Competency Based Curriculum Internal Medicine Residency Program The George Washington University Curriculum last updated on: 04/29/2009 Rotation: Division: Site: Director: Rheumatology Division of Rheumatology The george Washington University James D. Katz, MD, FACP, FACR General Description of the Rotation including educational purpose To acquire medical knowledge and clinical skills in rheumatology appropriate for an internist in both ambulatory and hospital-based sittings. Residents will participate in direct patient care, problem-based learning, and learn to interpret laboratory tests and radiological techniques frequently used in the evaluation and management of rheumatological diseases. Residents will learn basic arthrocentesis technique. Specifically: The resident should be able to formulate a differential diagnosis on the basis of clinical findings and pertinent laboratory values. The resident should understand the differential diagnosis based on synovial fluid analysis. The resident should learn how to interpret specialized laboratory testing frequently used in rheumatic disease assessment including: ANA, RF, ESR, CRP, and complement levels. The resident should gain familiarity with the use and interpretation of radiological techniques applicable to rheumatological problems. Residents should acquire an exposure to the basic immunological, anatomical, biochemical, and molecular-biological concepts necessary to appreciate the pathophysiology of rheumatic diseases with attention to: 1. Humoral and cell mediated immunity, B and T cell function, and activation 2. Autoantibody effector mechanisms 3. Inflammation mediators, cytokines Teaching Methods In order to achieve the goals and objectives for the teaching program the following experiences have been established for the purpose of teaching medical residents. These include: A) the inpatient rheumatology experience, B) the ambulatory rheumatology experience, C) interaction with other clinical specialties, D) didactic conferences, E) an optional research experience, and, F) continuing medical education and medical society participation (residents may participate in monthly rheumatology City- Wide Grand Rounds and monthly DC Rheumatism Society meetings at no cost). Assessment Method (residents) Each rotating resident should complete a Post-test at the end of the rheumatology rotation (see addendum below). Attending evaluation of the rotating resident for both clinical performance and procedural skills will be completed via Evalue. Assessment Method (Program Evaluation) See addendum below for a copy of the evaluation form. Level of Supervision
The rheumatology experience is based upon an apprenticeship-style of teaching. An attending sees every patient that a resident sees. The resident is expected to communicate his or her findings and suggestions (after being staffed by an attending) directly to the referring physician or team. Resident/Intern Responsibilities n order to achieve the goals and objectives for the teaching program the following experiences have been established for the purpose of teaching medical residents. These include: A) the inpatient rheumatology experience, B) the ambulatory rheumatology experience, C) interaction with other clinical specialties, D) didactic conferences, E) an optional research experience, and, F) continuing medical education and medical society participation (residents may participate in monthly rheumatology City-Wide Grand Rounds and monthly DC Rheumatism Society meetings at no cost). Out-patient clinics AM clinics begin at 8:30 AM and PM clinics begin at 1PM. Rheumatology clinic is located on the third floor of the ACC building. Academic conference Academic conference takes place weekly on Thursdays at 8 AM. Conference is held in the ACC building 1-401. Each rotating resident should complete a Post-test at the end of the rheumatology rotation (see addendum below). Attending evaluation of the rotating resident for both clinical performance and procedural skills will be completed via Evalue. The monthly academic conference schedule can be picked up at the Division Secretary s office in the ACC building, room 3-416. Board review and attending hospital walk rounds Rounds start on Thursdays at 1:30 PM at GWU hospital doctor s lounge on the ground floor. Presentation Each rotating resident should prepare a short evidence-based presentation on a topic of choice in rheumatology. Presentation is to be given one Thursday afternoon during board review rounds. Educational Objectives by PGY year and Core Competencies Patient Care (please be specific to your rotation) PGY-1: PGY-2: PGY-3: Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Competency:Health promotion skills. Objectives:Procedure Log signed for a minimum of 3 procedures (E-value). Skill = competence in medical procedures. Complete a minimum of 2 supervised hospital consultations and 5 supervised outpatient new patient evaluations. Skill = clinical judgement. Medical Knowledge (please be specific to your rotation) PGY-1: Goal. Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Competencies. Scientific understanding. Objectives.
