatic diseases, perform a relevant physical examination with awareness of findings characteristic of rheumatic diseases, and be able to concisely reduce the information from the history and physical examination into a brief but relevant verbal presentation.
2. Be able to formulate a plan for working through the differential diagnosis of possible rheumatologic disorders in a given case in a cost-effective manner.
3. In the more common rheumatologic disorders, understand the pathophysiologic mechanisms and therapeutic approaches currently in use.
4. Become proficient in specialized rheumatologic evaluations such as muscle testing, range of motion evaluation, and biomechanical aspects of the musculoskeletal system.
5. Understand the pharmacology and clinical use of cortiocosteriods, nonsteroidal anti-inflammatory agents, immunosuppressive agents, and other immunoreactive agents used in rheumatologic disorders.
6. Understand the usefulness and limitations of such tests as antinuclear antibody testing, tests for specific autoantibodies, quantitative immunoglobulins, serum complement levels, T and B cell analyses and other relevant immunologic tests as they apply to the rheumatic diseases.
7. Become proficient in distinguishing systemic lupus erythematosus from mixed connective tissue disease, rheumatoid arthritis, progressive systemic sclerosis, polymyositis-dermatomyositis, and other connective tissue disorders.
8. Become proficient in the differential diagnosis of osteoarthritis, rheumatoid arthritis, crystal-associated arthritis, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, infectious arthritis, and other arthritises.
9. Become acquainted with the major sources of information in rheumatology with respect to current textbooks and journals.
10. Learn the role of HLA typing in immunogenetic associations in the rheumatologic diseases.
11. Become acquainted with ongoing major research endeavors within the Division of Rheumatology for future reference and possible participation.

Description of course activities
In general, the major activities of this course will revolve around five one-half day clinics and formal presentation sessions for inpatient consultations. Students will be expected to participate in the initial encounters with both inpatients and outpatients, often in concert with the house staff and fellows. Students will be given the opportunity to perform technical procedures where indicated and are expected to participate in a day-in and day-out fashion in the consultative activities of the Division. Organized faculty lectures for the students and house staff will be presented weekly. In addition, there are special research seminars, clinical case conferences with pathophysiologic correlations, x-ray conferences, and a journal club scheduled weekly which students are expected to attend.

Type of students who would benefit from the course
Students interested in internal medicine, orthopedic Surgery, family medicine, dermatology, nephrology, ophthalmology, etc. The primary care specialties and several subspecialties all deal with a large number of patients with chronic and acute rheumatic diseases. Because of the relationships with other organ systems, the rotation will prove of value to people interested in all the above-mentioned subspecialties, including neurology and physical medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Consult Rounds VLTC Clinic
Tuesday VLTC clinic - Noon teaching conference Consult Rounds
Wednesday TDC Clinic - Noon teaching conference Consult Rounds
Thursday PCP Rheumatology Clinic - Medical grand rounds Consult Rounds
Friday PCP Rheumatology Clinic Radiology conference - Consult Rounds
Saturday Unassigned Unassigned
Sunday Unassigned Unassigned

 Average number of patients seen per week: 18-22
 Call Schedule: NA

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty and fellows in training
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Faculty will discuss desired format at the start of rotation.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Student expected to write H&P's on their patients, present an article in Journal Club or review an assigned topic at the request of faculty,
  B. Format - What guidelines are set for the student's written work?
    Standard History & Physical Write up & Clinic notes.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to cases and student selected
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Journal Club; Weekly conference discussion; Consult Rounds; oral presentation of cases, ability to answer questions directed at them by faculty, degree of participation in weekly activities, etc,

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Evaluation will be primarily through direct interaction with responsible faculty. Interviews will be informal and individually oriented. Periodic case presentations will be critiqued by the faculty and house staff in a constructive fashion. A formal critique of the student's performance on the rotation will be given in confidence on the last day of the rotation.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.