Boston University Medical Campus
Rheumatology

Rheumatology Fellowship Program

LEADERSHIP

PROGRAM OVERVIEW

The Boston University Medical Center (BUMC) Rheumatology Program provides organized training and supervision experience over two years sufficient for the trainee to acquire competence as a consultant in rheumatology. The program provides both the facilities and clinical experience with supervision to achieve this goal. The facilities include in-patient facilities at Boston Medical Center and at the Boston VA Medical Center. Each is fully equipped with imaging facilities (including computerized tomography and magnetic resonance imaging), a fully equipped clinical laboratory on a 24 hr basis and has a polarized light microscope available for use by the fellows. Rehabilitation and ambulatory facilities are available at each site. Resources for specialized tests specific for rheumatology are available at each site either on site or by contract arrangement. Meaningful working relationships with faculty in radiology and orthopedic surgery are available at each site in the program.

The clinical experience in BUMC Rheumatology includes supervision as a multidisciplinary team member in both inpatients and outpatients with a wide variety of rheumatic and musculoskeletal diseases and other illnesses with rheumatologic musculoskeletal manifestations. Fellows are given opportunity to assume responsibility for and follow patients throughout the training period (see Continuity Clinics Year 1 and 2). Additional specialized out-patient training is available in scleroderma (see Outpatient Scleroderma-Year 1/2) and vasculitis (see Outpatient Vasculitis-Year 1/2).

The program specifically provides the environment and resources for fellows to gain experience in the diagnosis and treatment of patients with the following: diffuse connective tissue diseases, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis/dermatomyositis, spondyloarthropathies, vasculitis, crystal-induced arthropathies, osteoarthritis, regional musculoskeletal pain syndromes, non-articular rheumatic diseases including fibromyalgia, non-surgical sports injury, systemic diseases with rheumatic manifestations, metabolic bone diseases, osteoporosis, pediatric rheumatology/juvenile rheumatoid arthritis, infection of joints, joint surgery, acute and chronic musculoskeletal pain.

The program additionally provides sufficient specific experience for the fellow to acquire skill in:

1) the use of non-steroidal anti-inflammatory drugs, glucocorticoids, cytotoxic drugs, biologic response modifiers, antihyperuricemic drugs and antibiotic therapy for infectious musculoskeletal diseases.

2) examination of the musculoskeletal system,

3) the development of differential diagnoses for complexes of symptoms and signs related to rheumatic disease,

4) the diagnostic aspiration and analysis by light and compensated, polarized microscopy of synovial fluid, and

5) the therapeutic injection of diarthrodial joints, bursae, tenosynovial structures and enthuses.

Additional experience is provided in the interpretation of pathologic material, bone and joint imaging techniques, bone density interpretation, nailfold capillary microscopy, arthroscopy indications and interpretation of electromyography and nerve conduction studies. Formal instruction in the major areas of rheumatology is provided in the Fellow Curriculum series of lectures (see below) and is supplemented by Rheumatology Grand Rounds, Orthopedic Grand Rounds and Medical Grand Rounds.

RECOMMENDED RESOURCES

Major Textbooks:

Primer on the Rheumatic Diseases, 12th edition, Athritis Foundation, 2001 Rheumatology, 2nd edition, eds J.H. Klippel, P.A. Dieppe

Arthritis & Allied Conditions, 12th edition, eds D.J. McCarty, W.J. Koopman

Oxford Textbook of Rheumatology, 2nd edition, P.J. Maddison, D.A. Isenberg, P. Woo, D.N.

Glass Diagnosis of Bone and Joint Disorders, D. Resnick, G. Niwayama

Systemic Lupus Erythematosus, 2nd edition, R.G. Lahita

Major Journals:

Arthritis and Rheumatism (www.interscience.wiley.com)

Journal of Rheumatology (www.jrheum.com)

Arthritis Care & Research (www.interscience.wiley.com)

Journal of Clinical Investigation Journal of Bone and Joint Surgery

New England Journal of Medicine (www.nejm.org)

Annals of Internal Medicine

Other Resources:

ACR slide collection (www.rheumatology.org)

BOD syllabus

Up-To-Date (www.uptodateonline.com)

MicroMedex (drugdb.bmc.org) Epocrates

Priniciple Teaching/Learning Activities Assistant Professor of Medicine Boston University School of Medicine

Clinical Case Conference (CCC) – Wednesday morning each week from 9-10:30 AM. The responsible consult fellow on the BMC in-patient consult service presents patients active on the consult service. The subsequent discussion with participating faculty, fellows, students and residents focuses on differential diagnosis and management decisions.

Attending Rounds (AR) – Usually daily (M,T,W, Th, F, Sa, Sun) depending on the schedule of the consult attending and fellow. Attending rounds provide an important opportunity for single case-based learning which emphasize competence in obtaining the rheumatologic history, rheumatology physical exam skills, procedural skills, interpreting laboratory data, generating a rheumatology differential diagnosis and developing appropriate management plans.

Fellow Curriculum (FC) – A bi-weekly didactic lecture series given by key and other faculty which covers the following major areas of rheumatology: diffuse connective tissue diseases, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis/dermatomyositis, spondyloarthropathies, vasculitis, crystal-induced arthropathies, osteoarthritis, regional musculoskeletal pain syndromes, non-articular rheumatic diseases including fibromyalgia, non-surgical sports injury, systemic diseases with rheumatic manifestations, metabolic bone diseases, osteoporosis, pediatric rheumatology/juvenile rheumatoid arthritis, infection of joints, joint surgery, acute and chronic musculoskeletal pain.

Pathology Conference (PC) – A quarterly conference devoted to review of histopathologic specimens from in- or out-patients conducted by pathology faculty. Reviewed specimens may include skin, bone, muscle, joint, kidney, brain or other organ pathology. Each review is preceded by presentation of the case by the responsible fellow.

Radiology Conference (RC) – A biweekly conference devoted to plain musculoskeletal radiography. A monthly conference conducted by senior radiology faculty focuses on MRI imaging of rheumatic disease.

Journal Club (JC) – A biweekly review and critique of recent rheumatology literature from subspecialty and general medicine journals. Each fellow generally prepares at least 2 articles to review. Participants include key and other faculty, other fellows, residents and students.

Inter-Hospital Rounds (IHR) – A monthly evening session of interesting rheumatology cases hosted by each of the major Boston teaching hospitals. Fellows formally present cases they have personally been involved with and direct a discussion of the differential diagnosis, diagnostic studies, and review the relevant literature.