Fellowship Curriculum Overview
In any given month, the first-year fellow assigned to the inpatient consult service is responsible for organizing the activities of the service each weekday. During the first and second years of the fellowship, the trainee is on call an average of every third weekend, carried out under the direct supervision of an attending rheumatologist. Third-year fellows (for those choosing to undertake a third year) have no required inpatient duties, in order to provide sufficient protected time for research.
The consult team is responsible for care of patients at NMH, The Prentice Women's Hospital, the Jesse Brown VA Medical Center, and the Rehabilitation Institute of Chicago (collectively, "the McGaw Medical Center") during this period of time. Duties primarily include the supervised evaluation of inpatient consultations and the continued follow up of these patients during their hospitalization. Essential in this role is the development and refinement of the skills necessary for the clinical evaluation of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessment of the need for hospitalization, diagnostic evaluation strategies, and treatment plans.
This rotation focuses on the development of skill in providing consultation services, to include communicating with the referring physicians and ensuring support for continuing care of the patients' rheumatic condition after discharge. Fellows participate actively in the teaching activities of the consultation team, and may be called upon to perform literature research on topics appropriate to the cases at hand. Each month, one case is presented by each first-year fellow at our monthly case conference.
Through this experience, fellows also develop a comprehensive understanding of the indications, contraindications, techniques, and complications of arthrocentesis as well as the interpretation of results from this procedure. Fellows also acquire knowledge of and skill in educating patients about the procedure and in obtaining informed consent. Faculty supervision is required in developing these skills.
The inpatient consult service at Northwestern Memorial Hospital (NMH) provides experience with the care of rheumatology inpatients, inpatient consultations to both generalists and specialists of all varieties, care of patients in specialty units, consultations on patients going to orthopedic surgery, and emergency room consultations. The fellow assumes a consultative role, and guides the medicine residents on the rheumatology service in the routine care of patients. The non-specialty residents evaluate a subset of patients and report to the fellow, who is responsible for managing all the patients on the service. Fellows are responsible for the rheumatologic care of inpatients during their entire stay and for the acute and necessary daily follow-up evaluations on consultations. Non-rheumatologic medical management is performed by the managing service, under whom the patient is admitted. During this rotation the Attending rheumatologists generally change every week, providing the fellow with exposure over time to all of our clinical faculty in a meaningful environment.
First-year fellows care for outpatients during three half-days in the outpatient clinic. Fellows are in clinic two half-days in their second year and one half-day in their third (if a third year is undertaken). One half-day during each of the first two years may occur at the VA under the direct supervision of an attending rheumatologist. In each half-day, a fellow is generally responsible for 1 to 2 new consultations and 6 to 8 follow-up patients. All fellows have outpatient experience at Northwestern Medical Faculty Foundation (NMFF). This is the outpatient facility of the academic faculty of the Northwestern University Feinberg School of Medicine.
The fellow is given progressive autonomy in outpatient care throughout the fellowship, and will be appropriately supervised by assigned attending faculty members. The goal of this experience is for the fellows 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 over an extended period of time.
Fellows are also provided an experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases. These disciplines include rehabilitative medicine and pediatric rheumatology. The goal of these experiences is for the fellow to appreciate the approach to the specific conditions that relate to rheumatic disorders within these subspecialties. This interdisciplinary interaction can occur in the form of a clinical rotation, multidisciplinary conference, etc. Clinical experiences are under the direction of attending physicians in the respective subspecialty who participate fully in the educational goals of the rotation. For first-year fellows, these rotations occur during months when the trainee is not on duty on the inpatient consult service.
Conferences are held on a scheduled basis with attendance required of all fellows and divisional faculty. There are one clinical conference, one basic science conference, one literature review conference (journal club) and one research conference each month. The content of these conferences often includes members from clinical divisions outside of Rheumatology, as well as participation from members of the Departments of Radiology, Microbiology-Immunology, Biochemistry, Molecular Biology and Cellular Biology, Pediatric Rheumatology, Pathology, Rehabilitation Medicine, and Physical therapy who have specific interests clinical or basic science interests related to the field of rheumatic disease. Fellows will be required to attend a minimum of 70% of each of the conferences.
In addition to participating in the organized didactic conferences established within the fellowship program, it is also strongly encouraged that all fellows become members of the American College of Rheumatology as well as The Chicago Rheumatism Society. Participation in the continuing medical education activities of these professional organizations is encouraged and helps foster standards of professionalism and augment the process of lifelong learning.
An active, mandatory research component is included within the fellowship training program. A meaningful research experience is provided by the inclusion of appropriate protected time for each fellow who undertakes intensive research (fellows who choose to undertake a third year do not have inpatient duties and are only required to be in the outpatient clinic one half-day each week).
Exposure to divisional research programs is initiated early in the fellowship, within the first few months, to allow the fellow adequate insight into the areas of research in preparation for the ultimate selection of a faculty member to serve as a specific research mentor for the remainder of the fellowship training program (starting in the second year, and continuing into the optional third year if desired). The immediate goal of the research experience is for the fellow to learn sound methodology in designing and performing research studies and the correct interpretation and synthesis of research data. During this phase of training, the fellow works under close guidance of the research mentor. Fellows are provided opportunities for basic science research or for work in the fields of epidemiology and health services research conducted by members of the division.
Procedural skills are taught in both the inpatient and outpatient settings. These skills include musculoskeletal examination, joint aspiration, joint injection, soft tissue injection, and synovial fluid analysis. Procedures are performed under the direct supervision of a faculty member. Direct observation will occur until the faculty member and the fellow are confident of successful completion. During the course of the program, the fellow keeps a procedure log to ensure adequate skills have been obtained.
The program provides an environment for the fellow which fosters and highly regards the activities of teaching. This includes the education of not only medical students, physicians, and other allied health personnel but also the education of patients. The development of these skills occurs during inpatient teaching rounds, the outpatient clinical experience, didactic lectures, and personal feedback from individual faculty.