Department of Medicine - Knoxville

Residency Program

Curricula Area - Rheumatology

1. Curricular Area: Rheumatology
   
2. Location:
   • Faculty Rheumatology, POB C, Suite 555, Phone:   546-6554 
     
     
3. Faculty:     
   • Gary L. Klipple, MD, Associate Professor
   • Christy C. Park, MD, Assistant Professor
   • Thomas C. Namey, MD, Professor
     
4. Schedule:     
   • Days: Monday through Friday 8:00 AM until 5:00 PM The resident is expected to attend Grand Rounds and Noon Conferences. The resident is excused from the rotation to attend their scheduled Ambulatory Care Clinic.
   • Nights: None   
     
     The resident will be expected to perform a competent history and physical examination focused on rheumatological disorders by the completion of the rotation. The resident will see patients who are presenting to the office as both new and established patients. The attending and resident will review the history, examination findings and recommendations for further testing and therapy with the patient. The resident will occasionally be asked to participate in the care of hospitalized patients on both weekdays and weekends.
     
     
5. Related Conferences/Venues: Rheumatology Noon Conference*, 12:00 – 1:00 PM , Fourth Friday of each month, Dept. of Medicine Conference Room. Also see Procedural Venue.
   
   
6. Primary Goals:   Rheumatology and non-operative orthopedics deals with the diagnosis, prevention and management of localized musculoskeletal complaints, inflammatory arthropathies, systemic rheumatic diseases, inflammatory muscle diseases, degenerative and osteoarthritis, osteoporosis and soft-tissue rheumatic diseases. The general internist should have competency in the diagnosis and management of these local musculoskeletal and systemic conditions. Residents completing this rotation will be able to evaluate and manage common rheumatologic problems and know when to refer appropriately. The resident will be proficient in monitoring the effects of anti-inflammatory, immunosuppressive and cytotoxic medications. In addition, there will be a focus on literature review of clinical cases and of the resident’s ongoing study program.
   
   
7. Primary Objectives:   During this rotation, the resident should gain knowledge and experience in the evaluation, interpretation and management of the following:

     a. Musculoskeletal Exam

     b. Common presentation of rheumatic diseases

       Arthralgias, monoarthritis, oligoarthritis and polyarthritis (acute and chronic)

       Myalgias, local and diffuse

       Musculoskeletal weakness

       Nonarticular signs and symptoms of rheumatic disease, e.g. Raynaud’s

     c. Regional Rheumatic Disease

       Evaluation and management of local pain and dysfunction including the neck, shoulder, low back, wrists, hands, hip, knee, ankle and feet

       Bursitis and tendonitis

     d. Osteoarthritis and Degenerative Articular Diseases

     e. Systemic and Inflammatory Rheumatic Diseases

       Rheumatoid arthritis

       Systemic lupus erythematosis

       Dermatomyositis and polymyositis

       Sjogren’s syndrome

       Scleroderma

       Spondyloarthropathies

       Crystal-induced synovitis

       Septic arthritis

       Vasculitides

       Polymyalgia rheumatica

     f. Fibromyalgia and Myofascial pain

     g. Osteoporosis

     h. Ordering and interpreting tests including analysis of synovial fluid, ANAs, ANCA, ESR, CRP, complement levels, and RF.

     i. Introduction to the interpretation of bone and joint radiographs
   
   The resident will be able to recognize and initiate diagnostic testing and appropriate therapy for the majority of Rheumatologic disorders. They will learn when it is appropriate to manage the patient in a primary care setting and when to seek consultation with a Rheumatologist for further management.

   See Core Competency Table**   

    

8. Supplemental References, Suggested Readings :    Klippel, JH, (Editor), Crawford, L, Stone, JH, Weyand, CM (Co-editors)   

   Primer on the Rheumatic Diseases, 12 th Edition. 2001. National Book Network. ISBN 0912423293. This text is provided to the resident.
   
   

9. Procedures:   The resident will have the opportunity to become familiar with and proficient in several procedural skills during the rotation including arthrocentesis and corticosteroid injection of the knee and shoulder, injection of subacromial, trochanteric and pes anserine bursa, injection of first carpometacarpal joints and various trigger points and tenosynovia.
   
   
10. Other Resources:   Several textbooks, various reference materials and joint models are available for in office use.
    
    
11. Research Opportunities: Residents frequently encounter patients during the rotation who are suitable for a case report. Experienced faculty and mentoring are readily available to assist with these efforts.
    
    
12. Method of Resident Evaluation: Each resident is informally and continually evaluated during the course of the rotation. Feedback is given in these situations in an immediate, pertinent and constructive manner. The overall course evaluation will be discussed with the resident and a written evaluation will be forwarded to the Department of Medicine using New Innovations.
    
    
13. Method of Specialty Evaluation: Residents are asked to provide feedback to the attending in an informal manner during the course of the rotation. They will complete an evaluation form using New Innovations at the end of the rotation. Cumulative feedback to the attending faculty member will be given by the Departmental Chair.

    *See Appendix A - noon conferences

    ** See Appendix B - core competencies