MEDU-4046 - Clinical Rheumatology - Year 3

MEDU-4046 - Clinical Rheumatology - Year 3

Elective Title: Clinical Rheumatology - Year 3
Course Number: MEDU-4046
Elective Type: clinical Duration/Weeks: 2 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Vijaya Murthy, M.D. Periods Offered: 1AB-7AB, 9AB-13AB excluding holiday period 8 
Coordinator: Kiki Baldwin Other Faculty: Dr. Raymond Pertusi
Location to Report on First Day:
Contact Dr. Murthy or the rheumatology fellows assigned to the consult service

At the completion of the rheumatology rotation, the student should have a good working knowledge about the following specific objectives as they pertain to each of the specific goals of the curriculum:

1. Clinical competence in a variety of clinical settings:
a. All students should be familiar with those specific clinical objectives for the basic diseases seen in the practice of rheumatology.
b. Demonstrate familiarity and basic knowledge as a consultant.
c. Possess communication skills that will allow the student to interact with peers and professionals.
d. Qualities of professionalism and humanistic skills will be demonstrated as is appropriate for patient care.
2. Lifelong learning:
a. Students will demonstrate proficiency at attending and participating in conferences.
b. Students will demonstrate that they are reading the medical literature as pertains to their patients. This will include participating in discussions about patient care; participating in the rheumatology journal club; & providing pertinent review articles regarding patients on the consult service.

How to appropriately order IMMUNOLOGIC TESTS
1. Understand the appropriate use of immunologic tests
2. understand the clinical utility of specific immunologic tests

Description of course activities
In order to achieve the goals and objectives for the rotation a number of experiences are available to the students. These include: A) The inpatient rheumatology consultation experience where the student will see patients on the inpatient consultation service. This will be supervised by both the rheumatology fellow and attending physician. They will also be responsible for follow up of these patients during their hospitalization. Essential in this role of consultant is the development and refinement of 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. Essential in this rotation will be developing skills in providing consultation services, to include communicating with the referring physicians and ensuring support for continuing care of the patients' rheumatic condition. A student will be called upon to perform literature research on topics appropriate to the case at hand. Through this experience the student will also develop a comprehensive understanding of the indications, contraindications, techniques, complications of arthrocentesis as well as the interpretation of results from this procedure. Faculty supervision is required in developing these skills. B) The ambulatory rheumatology experience where all students will be required to attend the general rheumatology clinics in the Primary Care Pavilion (PCP), the Victory Lakes Town Center (VLTC) clinics, and in the TDCJ. Dedicated attending faculty members will appropriately supervise this experience. The goal of this experience will be for the student to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions. A student may also have the opportunity to observe a faculty member in clinic to obtain additional experience. C) Didactic Conferences which are held on a regularly scheduled basis with attendance required of all students. These conferences will include the weekly teaching conferecnes, journal club sessions, radiology conference & clinical rheumatology conference. In the journal club, the student may be required to present recent articles on rheumatology for discussion and critical review. In the radiology conference, all x-rays obtained in the previous week will be reviewed with a faculty radiologist. In the clinical rheumatology conference, the faculty or rheumatology fellow will discuss a specific rheumatologic disease topic. The faculty on the consultation service will also hold non-scheduled didactic teaching sessions to cover additional topics that arise from the patients on the service. D) Rheumatology Core Curriculum & Recommended Reading is in addition to participating in the organized didactic conferences established. This is a series of self-study clinical cases developed by the American College of Rheumatology to illustrate diseases and clinical problems in rheumatology. Each case has a clinical presentation; questions regarding the case and detailed discussion of the case and answers for each problem. The ACR Core Curriculum is available for viewing by slideshow in the Rheumatology Division area, with access to the ACR website, It is encouraged that all students complete as many cases as possible during the rotation. All students are also asked to read the chapters on Rheumatology topics in their Internal Medicine textbook of choice during the rotation.

1. How to diagnose and manage a patient with ARTHRITIS and rheumatic diseases
2. Be able to describe the clinical presentation, pathophysiology and diagnosis of osteoarthritis, rheumatoid arthritis, systemic lupus, other autoimmune disorders, gout, and infectious arthritis
3. Be able to discuss how to evaluate patients with musculoskeletal complaints
4. Be able to describe basic treatment regimens for the above diseases
5. Be able to describe the clinical presentation, pathophysiology and diagnosis of gout versus pseudogout
6. Be able to describe basic treatment regimens for the above diseases
7. Recognize the clinical features and complications of systemic lupus erythematosus, scleroderma, MCTD, polymyositis/dermatomyositis, Sjogren's syndrome, the vasculitis, etc.

Type of students who would benefit from the course
This rotation is especially useful for individuals tending toward specialization in Internal Medicine, Orthopedic Surgery or Family Medicine. The primary care specialties all deal with a large number of patients with chronic and acute musculoskeletal. In addition, because of the relationships with other organ systems, the rotation will also prove of value to people interested in subspecialties such as Ophthalmology, Dermatology, Neurology and Physical Medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8 - 12 Consult Rounds 1 - 5 VLTC clinic
Tuesday 8 - 12 VLTC Clinic 1 - 5 12:00 Rheumatology Grand Rounds - Consult r
Wednesday 8 - 12 TDC clinic - Noon teaching conference 1 - 5 Consult Rounds
Thursday 8 - 12 PCP Rheumatology Clinic - Medical Grand Ro 1 - 5 Consult Rounds
Friday 8 - 12 PCP Rheum. Clinic 1 - 5 Radiology Conf. - Consult Rounds
Saturday Unassigned Unassigned
Sunday Unassigned Unassigned

 Average number of patients seen per week: 18-25
 Call Schedule: No night call

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Other Students normal do not participate in research in one month elective - However, this is available to interested candidates including lab experience

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 & Rheumatology Fellows
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Students present patient visits and consults to Faculty in standard format. Students should actively participate in inpatient consult rounds as well, where they are expected to verbally present the case to our consult team, including the attending faculty.
  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)?
    H & Ps and consult notes written by students are reviewed by the faculty.
  B. Format - What guidelines are set for the student's written work?
    Standard format for hospital or 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?
    Not needed
  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)?
    The student is expected to see patients daily in the assigned clinics and on the Consult Service. The Student is expected to attend Rheumatology Journal Club, Radiology Conference, & the Weekly clinical Rheumatology Teaching Conferences. The student is expected to review pertinent rheumatology literature when so assigned by the faculty. The student may be asked to present a journal club session of a given topic or article.

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.
    Formal formative evaluations will occur at the completion of the rotation. The forms used for evaluation of the students are those provided by the Internal Medicine Program for an elective rotation. For the clinical rotation, the supervising faculty member will complete an evaluation form. All completed evaluation forms are returned to the Office of Student Affairs for review and placement in individual's permanent file. The student should receive verbal feedback on their performance from the supervising faculty.

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.