Rheumatology Student Information

Student Information

Contact Information:

Rotation Supervisor: Dr. Mark Francis
Division Secretary: Chris Melito

Those starting on Monday should come to the internal medicine clinic by 8:30.
Those starting on Tuesday should come to the internal medicine clinic after grand rounds.
The rheumatology nurses are Sue Redding, R.N., Jan Buhr, R.N., Sara Myers, L.P.N., and Pat Walkington, M.A.

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Length of Rotation:

2 weeks. We do not offer one week rotations.

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General Objectives:

Learning history and physical exam skills to evaluate patients with musculoskeletal problems.

Learn clinical presentations and management of the more common rheumatic disorders, such as:

Rheumatoid Arthritis

Osteoarthritis

Systemic Lupus Erythematosis

Bursitis and Tendonitis

Fibromylagia

Crystaline Disorders

Seronegative Spondyloarthropathies

Become acquainted with aspiration and injection techniques.

Learn basic science principals for rheumatology

Purine metabolism (gout)

HLA and other genetic factors and disease (ankylosing spondylitis, rheumatoid arthritis, others)

Histology, physiology, and pathology of joints (rheumatoid arthritis, others)

Autoantibodies and B cells (SLE, rheumatoid arthritis, others)

T cells (rheumatoid arthritis, SLE, others)

Cytokines (rheumatoid arthritis, SLE, others)

Cartilage physiology and pathology (OA and others)

Immune complexes (vasculitis, viral arthritis, SLE, others)

Inflammation (crystalline disorders, rheumatoid arthritis, others)

Pharmacology (all)

Anatomy (localized joint and soft tissue problems, others)

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Key Learning Resources:

While the required reading is from Kippel et al. Primer on the Rheumatic Diseases 13th Edition, reading similar material from other sources is permissible.

Other sources are available in my office; please let me know if you borrow any of them:

Primary rheumatology texts. Klippel’s Rheumatology does a particularly good job with figures and photographs; Koopman’s Arthritis and Allied Conditions is a good overall text. Each will supply more information than the Primer on a given topic.

Moskowitz’s Clinical Rheumatology. A good source to explore differential diagnosis. Chapters are grouped according to clinical presentation rather than disease (acute monoarticular arthritis, arthritis and skin rash, etc.).

ACR Rheumatology Core Curriculum Slide Series. 26 cases with questions and answers keyed to slides. Sides are arranged in order on three carousels with a question and answer book. Lots of physical exam findings. Donated by the SIU Alumni Association.

Schumacher’s Case Studies in Rheumatology. Short cases are presented with a clue followed by questions, answers, pearls, and pitfalls. A fun way to learn some rheumatology.

Brower’s Arthritis in Black and White. Best introductory text on X-rays in rheumatology. Short.

MKSAP reviews and questions and answers.

West’s Rheumatology Secrets. Uneven but with a question and answer format.

Rheumatic Disease Clinics of North America. Generally good but uneven reviews.

Dieppe’s Atlas of Clinical Rheumatology and Hunder’s Atlas of Rheumatology for clinical exam findings.

Sheon’s Soft Tissue Rheumatic Pain for wide variety of nonsystemic, local musculoskeletal problems.

Immunology:

Janeway’s Immunobiology and Roitt’s Immunology. Best introductory texts into immunology with a heavy emphasis on diagrams.

Stites’ Medical Immunology. Background information shorter than Janeway and Roitt but not as well explained. Useful, short synopses of immunological problems in a variety of diseases.

Paul’s Fundamental Immunology. Short of the primary source material, this is the best immunology text, but it is not for the faint-hearted.

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Expectations of Students:

Students will perform history and physical exams on rheumatology patients, primarily in the outpatient setting. They will write their history and physical exams on the appropriate forms.
Students may also perform history and physical exams on inpatients. They may also follow inpatients and are responsible for collecting data, performing follow-up histories and physicals, presenting at rounds, and writing notes.
Performing joint aspirations and injections is not a primary goal of this rotation; understanding when and when not to perform these procedures is a primary goal. We have knee and shoulder models students can use to practice these techniques.
Students will be asked to present an article for journal club.
Students are expected to read the sections of The Primer as outlined and to read about the patients they evaluate.