Written Examination. Skill = knowledge acquisition. Attend one major rheumatology conference (either rheumatology grand rounds or DC Rheumatism Society meeting. Skill = self-improvement, life-long learner. Attend weekly rheumatology academic conferences. Skill = interpret and apply evidence-based medicine. PGY-2: PGY-3: Practice-Based Learning (choose from below) Identify strengths, deficiencies and limits in one s knowledge and expertise; Set learning and improvement goals. Identify and perform appropriate learning activities. Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement. Incorporate formative evaluation feedback into daily practice. Locate, appraise and assimilate evidence from scientific studies related to their patients health problems. Use information technology to optimize learning. Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident s teaching abilities by faculty and/or learners. System-Based Practice (choose from below) Work effectively in various health care delivery settings and systems relevant to their clinical specialty. Coordinate patient care within the health care system relevant to their clinical specialty. Incorporate considerations of cost awareness and risk-benefit analysis in patient care. Advocate for quality patient care and optimal patient care systems. Work in interprofessional teams to enhance patient safety and improve patient care quality. Participate in identifying systems errors and in implementing potential systems solutions. Professionalism (choose from below) Compassion, integrity, and respect for others Responsiveness to patient needs that supersedes self-interest Respect for patient privacy and autonomy Accountability to patients, society, and the profession Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation Interpersonal Skills and Communication (choose from below) Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
Communicate effectively with physicians, other health professionals, and health related agencies Work effectively as a member of leader of a health care team or other professional group Act in a consultative role to other physicians and health professionals Maintain comprehensive, timely, and legible medical records Teaching Methods (Check all that apply) Attending teaching rounds Patient Management Discussions Conferences Individual instruction of procedures Interdisciplinary Rounds Small-group discussion Bedside Rounds Review of diagnostics including radiology Teaching Materials (check all that are used during the rotation) Reading list (required) Radiologic studies Handouts Pathology material Articles from the literature Case Studies Methods used to Evalute Residents (check all that apply) Evaluation of Resident Observation of Resident s competency Observation of Resident s leadership and teaching skills Review of Resident s documentation history/physical, progress notes Attendance or rounds and conferences are monitored Conferences (please list date, time, location) Clinics (please list date, time, location)
Reading List Primer on the rheumatic diseases. 13th Ed. Arthritis Foundation, Atlanta, Georgia, 2001. Rheumatoid Arthritis Emery P. Treatment of rheumatoid arthritis. BMJ. 2006 Jan 21;332(7534):152-155. Firestein GS. Immunologic mechanisms in the pathogenesis of rheumatoid arthritis. J Clin Rheumatol. 2005 Jun;11(3 Sup pl):s39-44. Osteoarthritis American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 Update. Arthritis Rheum. 2000; 43:1905-1915. Gout Emmerson BT. The management of gout. N Engl J Med. 1996; 334:445-451. Psoriatic Arthritis Ruderman EM. Treatment advances in psoriatic arthritis. Curr Rheumatol Rep. 2005 Aug;7(4):313-318. Ritchlin CT. Pathogenesis of psoriatic arthritis. Curr Opin Rheumatol. 2005 Jul;17(4):406-412. Seronegative spondyloarthropathies Ritchlin CT. Recent advances in the treatment of the seronegative spondyloarthropathies. Curr Rheumatol Rep. 2001 Oct;3(5):399-403. Fibromyalgia Mease PJ. Fibromyalgia syndrome. J Rheumatol. 2005 Nov;32(11):2270-2277. Systemic Lupus Erythematosus Lam GK. Assessment of systemic lupus erythematosus. Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S120-132. Systemic Sclerosis Zandman-Goddard G. New therapeutic strategies for systemic sclerosis-a critical analysis of the literature. Clin Dev Immunol. 2005 Sep;12(3):165-173. Sjogren s Syndrome Hansen A. Immunopathogenesis of primary Sjogren's syndrome: implications for disease management and therapy. Curr Opin Rheumatol. 2005 Sep;17(5):558-565. Fox RI. Sjogren's syndrome. Lancet. 2005 Jul 23-29;366(9482):321-331. Vasculitides Rahman W. Giant cell (temporal) arteritis: an overview and update. Surv Ophthalmol. 2005 Sep- Oct;50(5):415-428. Bonfioli AA. Behcet's disease. Semin Ophthalmol. 2005 Jul-Sep;20(3):199-206. Langford CA. Wegener's granulomatosis: current and upcoming therapies. Arthritis Res Ther. 2003;5(4):180-191. Sarcoidosis Bonfioli AA. Sarcoidosis. Semin Ophthalmol. 2005 Jul-Sep;20(3):177-182. Amyloidoses Brunt EM. Metabolic storage diseases: amyloidosis. Clin Liver Dis. 2004 Nov;8(4):915-930. Osteoporosis
Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. 2005 Dec;115(12):3318-3325. Heaney RP. Advances in therapy for osteoporosis. Clin Med Res. 2003 Apr;1(2):93-99. Web Resource American College of Rheumatology Website http://www.rheumatology.org/educ/training/resources.asp?aud=mem Association of Rheumatology Curriculum Cases http://www.rheumatology.org/educ/cases/index.asp?aud=fel University of Washington Website: Knee Disorders http://uwcme.org/site/courses/legacy/knee/ University of Washington Website: Approaches to Differential Diagnosis in Musculoskeletal Imaging http://www.rad.washington.edu/mskbook/ University of Washington Website: Radiology of Arthritis for the Non-Radiologist http://uwcme.org/site/courses/legacy/arthritis/