Learning Objectives and Assessment Methodologies Combined Medicine-Pediatrics Rheumatology Elective Overview: Med-Peds PGY2 s, PGY3 s and PGY4 s can elect to spend one four-week rotation with the adult and pediatric rheumatology units. Residents will spend two half-days each week in the Pediatric Rheumatology Clinics, two half-days in the month in the allergy clinic, two halfdays per week in their own continuity clinic, and the remainder of the time in the adult rheumatology clinic. Supervision of the residents will be by full-time faculty in our division of Pediatric Rheumatology and Immunology and in the division of Allergy/Immunology and Rheumatology. Residents will preferentially perform initial evaluations of adult and pediatric patients presenting with undifferentiated musculoskeletal complaints. Optimally, the resident will perform the initial evaluation, and see the patient back in follow up as often as possible to follow the results of their diagnostic and therapeutic interventions. Each patient is presented to a Rheumatology attending who then sees the patient to verify history and physical findings. The Med-Peds resident and Rheumatology, Allergy, or Immunology attending together develop a diagnostic and therapeutic plan. The Med-Peds resident will be responsible for documenting the visits and for understanding the correspondence with the patients referring physicians. It is the mission of this elective to provide residents a solid foundation in rheumatology, allergy, and immunology. This will train them to be physicians who will approach the patient with musculoskeletal, allergic, and immunologic complaints in an organized, efficient and professional manner; who will continue life-long learning in the subspecialties of rheumatology, allergy, and immunology which will enhance their knowledge base; and will enhance their communication and interpersonal skills as they relate to the subspecialties. Principle Teaching/Learning Activities: The principle teaching and learning activity during the Med-Peds Rheumatology elective is direct patient care activity working one-on-one with the Rheumatology attending staff. Med-Peds residents are expected to perform the appropriate procedures on their patients under the supervision of the Rheumatology attending or credentialed Rheumatology fellows; these procedures may include: joint aspiration and injection, microscopic examination of joint fluid, manipulation and injection of soft tissue pathology, and allergy testing and injections. Once during their rotation, the Med-Peds resident will present a one-hour talk to the Rheumatology faculty and fellows during the weekly Rheumatology conference, and they will attend all principle teaching conferences within the Rheumatology division. Their principle site of activity will be the ambulatory clinics as described above, but inpatient consultations
may be an additional learning opportunity as long as they do not significantly interfere with the ambulatory clinic sessions. by Relevant Competency In the tables below, the principle educational goals for the Combined Med-Peds Rheumatology Rotation are listed for each of the six ACGME competencies. The second column of the table indicates the most relevant assessment methods used to ensure that each resident achieves the educational objectives of each goal. 1) Patient Care by Level Each resident will efficiently perform a detailed history and examination of the musculoskeletal and immune systems. Each resident will formulate an appropriate differential diagnosis and efficient plan for the initial evaluation and management of patients with musculoskeletal and allergy complaints. Each resident will list the indications, contra-indications, and perform competently the procedures of joint aspiration, joint injection, and synovial fluid analysis. Direct Faculty 2) Medical Knowledge Each resident will describe the diagnostic criteria and natural history of rheumatoid arthritis, osteoarthritis, crystal induced arthritis, systemic lupus erythematosus, seronetative spondyloarthropathies, fibromyalgia, septic arthritis, Dermatomyositis, Systemic Lupus Erythematous, Scleroderma/Morphea, Acute Rheumatic Fever, Patellofemoral Pain Syndrome, Hypermobility Syndrome, Kawasaki s Disease, Toxic Synovitis of the Hip, Henoch Schonlein Purpura, Mixed Connective Tissue/Undifferentiated Connective Tissue Disease, and Musculoskeletal Pain without Inflammation Each resident will be able to recite the indications and side effects of the commonly used agents such as NSAIDs, hydroxychloroquine, sulfasalazine, minocycline, Participation and Presentation at weekly Rheumatology conference Patient case log
methotrexate, azathioprine, cyclophosphamide, etanercept, infliximab, leflunomide, corticosteroids, colchicine, probenecid, allopurinol, inhaled steroids, immunotherapy, leukotriene inhibitors, antihistamines, H2 blockers, adalimumab, anakinra, and monoclonal Ab to IgE. Each resident will recognize the key radiographic features of rheumatoid arthritis, osteoarthritis, gout, pseudogout, and seronegative spondyloarthropathies. Participation and presentation at weekly Rheumatology conference 3) Practice-Based Learning and Improvement Each resident will be able to identify and acknowledge gaps in personal knowledge and skills in the care of patients with musculoskelatal and allergic complaints Each resident will be able to list useful sources to fill knowledge gaps about musculoskeletal and allergic complaints and problems. Reading log 4) Interpersonal Skills and Communication Each resident will be able to clearly and succinctly present patient information, both verbally and in writing, and discuss patient information with referring physicians. Direct Faculty Chart Review Each resident will communicate clearly, compassionately, and sensitively with patients and their families around complex rheumatologic and allergic issues. Periodic Patient Evaluation of Resident
5) Professionalism Each resident will demonstrate sensitivity and responsiveness to the unique personal and cultural situation of each patient, and provide care respecting each patient s personal values and goals, taking into consideration their developmental stage. Each resident will demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues in all health professions. Each resident will behave professionally and ethically toward towards patients, families, colleagues, and all members of the health care team. Periodic Patient Evaluation of Resident Periodic Patient, Staff, and Nursing Evaluation of Resident Periodic Patient, Staff, and Nursing Evaluation of Resident 6) Systems-Based Practice Each resident will understand and utilize the multidisciplinary resources necessary to care optimally for patients with rheumatologic and allergic issues, including support groups. Each resident will be able to collaborate with other members of the health care team to assure comprehensive care for patients with rheumaologic and allergic issues. Each resident will be able to assist their patients in negotiating the health care system complexities. Direct Faculty Global Peer Assessment Direct Faculty
Each resident will be able to use evidence-based, costconscious strategies in the care of patients with rheumatologic and allergic issues. Periodic Patient Evaluations Direct Faculty Recommended Resources Cassidy JT, Petty RE, Textbook of Pediatric Rheumatology (Fourth Edition). Philadelphia: W.B. Saunders, 2001. Reprints specific to patient issues are also provided to residents Primer for Rheumatologic Diseases Evaluation Methods Residents are formally evaluated by the Rheumatology Attendings and Fellows, patients, nurses, and staff at the end of the rotation using the standard evaluation forms used by the Internal Medicine-Pediatrics Residency for all residents.