Fellowship Curriculum

Mission

The mission of the SUNY HSC Syracuse Rheumatology Fellowship Training Program is to train physicians to:

  1. Be clinically competent in Rheumatology and related fields of interests.
  2. Be capable of working in a variety of ways, including as an expert consultant, clinician, teacher, and, with additional training, as a clinical or a basic science investigator.
  3. Develop and maintain habits of lifelong learning to further enhance their knowledge, skills and professionalism.

FULL TEXT OF THE 17-18 CURRICULUM

Specific Goals

Clincial Competency is essential for all physicians. By graduation the training rheumatologist must be competent in the following 6 Core Competencies:

Patient Care

PC1 : Gathers and synthesizes essential and accurate information to define each patient’s clinical problems.

  • Proficient in taking a complete history, performing a physical examination (particularly of the joints and musculoskeletal structures) and the use laboratory and imaging studies
  • Demonstrates expertise in the performance and interpretation of the musculoskeletal examination

PC2: Develops and achieves a comprehensive management plans for each patient.

  • Possesses the ability and to analyze critically the clinical and laboratory data, integrate this with their basic foundation of medical knowledge, and formulate appropriate differential diagnoses and therapeutic plans.
  • Prescribes and manages immunomodulatory therapy
  • Provides patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

PC3: Manages patients with progressive responsibility and independence

  • Manages the care of patients with acute and chronic, common and complex rheumatologic diseases across multiple care settings
  • Advocates for individual patients

PC4a/b: Demonstrates skills in performing and interpreting invasive & non-invasive procedures

  • Performs procedures including arthrocentesis and injections, compensated polarized microscopy, and interpretation of synovial fluid analysis
  • Demonstrates expertise in the performance and interpretation of the musculoskeletal examination

PC5: Requests and provides consultative care

  • Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment.
  • Models management of discordant recommendations from multiple consultants  
  • Proficient in performing as a rheumatology consultant or health care team leader for patients with primary rheumatologic diagnoses.
  • Provides rheumatology consultation to other specialties and providers

Medical Knowledge

 MK1: Possesses Clinical Knowledge

  • Possesses a basic core of knowledge of the clinical features and presentations, pathophysiology, laboratory and imaging manifestations and comprehensive management of rheumatologic and musculoskeletal diseases. This includes arthritis in all its forms, both acute and chronic, as well as metabolic diseases of bone, osteoporosis and musculoskeletal pain syndrome and systemic diseases with rheumatic manifestations, particularly including the connective tissue diseases. 
  • Possesses a knowledge base that includes an appropriate content of anatomy, genetics, biochemistry, immunology, genetic basis, cell biology,  physiology, pharmacology, epidemiology, statistics, ethics, and human/social behavior as needed for the Clinical practice of Rheumatology and evidence-based decision making
  • Possesses a core knowledge of treatment for both common and uncommon diseases found in Rheumatology.  This includes understanding the principles, indications and contraindications, risks, complications (including adverse events interactions), techniques and interpretation of results of diagnostics, screening test/procedures, pharmacokinetics, metabolism, cost and utility of the various treatments.  It also includes recognition of the need for appropriate consultation, and of reasonable expectations from such a consultant. 

 MK2: Knowledge of diagnostic testings and procedures

  • Demonstrates expertise in the performance and/or interpretation of diagnostic, imaging studies and therapeutic procedures common to the practice of Rheumatology, particularly arthrocentesis and relevant to the evaluation of patients with suspected or established rheumatic and musculoskeletal disease. This includes understanding the principles, indications and contraindications, risks, cost, and utility of the procedures.

 MK3: Scholarship

  • Possess a level of skill and expertise in clinical and/or basic research defined as competence in understanding the quality of experimental and clinical trial design, implementation, data analysis and interpretation of research studies. This includes research methodology, critical interpretation of data and of published research, and responsible use of informed consent.