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Clinical Activity, Division Conferences and other Educational Activities:

CLINIC WRAP-UP. While we will discuss teaching points during clinic, there will be times when we do not have time for discussions in the clinic. If you have questions about your clinic patients that we did not have a chance to address in the clinic, please bring them up at the start of our teaching sessions with the appropriate rheumatology faculty. Similarly, we will try to make teaching points that we did not have a chance to discuss during clinic.

CORE SEMINARS. In this series we will cover the core material you need to know about rheumatology. We attached a list of key subject areas along with the teaching session times. These sessions are meant to be interactive teaching forums, not lectures. To get the maximum benefit from these sessions, you are expected to read the assigned sections of the PRIMER before the teaching session. We will then discuss the material. We will ask you questions; you can ask us questions. While we will certainly get an impression of your fund of knowledge and your preparation for the session, the primary goals of this format are to:

1. Adjust the discussion according to your knowledge level.
2. Keep everyone awake.
3. Improve long term knowledge. Studies indicate that you are more likely to remember material discussed in this manner rather than passively hearing the same information.
4. Keep learning fun.
5. Provide incentive to read the material.

To properly prepare for these sessions, it is important that the residents work together with the medical students on the rotation to coordinate the topic to be discussed with sufficient time to allow everyone to read about the topic before the teaching session.

While there will be exceptions to most every teaching point we discuss, we will focus on the generalities, unless we are sure the fundamentals are already firmly grasped.

JOURNAL CLUB. Residents and students will present a journal article to their colleagues. You should pick a research article with data (not a review) pertaining to rheumatology published in the last 2-3 months, preferably based on a patient you evaluated. The best sources are typically NEJM, Annals of Internal Medicine, Lancet and Arthritis and Rheumatism. Check with Dr. Ranatunga to make sure the article is appropriate.

Please bring a copy of the article for everyone and make your presentations brief (approximately 5 minutes). State the hypothesis of the article and the experimental design without reading the entire list of inclusion and exclusion criteria (please). Review the main findings by examining the relevant figures or tables. Briefly discuss the merits and drawbacks of the work. We will then discuss the article and its implications.

RHEUMATOLOGY CLINIC SCHEDULES:

Monday

8:30 AM – 12:30 PM Drs. Francis and Miller
1:00 PM – 4:30 PM Dr. Ranatunga

Tuesday

9:00 AM – 12:30 PM Drs. Ranatunga and Miller

Wednesday

9:00 AM – 12:30 PM Drs. Ranatunga and Miller
1:00 PM – 4:30 PM Dr. Ranatunga

Thursday

8:30 AM – 12:30 PM Drs. Francis and Miller
1:00 PM – 4:30 PM Dr. Miller

Friday

8:30 AM – 12:30 PM Dr. Ranatunga

All times may vary because of patient scheduling.

All rheumatology clinics are held in the medicine clinic which is located on the first floor of the SIU Clinics Building (751 N. Rutledge).

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Assessment Methods:

Observation/verification of history and physical exams.
Assessment of students’ clinical impression and plans for the patients they evaluate.
Clarity of oral presentations and written notes.
During learning sessions, students will have the opportunity to demonstrate their knowledge of the topic assigned.
Students will present a critical analysis of one or more research papers to the faculty.
We will meet at the end of the rotation for feedback.

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Assessment of the Rotation:

The rheumatology faculty will meet at the end of the rotation to discuss the progress of each student and to give a comprehensive evaluation that represents input of all the attending physicians. We will also elicit the input of nurses, patients, and others involved with you during the service. The critical issues are in what we tell you and in the comments that we write, not the summary score. Within the last week of your rotation, be sure to set up a meeting with Dr. Francis so that he can give you face-to-face feedback.

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Web Sites:

www.arthritisrheum.org American College of Rheumatology
www.arthritis.org Arthritis Foundation

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