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Inpatient Rheumatology rotations
The fellows assigned to these rotations will be responsible for organizing the activities of the services. Our program has three inpatient rotations. These are: the Jackson Memorial Hospital rotation, the University of Miami Hospital and Clinics rotation and the Miami Veterans Affairs Medical Center “private service” rotation. These primarily include the supervised evaluation of inpatient consultations and patients admitted to the various hospital services as well as the continued follow-up of these patients during their hospitalization. There is no dedicated rheumatology inpatient ward as our patients are usually admitted to the medical service wards.
Essential in this role is the development and refinement of clinical evaluation skills of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans. Also essential in these rotations will be developing skills providing consultation services to include communicating with the referring physicians and ensuring support for continuing care of the patients’ rheumatic condition. The fellows will be called upon to perform literature research on topics appropriate to the case(s) at hand. They will participate actively in the teaching activities of the consultation team. Through this experience the fellow will also develop a comprehensive understanding of the indications, contraindications, techniques (including ultrasound), complications of arthrocentesis as well as the interpretation of results from this procedure. The fellows will also acquire the knowledge of and skill in educating patients about the procedure and in obtaining informed consent. Faculty supervision is provided through multiple one on one teaching interactions with the assigned attending physician and the program director including thrice weekly formal attending rounds.
The ambulatory (outpatient) Rheumatology experience
All fellows attend four half-day clinics unless on the research rotation (when they attend two clinics one at Jackson Memorial Hospital and one at Veteran’s Administration Hospital). These are divided into one Jackson Memorial Hospital (JMH) clinic (continuity clinic), 2 faculty practice clinics and one Miami VA Clinic (continuity clinic). This experience continues through the fellowship with progressive responsibility. The JMH clinics are supervised by three full-time faculty members and the Miami VA clinic by two full-time faculty members. The goal of this experience will be 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. The fellows follow their own panel of patients for the two years of the fellowship in these “continuity clinics.” In addition to the main ambulatory clinics, Fellows also will have the opportunity to rotate through an injection clinic where they will be able to gain exposure and experience utilizing an ultrasound to guide injections.
Interdisciplinary interactions
The fellows are provided an experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases. These disciplines include Dermatology, Ophthalmology, Orthopedic Surgery, Physical Medicine and Rehabilitation, Nephrology, Pulmonary Medicine, Neurology and others. 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 multidisciplinary conference, elective outpatient experience, etc. The monthly Rheumatology Interdisciplinary Conference provides such an opportunity as well. Clinical experiences should be under the direction of attending physicians in the respective subspecialty who participate fully in educational goals of the rotation. Rotations are arranged individually by the fellows with the assisstance of the program director.
Didactic conferences
Conferences are held on a regularly scheduled basis with attendance required of all fellows. These include a bi-monthly Journal Club, monthly Immunology conference, monthly basic science conference, monthly research conference, a weekly Fellows Conference (basic science and clinical subject presentations by visiting /local faculty or the fellows), a monthly Rheumatology Case Presentation Conference, a monthly Rheumatology Interdisciplinary Conference, a monthly Rheumatology Clinicopathologic/ACR Slide Review Conference, monthly Rheumatology Grand Rounds and weekly Medical Grand Rounds.