Systems Based Practice

SBP 1: Works effectively within an interprofessional team

  • Facilitates the learning of patients, families and members of the interprofessional team

SBP 2: Recognize system error and advocates for system improvement

  • Demonstrates competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, during health and all stages of illness including their cost effectiveness
  • Demonstrates an awareness of the larger content and system on health care delivery and the ability to effectively call on system resources to provide safe and quality care
  • Enhance and promote patient safety and the quality of health care at both the individual and systems level

SBP 3: Identifies the forces that impact the cost of health care, and advocates for and practices cost-effective care

  • Shows increasing appreciation and understanding of cost effectiveness in patient care and resource utilization.
  • Demonstrates an understanding of managed care, federal versus private insurers and the social consequences of the uninsured.
  • Contributes to the fiscally sound and ethical management of a practice

SBP 4: Transitions patients effectively within and across health delivery systems

  • Effectively communicates and manages the transition of care with other healthcare providers

Practice – Based Learning and Improvement Objectives

PBLI 1: Monitors practice with a goal for improvement

  • Systematically analyzes their practice using quality improvement methods, and implement changes with the goals for improvement
  • Initiates their own self review in the quality of the work that they do, including evaluating patient care experiences as well as the progressive acquisition of specialty knowledge.
  • Engages in lifelong learning

PBLI 2: Learns and Improves via performance audit

  • Understands the limits of their knowledge and experience and asks for help when needed. Self improvement comes from: regular assessments of all competencies; setting learning and improvement goals; identifying and performing appropriate learning activities; and receiving balanced and honest feedback from the fellowship program.

PBLI 3: Learns and improves via feedback

  • Continues to improve in their ability to receive feedback in identifying strengths and deficiencies. They use this knowledge to translate into better patient care

PBLI 4: Learns and improves at the point of care

  • Demonstrates competence in information technology and the ability to find answers to clinical questions that are asked. As fellow progresses through their training, there should be increasing evidence that the scientific literature is being used to guide clinical decision-making.
  • Participate in the education of patients, families, students, fellows and other health professionals.

Interpersonal Communication Skills

ICS 1: Communicates effectively with patients and caregivers

  • Development of excellent oral, written, and electronic communication skills with patients, peers and paramedical personnel across a broad range of socioeconomic and cultural backgrounds.
  • Obtain procedure specific informed consent by competently educating patients about rationale, technique and complications of procedures.

ICS 2: Communicates effectively in interprofessional teams

  • Consistently and actively engages in collaborative communications with all team members and leader

ICS 3: Appropriate utilization and completion of health records

  • Maintains comprehensive, timely and legible medical records and communicates clinical reasoning

Professionalism

Prof 1: Has professional and respectful interactions with patients, caregivers, and members of interprofessional team

  • Develops qualities of professionalism and humanistic skills, including integrity, compassion and respect for patients, peers and paramedical personnel.

Prof 2: Accepts responsibility and follows thru on tasks

  • Are responsive to patient needs that supersedes self-interest, respect patient privacy and autonomy, accountable to patients, society and the profession.

Prof 3: Responds to each patient’s unique characteristics and needs

  • Sensitive and responsive to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation

Prof 4: Exhibits integrity and ethical behavior in professional conduct

Fellows will develop the ability to work in a variety of settings

  • As a primary health care provider for acutely ill in-patients, including in the Emergency Department and Intensive Care Unit, and ambulatory out-patients. 
  • As a rheumatology consultant to other internists and other physicians in these settings. 
  • As the leader of a multi-disciplinary health care team, including other medical and surgical specialists, rehabilitation therapists, home health care providers, etc.
  • As a teacher of their clinical skills, professionalism and humanistic skills to trainees at more junior levels, so as to serve as a model for trainees. 

Life Long Learning

The program enables the trainee with the skill set to acquire, critically analyze, synthesize and reassess their knowledge, skills and professionalism. This is achieved through the development of independent study habits for acquiring clinical and research knowledge and skills; and attendance, presentation and participation in the organization of local, regional and national educational and scientific conferences. 

Continuing medical education and society memberships

Fellows are strongly encouraged to become members of the American College of Rheumatology and the American College of Physicians.  Their participation in the CME activities of these organizations is important to promote their standards of professionalism and the process of life-long learning. The department of medicine will pay for one membership in a major subspecialty society per fellow. 

