Inpatient and Outpatient Experience
Inpatient Rheumatology Experience
Each fellow will be responsible for the Consult Service for a total of 23 weeks during their two years of fellowship training, and will personally see approximately 300 patients. On average, the fellow will have direct patient care responsibility for 2 cases and serve as a consultant on 8 at any given time. The consult service covers 3 hospitals settings that serve diverse patient population needs:
- SUNY Upstate Medical University
- Crouse Irving Memorial Hospital
- Veterans Administration Hospital)
The fellow is responsible for running the Consult Service will distribute patients to any rotating Medicine residents and medical students. All initial patient consults must be seen by the fellow on-service an/or reported directly to the fellow by the resident or medical students before they are discussed with the attending.
Upstate Health Care Center
Upstate University Hospital
Under the supervision of the Consult Attending, the fellow will develop and refine their clinical evaluation skills of patients with rheumatic diseases, including appropriate differential diagnosis, diagnostic evaluation, treatment, and the need for continued hospitalization. Their exposure on the inpatient service will hone their understanding of indications and contraindications, techniques and possible complications of arthrocentesis and interpretation of results. Fellows will acquire skills in performing synovial fluid crystal analysis by polarized light microscopy as well as other non-invasive and invasive procedures.
Consult consists of formal rounding 3 times a week (Mon., Wed., and Friday). Rounds on Tuesday and Thursday are dependent based off of the attending preference and the patient needs
The On-call schedule is generally divided on a weekly basis between the four fellows. Call hours are adjusted accordingly to comply with ACGME Duty Hour requirements. Fellows cover Monday through Sunday. For fellows whom are not on call on Saturdays and Sundays, are entirely free from hospital duties. Call is taken from home via beepers and telephone.
While on In-patient consult service, fellows are excused from all their clinic duties except for their continuity clinic.
A fellow will be assigned as back-up consult to the primary consult fellow during the consult week from Monday to Friday. The main responsibilities of the back-up consult is to cover the primary fellow on consult during their assigned continuity clinic. The start and stop time for the back-up will be from 11:30 pm-5:00 pm. The backup consult will be available for assistance when there is no back-up resident and a need for at least 1 new consult. Each fellow will be assigned another fellow to be their back-up consult throughout the academic year.
Inpatient Call Schedule Sample
Outpatient Rheumatology Experience
Fellows are assigned to 3 Half-day ambulatory clinics per week. During the course of their two-year fellowship, on average they will see 1.5 new and 5 follow-up patients per session leading to a total of more than 600 new and 2,000 follow-up patients during the course of their 2-year training. Continuity of follow-up with the same fellow is emphasized. Fellows have their own continuum of care ½ day clinic once per week that is precepted by an attending and participate in 3 other half-day clinics per week that can vary in location from our 5 outpatient clinic settings:
- Adult - University Health Care Center (UHCC)
- Adult - Veterans Administration arthritis clinic (VA)
- Adult - The Hill Medical Center
- Pediatric Rheumatology Outpatient Center – Physicians Office Building
- Upstate Rheumatology (Homer)
The outpatient experience allows for the development of progressive responsibility with appropriate supervision by faculty. The end-goal is to have the fellow ready for unsupervised practice by becoming expert in the evaluation and management of outpatient rheumatic disease problems while understanding patient’s natural history over several years.