Rheumatology Fellowship Program
Eugene Kissin, MD, Associate Professor of Medicine
Maureen Dubreuil, MD, Instructor
David T. Felson, MD, MPH, Professor of Medicine, Chief of Clinical Epidemiology
Robert Lafyatis, MD, Professor of Medicine, Director Scleroderma Center
Devyani Misra, MD, Instructor
Tuhina Neogi, MD, PhD, Associate Professor of Medicine
Paul A. Monach, MD, PhD, Associate Professor of Medicine, Chief of Rheumatology at the VA
Robert W. Simms, MD, Professor of Medicine, Section Chief, Rheumatology
Michael York, MD, Assistant Professor of Medicine, Clinical Director, Quality Leader
Program Coordinator: Jackie M. Chapski
Rheumatology Fellowship Training Program Highlights
The Boston University Medical Center (BUMC) Rheumatology Fellowship Training Program is part of the Section of Rheumatology at Boston University School of Medicine, whose members include numerous internationally recognized rheumatologists.
The Rheumatology Fellowship Program at BUMC offers rigorous clinical and research training, preparing our trainees for careers in academic medicine as well as community practice. The following provides a few key highlights of the program:
1) Clinical Training
The clinical training portion of the fellowship program provides broad general rheumatology clinical training, as well as focused experiences in the form of tertiary care referral specialty clinics, including vasculitis, scleroderma, and systemic lupus erythematosus. The inpatient consult service also provides broad exposure to rheumatic disease emergencies and care of complicated rheumatic disease patients. The diversity of the local patient population, as well as the tertiary care referral population for rare rheumatic diseases ensures that our trainees have a well-rounded experience that more than adequately prepares them for diagnosis and management of all rheumatic diseases. The clinical training is complemented by a highly rated formal didactic curriculum (see Program Overview below)
2) Musculoskeletal Ultrasound Training
One of the unique aspects of the BUMC Rheumatology Fellowship Program is the well-established musculoskeletal ultrasound training program under the direction of Dr. Eugene Kissin, who is nationally recognized as an expert and pioneer in this area. Dr. Kissin has been instrumental in developing a standardized national training program for rheumatology fellows and currently serves as the USSONAR Program Director. For further information of this training, please see the USSONAR website.
3) Research Training
A major strength of the BUMC Rheumatology Fellowship Program is the strength of the research training opportunities available for clinical, translational, and basic science research. This is largely due to the exceptionally strong faculty researchers at BUMC, all of whom are well-funded (NIH, American College of Rheumatology, Arthritis Foundation, Vasculitis Foundation, Scleroderma Foundation, etc.). BUMC Rheumatology faculty peer-reviewed publications are ranked #4 in the country for impact, a remarkable feat given that the top 3 institutions have a much larger research faculty, illustrating the high quality of research performed at BUMC. Our trainees are also highly successful in obtaining career development awards to aid their research training endeavors.
Fellows interested in clinical research are encouraged and supported to participate in the Clinical Research Training Program CREST through which fellows can obtain a Master of Science in Epidemiology through the BU School of Public Health. Fellows also attend research meetings in the Clinical Epidemiology Unit (headed by Dr. David Felson) . In addition, both the Scleroderma and Vasculitis programs have opportunities for clinical, basic, and translational research:Scleroderma basic and translational research program, Scleroderma clinical research program, Vasculitis clinical and translational research program
Here are some examples of publications of research performed during their fellowship by past graduates of our fellowship training program, highlighting the strength of the research training and successes of our fellows:
Annals of the Rheumatic Diseases 2013: in-press, American Journal of Medicine 2013: in-press; Seminars Arthritis Rheum 2013: http://www.ncbi.nlm.nih.gov/pubmed/23312549
Peter C. Grayson:
Arthritis Care & Research 2013: http://www.ncbi.nlm.nih.gov/pubmed/23861259; Annals of the Rheumatic Diseases 2012: http://www.ncbi.nlm.nih.gov/pubmed/22328740 ; Journal of Rheumatology 2012: http://www.ncbi.nlm.nih.gov/pubmed/22174204; Seminars Arthritis Rheum 2011: http://www.ncbi.nlm.nih.gov/pubmed/21507463; Arthritis Care & Research 2011: http://www.ncbi.nlm.nih.gov/pubmed/20824805
American Journal of Medicine 2013: http://www.ncbi.nlm.nih.gov/pubmed/23410565; Arthritis Care & Research 2011: http://www.ncbi.nlm.nih.gov/pubmed/22588746; Journal of Rheumatology 2011: http://www.ncbi.nlm.nih.gov/pubmed/21724703; Seminars Arthritis Rheum 2011: http://www.ncbi.nlm.nih.gov/pubmed/21435695
Arthritis Care & Research 2011: http://www.ncbi.nlm.nih.gov/pubmed/21452274
Journal of Rheumatology 2012: http://www.ncbi.nlm.nih.gov/pubmed/22174209
Rheumatology 2012: http://www.ncbi.nlm.nih.gov/pubmed/22039267; Journal of Rheumatology 2011: http://www.ncbi.nlm.nih.gov/pubmed/21411717; Annals of the Rheumatic Diseases 2010: http://www.ncbi.nlm.nih.gov/pubmed/19628821; Curr Opin Rheumatol 2009: http://www.ncbi.nlm.nih.gov/pubmed/19077717