SPECIFIC GOALS

CLINICAL COMPETENCY is essential for all physicians. By graduation the training rheumatologist must be competent in the following 6 Core Competencies:

           

Patient Care

PC1 : Gathers and synthesizes essential and accurate information to define each patient’s clinical problems.

  • Proficient in taking a complete history, performing a physical examination (particularly of the joints and musculoskeletal structures) and the use laboratory and imaging studies
  • Demonstrates expertise in the performance and interpretation of the musculoskeletal examination

PC2: Develops and achieves a comprehensive management plans for each patient.

  • Possesses the ability and to analyze critically the clinical and laboratory data, integrate this with their basic foundation of medical knowledge, and formulate appropriate differential diagnoses and therapeutic plans.
  • Prescribes and manages immunomodulatory therapy
  • Provides patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

PC3: Manages patients with progressive responsibility and independence

  • Manages the care of patients with acute and chronic, common and complex rheumatologic diseases across multiple care settings
  • Advocates for individual patients

PC4a/b: Demonstrates skills in performing and interpreting invasive & non-invasive procedures

  • Performs procedures including arthrocentesis and injections, compensated polarized microscopy, and interpretation of synovial fluid analysis
  • Demonstrates expertise in the performance and interpretation of the musculoskeletal examination

PC5: Requests and provides consultative care

  • Provides consultation services for patients with very complex clinical problems requiring extensive risk assessment.
  • Models management of discordant recommendations from multiple consultants  
  • Proficient in performing as a rheumatology consultant or health care team leader for patients with primary rheumatologic diagnoses.
  • Provides rheumatology consultation to other specialties and providers

Medical Knowledge

 MK1: Possesses Clinical Knowledge

  • Possesses a basic core of knowledge of the clinical features and presentations, pathophysiology, laboratory and imaging manifestations and comprehensive management of rheumatologic and musculoskeletal diseases. This includes arthritis in all its forms, both acute and chronic, as well as metabolic diseases of bone, osteoporosis and musculoskeletal pain syndrome and systemic diseases with rheumatic manifestations, particularly including the connective tissue diseases. 
  • Possesses a knowledge base that includes an appropriate content of anatomy, genetics, biochemistry, immunology, genetic basis, cell biology,  physiology, pharmacology, epidemiology, statistics, ethics, and human/social behavior as needed for the Clinical practice of Rheumatology and evidence-based decision making
  • Possesses a core knowledge of treatment for both common and uncommon diseases found in Rheumatology.  This includes understanding the principles, indications and contraindications, risks, complications (including adverse events interactions), techniques and interpretation of results of diagnostics, screening test/procedures, pharmacokinetics, metabolism, cost and utility of the various treatments.  It also includes recognition of the need for appropriate consultation, and of reasonable expectations from such a consultant. 

 MK2: Knowledge of diagnostic testings and procedures

  • Demonstrates expertise in the performance and/or interpretation of diagnostic, imaging studies and therapeutic procedures common to the practice of Rheumatology, particularly arthrocentesis and relevant to the evaluation of patients with suspected or established rheumatic and musculoskeletal disease. This includes understanding the principles, indications and contraindications, risks, cost, and utility of the procedures.

 MK3: Scholarship

  • Possess a level of skill and expertise in clinical and/or basic research defined as competence in understanding the quality of experimental and clinical trial design, implementation, data analysis and interpretation of research studies. This includes research methodology, critical interpretation of data and of published research, and responsible use of informed consent.

