***2008 Fellowship positions have been filled*** Applications for 2009 fellowship will be accepted through April 2008 via ERAS (Electronic Residency Application Service). Please visit www.aamc.org/eras for details on ERAS. The three-year fellowship in rheumatology prepares individuals for careers in academic clinical or clinical rheumatology. The program meets the requirements for board eligibility in rheumatology. The fellowship may be divided into clinical and research components. The following describes the goals and objectives for the rheumatology fellowship program. In order to achieve the goals and objectives for the fellowship program the following experiences have been established for the purpose of teaching Rheumatology fellows. These include: A) the inpatient rheumatology experience, B) the ambulatory rheumatology experience, C) ambulatory rotations with other clinical subspecialties, D) didactic conferences, E) a research experience, F) continuing medical education and society participation, G) development of teaching skills, and H) development of procedural skills. A. The inpatient rheumatology experience:
The fellows assigned to this rotation we will be responsible for organizing the activities of this service. This primarily includes the supervised evaluation of inpatient consultations and patients admitted to the rheumatology service as well as the continued follow up of these patients during their hospitalization. Essential in this role is the development and refinement of clinical evaluation skills of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans. Essential in this rotation will be developing skills in providing consultation services, to include communicating with the referring physicians and ensuring support for continuing care of the patients' rheumatic condition. A fellow will be called upon to perform literature research on topics appropriate to the case at hand. They will participate actively in the teaching activities of the consultation team. Through this experience the fellow will also develop a comprehensive understanding of the indications, contraindications, techniques, complications of arthrocentesis as well as the interpretation of results from this procedure (see procedural skills section below for more details). The fellow will also acquire the knowledge of and skill in educating patients about the procedure and in obtaining informed consent. Faculty supervision is required in developing these skills. The inpatient experience at Northwestern Memorial Hospital (NMH) provides experience with the care of rheumatology inpatients, inpatient consultations to both generalists and specialists of all varieties, care of patients in specialty units, consultations on patients going to orthopedic surgery, and emergency room consultations. Others are the acute care teaching hospitals affiliated with Northwestern University Feinberg School of Medicine. For patients at NMH, if admitted by the rheumatology service the rheumatology fellow is directly responsible, under the supervision of the rheumatology attending, for the supervision of the care of the patients. Rheumatology patients admitted to the Jesse Brown VA Medical Center become the responsibility of the assigned inpatient team. Therefore, the fellow assumes a consultative role, similar to the role at NMH for inpatient consultations. The medicine residents on the rheumatology service do not assume responsibility for the care of patients. The non-specialty residents evaluate a subset of patients and report to the fellow, who is responsible for managing all the patients on the service. Fellows are responsible for the care of rheumatology inpatients during their entire stay and for the acute and necessary daily follow-up evaluations on consultations. During this rotation the Attending rheumatologists generally change every 2 weeks, providing the fellow with exposure to all the clinical faculty in a meaningful environment. During both years of the fellowship the trainee is on call an average of every third weekend. This call is carried out under the direct supervision of an attending rheumatologist. The team is responsible for care of patients at NMH, Jesse Brown VA Medical Center and the Rehabilitation Institute of Chicago during this period of time. B. The ambulatory rheumatology experience:
All fellows will be required to maintain a minimum of the equivalent of 1.5 days in the outpatient clinic for the first 12 months. For the second 12 months the outpatient clinic responsibility will depend on goals of the trainee, and will be arranged with the Training Program Director and the Division Chief. One half day during both years occurs at the VA under the direct supervision of an attending rheumatologist. The fellow is responsible for 1 to 2 new consultations and 6 to 10 follow-up patients. The remainder of the outpatient experience is at Northwestern Medical Faculty Foundation (NMFF) 3 blocks south of the medical school. This is the outpatient facility of the academic faculty. The fellow sees 1 to 2 new consultations and 6 to 10 follow-up patients per half day. This experience will continue with progressive responsibility through the fellowship and will be appropriately supervised by dedicated attending faculty members. The goal of this experience will be for the fellows to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time. C. Interdisciplinary interactions:
The fellow is provided an experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases. It is suggested that these disciplines include: 1) rehabilitative medicine and 2) pediatric rheumatology (elective). The goal of these experiences is for the fellow to appreciate the approach to the specific conditions that relate to rheumatic disorders within these subspecialties. This interdisciplinary interaction can occur in the form of a clinical rotation, multidisciplinary conference, etc. Clinical experiences should be under the direction of attending physicians in the respective subspecialty who participate fully in the educational goals of the rotation. D. Didactic Conferences:
Conferences will be held on a regularly scheduled basis with attendance required of all fellows and divisional faculty. There are one clinical conference, one basic science conference, one literature review conference (journal club) and one research conference each month. It is encouraged that the content of these conferences will include members from the divisions outside of Rheumatology to include the subspecialties outlined in section C as well as include participation from members of the Departments of Radiology, Microbiology-Immunology, Biochemistry, Molecular Biology and Cellular Biology, Pediatric Rheumatology, Pathology, Rehabilitation Medicine, and Physical therapy who have specific interests clinical or basic science interests related to the field of rheumatic disease. Fellows will be required to attend a minimum of 70% of each of the conferences. E. Research experience:
An active research component may be included within the fellowship training program, depending on the goals of the trainee. A meaningful research experience must be provided with appropriate protected time for each fellow who undertakes intensive research. Exposure to divisional research programs should be initiated early in the fellowship, within the first few months, to allow the fellow adequate insight into the areas of research in preparation for the ultimate selection of a faculty member to serve as a specific research mentor for the remainder of the fellowship training program. The immediate goal of the research experience is for the fellow to learn sound methodology in designing and performing research studies and the correct interpretation and synthesis of research data. During this phase of training the fellow will work under close guidance of the research mentor. The fellows are provided opportunities for basic science research or in the fields of epidemiology and health services research conducted by members of the division. F. Continuing medical education and society memberships:
In addition to participating in the organized didactic conferences established within the fellowship program it is also strongly encouraged that all fellows become members of the American College of Rheumatology as well as any respective local society on rheumatic diseases. Participation in the continuing medical education activities of these professional organizations are encouraged and will help foster the standards of professionalism and augment the process of lifelong learning. G. Experience in developing teaching skills:
The program provides an environment for the fellow which fosters and highly regards the activities of teaching. This includes the education of not only medical students, physicians, and other allied health personnel but also the education of the patients. Development of these skills requires the fellow to receive instruction and feedback in counseling and communication techniques. This latter training must include cultural, social, behavioral and economic issues such as confidentiality of information and indications for life support systems. The development of these skills will occur both during teaching rounds, outpatient clinical experience, didactic lectures (evaluation of teaching conferences) and personal feedback from individual faculty. H. Procedural Skills:
Procedural skills will be taught in both the inpatient and outpatient settings. These skills include musculoskeletal examination, joint aspiration, joint injection, soft tissue injection and aspiration, and synovial fluid analysis. First, the fellow will observe the procedure performed and explained by a board certified rheumatologist, until the fellow feels confident. The anatomy will be reviewed on a skeletal or in a textbook as needed. The procedure will then be performed under direct supervision of the faculty member. Direct observation will occur until the faculty member and the fellow are confident of successful completion. Thereafter, procedures will be performed by the fellow under the direction and with the knowledge of a faculty member, who will monitor, and be responsible for, the outcome in each case. During the course of the 3 year program, the fellow will share the procedure log with the faculty member to ensure adequate skills have been obtained. At least 50 successful procedures, with less than 2% complications, are expected for each year. For more information regarding fellowship programs you may write to:
Richard M. Pope, MD, Interim Rheumatology Fellowship Director
c/o Kelly Thompson
Division of Rheumatology
Northwestern University
240 E. Huron, McGaw Pavilion M300
Chicago, Illinois 60611 If you have further questions relating to the fellowship program you may call 312/503-8199. | 
