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Rheumatology Acute Care Rotation

Rotation Director: Dr. Kevin Deane  

Rheumatology encompasses a wide range of autoimmune and inflammatory diseases. The majority of rheumatology clinical practice is performed in the outpatient setting; however, many interesting and acutely ill patients with rheumatic diseases are seen on the inpatient service, and as emergent outpatient evaluations. These diseases include severe lupus, vasculitis, or complications of immunosuppressive therapy such as infection that, because of the relative rarity of these conditions, a resident may not otherwise encounter during their training. In addition, inpatients and emergent outpatients are often patients that require joint aspiration for diseases such as crystalline arthropathy. 
EDUCATIONAL GOALS: The resident will learn the appropriate evaluation and management approaches for patients with rheumatic diseases with a special focus on those patients that are acutely ill. This can include evaluations for vasculitis or lupus that include biomarker testing, imaging and tissue biopsy, and management strategies for patients with acute rheumatologic illness including but not limited to high-dose corticosteroid therapy, plasmapheresis and other forms of immunomodulation, as well as perioperative management of patients with rheumatic disease. In addition, the resident will learn the rationale, techniques and appropriate testing (e.g. synovial analyses) related to joint aspiration. This education will be applicable to residents interested in rheumatology as a career, as well as residents who may choose to do hospitalist medicine where familiarity with inpatient management of rheumatic diseases and joint aspiration will be of benefit. 
SCOPE OF WORK AND TIME COMMITMENT: For this rotation, the resident will serve as the primary rheumatology consultant for patients assigned to them. They will work with the rheumatology fellow to identify patients that the resident will evaluate on either an outpatient or inpatient basis. The resident will then perform the initial evaluation and discuss the diagnostic and management plan with the rheumatology fellow and attending, follow the patients as appropriate, and performing appropriate medical documentation. It is estimated that the resident will spend ~60% of their time performing urgent outpatient evaluations (clinic or emergency room), and 30% with inpatient evaluations. In addition, they will have approximately ½ day a week of rheumatology education through attendance at conferences and lectures. Based on the current monthly average of inpatient and emergent outpatient rheumatology consults, it is estimated that the resident will evaluate approximately 20 patients monthly (10 inpatient and 10 emergent outpatient), and perform approximately 4 joint aspirations/injections. The resident’s duty hours will be approximately 7:30 AM to 5:30 PM Monday through Friday. They will NOT perform overnight or weekend call.  Of note, this rotation is separate from the rheumatology outpatient elective rotation.  70% Ambulatory