Suzanne L. Chapnick:
Arthritis Care & Research 2010: http://www.ncbi.nlm.nih.gov/pubmed/20235199
William F. Harvey:
Annals of the Rheumatic Diseases 2012: http://www.ncbi.nlm.nih.gov/pubmed/22377805; Annals of Internal Medicine 2010: http://www.ncbi.nlm.nih.gov/pubmed/20194234; Arthritis & Rheumatism 2007: http://www.ncbi.nlm.nih.gov/pubmed/17393450
Steven C. Vlad:
Journal of Rheumatology 2011: http://www.ncbi.nlm.nih.gov/pubmed/21572158; Arthritis & Rheumatism 2009: http://www.ncbi.nlm.nih.gov/pubmed/19877089; Arthritis Research & Therapy 2009: http://www.ncbi.nlm.nih.gov/pubmed/19534782; Archives of Internal Medicine 2008: http://www.ncbi.nlm.nih.gov/pubmed/18541834; Neurology 2008: http://www.ncbi.nlm.nih.gov/pubmed/18458226; Arthritis & Rheumatism 2007: http://www.ncbi.nlm.nih.gov/pubmed/17599746
Grace H. Lo:
Arthritis & Rheumatism 2005: http://www.ncbi.nlm.nih.gov/pubmed/16145676; Annals of Internal Medicine 2005: http://www.ncbi.nlm.nih.gov/pubmed/15838068; JAMA 2003: http://www.ncbi.nlm.nih.gov/pubmed/14679274
Eugene Y. Kissin:
Arthritis & Rheumatism 2006: http://www.ncbi.nlm.nih.gov/pubmed/16874783; Arthritis & Rheumatism 2003: http://www.ncbi.nlm.nih.gov/pubmed/12910572; Rheum Dis Clin North Am 2003: http://www.ncbi.nlm.nih.gov/pubmed/12841299; Arthritis & Rheumatism 2002: http://www.ncbi.nlm.nih.gov/pubmed/12428243
The Boston University Medical Center (BUMC) Rheumatology Program provides organized training and supervision experience over two years sufficient for the trainee to acquire proficiency as a consultant in rheumatology. The program provides both the facilities and clinical experience with supervision to achieve this goal. The facilities include inpatient 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 supervised membership in a multidisciplinary team caring for both inpatients and outpatients with a wide variety of rheumatic and musculoskeletal diseases and other illnesses with rheumatologic or musculoskeletal manifestations. Fellows are given the opportunity to assume responsibility for and follow patients throughout the training period (see Continuity Clinics Year 1 and 2). Additional specialized outpatient training is available in scleroderma (see Outpatient Scleroderma-Year 1 and 2) vasculitis (see Outpatient Vasculitis-Year 1 and 2) and musculoskeletal ultrasound (see Musculoskeletal Ultrasound).
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; 5) the therapeutic injection of diarthrodial joints, bursae, tenosynovial structures and entheses; and 6) musculoskeletal ultrasound (MSK-US) in the diagnosis and monitoring of inflammatory and other disorders of tendons, ligaments, and joints. 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.
Major Textbooks:Primer on the Rheumatic Diseases, 13th edition, Arthritis Foundation, 2007 Rheumatology, 5th edition, Eds Hochberg, Silman, Smolen, Weinblatt, Weisman, 2010 Arthritis & Allied Conditions, 15th edition, Eds Koopman and Moreland, 2004 Oxford Textbook of Rheumatology, 3rd edition, Eds Isenberg, Maddison, Woo, Glass, Breedveld, 2004 Diagnosis of Bone and Joint Disorders, 4th edition, eds Resnick and Niwayama, 2002 Systemic Lupus Erythematous, 5th edition, Eds Lahita, Tsokos, Buyon, Koike, 2010 Vasculitis, 2nd edition, Eds Ball and Bridges, 2008 Kelley’s Textbook of Rheumatology, 8th edition, Eds Firestein, Budd, Harris, McInnes, 2008 Bone and Joint Imaging, 3rd edition, Eds Resnick and Kransdorf, 2004
Major Journals: (All are available on-line via BU Alumni Medical Library)Arthritis and Rheumatism Journal of Rheumatology Arthritis Care & Research Journal of Clinical Investigation Journal of Bone and Joint Surgery New England Journal of Medicine Annals of Internal Medicine
Other Resources:ACR slide collection (www.rheumatology.org/education/training/fellows/readinglist/index.asp) ACR reading list with linked PDF files (www.rheumatology.org) BU Medical School teaching syllabus Epocrates Up-To-Date (www.uptodateonline.com) (Access available through BMC Home-Page) MicroMedex (drugdb.bmc.org) (Access available through BMC Home-Page)
Principal Teaching/Learning ActivitiesClinical Case Conference (CCC) – Wednesday morning each week from 9:15-10:30 AM. The fellow on the BMC inpatient consult service presents patients active on the consult service. Approximately 20-25% of cases should relate to musculoskeletal medicine rather than systemic rheumatic diseases. Outpatient cases are encouraged. The subsequent discussion with participating faculty, fellows, students and residents focuses on differential diagnosis and management decisions. Review of the literature relating to at least one of the topics of discussion is strongly encouraged. 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 emphasizes development of competence and then proficiency 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 didactic lecture series (weekly early in the academic year, bi-weekly thereafter) given by key and other faculty which covers the following major areas of rheumatology: immunology, inflammation, genetics, 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 an article to review for each journal club. Participants include key 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. Revised: June 6, 2012