Rheumatology Training Program

Program Description

The Emory University Affiliated Rheumatology Fellowship Training program encompasses three critical rotations: Emory Clinic/Emory University Hospital, Grady Memorial Hospital and the Veterans' Affairs Medical Center.  During their first year of training fellows spend a total of six months at Emory and three months each at Grady and the VA. Clinical rotations during the second year are variable and depend on each fellow's preference and goals for the year.  A full complement of conferences is offered to round out the clinical experience both in clinical and basic science topics. Opportunities for experience in clinical and basic science as well as epidemiologic research exist at each of the three affiliate locations as well as at the Centers for Disease Control and Prevention and Rollins School of Public Health at Emory University.

Goals

During the two-year training program all fellows will:

• develop an extensive knowledge base on rheumatic disease
• develop proficiency in clinical history taking and physical examination
• become familiar with all diagnostic and therapeutic procedures in rheumatology
• become experts in analysis and integration of clinical data
• demonstrate excellence in patient management
• develop the ability to critically review the literature
• develop the ability to design, implement, interpret, and present research studies

Hospitals

The Emory Clinic/Emory University Hospital

During their six months at Emory, fellows attend the outpatient Rheumatology practice for three full days and one half-day each week. The full spectrum of rheumatic disease is seen, including complicated and unusual cases that have been referred from physicians throughout the southeast U.S. Under the supervision of Drs. Waltuck and Rott, fellows become proficient in careful history taking and physician examination with particular attention to the musculoskeletal system. Emphasis is placed on thorough workups and careful clinical follow up. In addition to outpatient care, fellows are responsible for all inpatient consultations and daily inpatient teaching rounds. While fellows are on rotation at Emory, they also attend an outpatient orthopedics clinic a half-day a week.

Grady Memorial Hospital

All fellows attend Grady Rheumatology clinic for one full day weekly and follow the same patients for the duration of their two-year training program. Fellows typically see three new patients and ten follow-ups on each clinic day. The fellow on rotation at Grady will also see outpatients an additional half-day per week as part of the Early Arthritis Clinic (EAC). In the EAC, patients with early inflammatory arthritis are followed and treated in a uniform fashion. Dr. Conn and a number of volunteer and part time clinical faculty staff the clinic. Inpatient consultation rounds are conducted daily and urgent outpatient consultations are seen in the Urgent Care Center and Emergency Care Center. Patients are referred to Rheumatology from an extensive primary care network that includes the medical clinics and community based practices within Grady Health Care System.  Ample time is allotted on this clinical rotation for independent study.  Fellows are encouraged to participate in ongoing studies of patients with rheumatic disease and also to initiate their own clinical projects.

Veterans Administration Medical Center

Fellows on rotation at the VA Medical Center attend three half-day clinics weekly. Two clinics are general Rheumatology sessions and the third is for new patients taking disease modifying agents for inflammatory arthropathies and vasculitis. Fellows develop proficiency in evaluating patients for second line therapy, counseling patients on their use, and carefully monitoring for efficacy and toxicity.  Daily consult rounds and didactic sessions are held with Dr. Atkinson. In addition to Rheumatology responsibilities, fellows are encouraged to attend daily medical morning report.  While fellows are on rotation at the VA, they also attend the Pediatric Rheumatology clinic for one half-day per week under the supervision of Dr. Vogler.

Conferences

Rheumatology Grand Rounds

Grand rounds are held for two hours every Wednesday afternoon and all faculty and fellows attend. Speakers are drawn from within the division, specialists in other divisions, and invited guest speakers from other institutions. All fellows are expected to present two lectures yearly on topics of their choosing. Staff is encouraged to present diagnostic dilemmas and cases with particularly difficulty management issues.

Pathology Conference

This conference is scheduled at least once a month. A staff pathologist leads didactic sessions as well as slide review. Fellows are encouraged to bring slides of recent interesting or challenging cases for review and discussion.

Radiology Conference

Radiology conference is held twice monthly in collaboration with the Department of Radiology, Division of Musculoskeletal radiology. A core curriculum covers all aspects of radiology as they relate to musculoskeletal disease. Didactic sessions are presented by the radiology staff on plain radiography, computed tomography, magnetic resonance imaging, arthography, and nuclear medicine. Radiographs of patients undergoing workups in our clinic are also presented for review.

Journal Club

Journal club is held weekly. Under the guidance of Dr. Conn all fellows participate by reviewing recent rheumatologic literature. It is expected that all fellows will read and be up to date on the contents of Arthritis and Rheumatism. All of the other major rheumatology journals are reviewed as well as any other pertinent papers from internal medicine, nephrology, pediatrics, radiology, orthopedics and immunology.

Other Conferences

Two additional didactic sessions are held monthly. During these sessions, lecturers are invited to present non-rheumatology topics of interest to rheumatologists. Subjects that have been presented in this forum include topics in orthopedics, neurology, rehabilitation medicine, podiatry, allergy, epidemiology, biostatistics, immunology, and alternative medicine. Through these conferences, fellows are encouraged to develop collaborative approaches to patient care.

Core Lecture Series

From the first day of training, fellows function as clinical consultants in rheumatology. Therefore, each summer, when new fellows are beginning their training, the faculty presents a core lecture series to rapidly orient fellows to the clinical practice of rheumatology. These lectures are supplemented with readings from the literature.

• approach to the patient with musculoskeletal complaints
• examination of the joints
• laboratory tests in rheumatology
• aspiration and injection of joints and soft tissues
• acute arthritis - diagnosis and treatment
• nonsteroidal anti-inflammatory drugs and analgesics
• corticosteroidsv
• rheumatoid arthritis
• systemic polyarthritis
• disease modifying therapy in rheumatoid arthritis
• SLE
• vasculitis
• myopathy/myositis
• scleroderma
• seronegative spondyloarthropathies
• soft tissue rheumatism
• PT/OT in rheumatic diseases
• the child with musculoskeletal complaints

In addition, core lectures regarding the immune system are integrated into the yearly conference schedule. Topics include cells of the immune system, cytokines, the HLA system and complements.