the inpatient rheumatology experience
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.