Systems Based Practice

SBP 1: Works effectively within an interprofessional team

  • Facilitates the learning of patients, families and members of the interprofessional team

SBP 2: Recognize system error and advocates for system improvement

  • Demonstrates competence in the practice of health promotion, disease prevention, diagnosis, care, and treatment of patients of each gender, from adolescence to old age, during health and all stages of illness including their cost effectiveness
  • Demonstrates an awareness of the larger content and system on health care delivery and the ability to effectively call on system resources to provide safe and quality care
  • Enhance and promote patient safety and the quality of health care at both the individual and systems level

SBP 3: Identifies the forces that impact the cost of health care, and advocates for and practices cost-effective care

  • Shows increasing appreciation and understanding of cost effectiveness in patient care and resource utilization.
  • Demonstrates an understanding of managed care, federal versus private insurers and the social consequences of the uninsured.
  • Contributes to the fiscally sound and ethical management of a practice

SBP 4: Transitions patients effectively within and across health delivery systems

  • Effectively communicates and manages the transition of care with other healthcare providers

Practice – Based Learning and Improvement Objectives

PBLI 1: Monitors practice with a goal for improvement

  • Systematically analyzes their practice using quality improvement methods, and implement changes with the goals for improvement
  • Initiates their own self review in the quality of the work that they do, including evaluating patient care experiences as well as the progressive acquisition of specialty knowledge.
  • Engages in lifelong learning

PBLI 2: Learns and Improves via performance audit

  • Understands the limits of their knowledge and experience and asks for help when needed. Self improvement comes from: regular assessments of all competencies; setting learning and improvement goals; identifying and performing appropriate learning activities; and receiving balanced and honest feedback from the fellowship program.

PBLI 3: Learns and improves via feedback

  • Continues to improve in their ability to receive feedback in identifying strengths and deficiencies. They use this knowledge to translate into better patient care

PBLI 4: Learns and improves at the point of care

  • Demonstrates competence in information technology and the ability to find answers to clinical questions that are asked. As fellow progresses through their training, there should be increasing evidence that the scientific literature is being used to guide clinical decision-making.
  • Participate in the education of patients, families, students, fellows and other health professionals.

Interpersonal Communication Skills

ICS 1: Communicates effectively with patients and caregivers

  • Development of excellent oral, written, and electronic communication skills with patients, peers and paramedical personnel across a broad range of socioeconomic and cultural backgrounds.
  • Obtain procedure specific informed consent by competently educating patients about rationale, technique and complications of procedures.

ICS 2: Communicates effectively in interprofessional teams

  • Consistently and actively engages in collaborative communications with all team members and leader

ICS 3: Appropriate utilization and completion of health records

  • Maintains comprehensive, timely and legible medical records and communicates clinical reasoning

Professionalism

Prof 1: Has professional and respectful interactions with patients, caregivers, and members of interprofessional team

  • Develops qualities of professionalism and humanistic skills, including integrity, compassion and respect for patients, peers and paramedical personnel.

Prof 2: Accepts responsibility and follows thru on tasks

  • Are responsive to patient needs that supersedes self-interest, respect patient privacy and autonomy, accountable to patients, society and the profession.

Prof 3: Responds to each patient’s unique characteristics and needs

  • Sensitive and responsive to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation

Prof 4: Exhibits integrity and ethical behavior in professional conduct

Fellows will develop the ability to work in a VARIETY OF SETTINGS

  • As a primary health care provider for acutely ill in-patients, including in the Emergency Department and Intensive Care Unit, and ambulatory out-patients. 
  • As a rheumatology consultant to other internists and other physicians in these settings. 
  • As the leader of a multi-disciplinary health care team, including other medical and surgical specialists, rehabilitation therapists, home health care providers, etc.
  • As a teacher of their clinical skills, professionalism and humanistic skills to trainees at more junior levels, so as to serve as a model for trainees. 

Life-long Learning

The program enables the trainee with the skill set to acquire, critically analyze, synthesize and reassess their knowledge, skills and professionalism. This is achieved through the development of independent study habits for acquiring clinical and research knowledge and skills; and attendance, presentation and participation in the organization of local, regional and national educational and scientific conferences. 

Continuing medical education and society memberships:

Fellows are strongly encouraged to become members of the American College of Rheumatology and the American College of Physicians.  Their participation in the CME activities of these organizations is important to promote their standards of professionalism and the process of life-long learning. The department of medicine will pay for one membership in a major subspecialty society per fellow. 

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