The inpatient and outpatient experience is the main training ground of the fellowship program. All trainees acquire experience in treating a wide range of rheumatologic problems because our 3 hospitals (UH, VA, and Crouse) have different types of patients, which together encompass the whole range of rheumatologic diseases.

Overall, each fellow receives approximately 80 hours per month of faculty supervision and teaching in the outpatient setting, and approximately 30 hours per month for inpatients. The combination of both patient settings provides an environment and resources for the fellow to gain in-depth experience in the diagnosis and treatment of patients with a mix of diseases such as:

• systemic connective tissue diseases (including rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis)
• various vasculitis syndromes with/without spondyloarthropathies
• crystal-induced synovitis, osteoarthritis
• non-articular rheumatic diseases (including fibromyalgia, nonsurgical exercise-related (sports) injuries)
• other systemic diseases with rheumatic manifestations
• metabolic bone disease (including osteoporosis, infection of joints, joint surgery, and rheumatologic problems requiring rehabilitation therapy)

In-depth experience is provided in the specific examination of all joints structures and functions, both axial and peripheral, as well as periarticular structures and muscles. Fellows become very skillful in constructing differential diagnoses for complex symptoms and signs related to rheumatologic diseases, also in the diagnostic aspiration and analysis by light and polarized light microscopy of synovial fluid, and in the therapeutic injection of diarthrodial joints, bursa, tenosynovial structures and entheses. The fellows also acquire in-depth experience and skill in the use of non-steroidal anti-inflammatory and disease-modifying drugs, also biologic response modifiers, glucocorticoids, cytotoxic and hypouricemic drugs, and antibiotic therapy for septic joints.  

Faculty Mentorship 

All fellows will be assigned a faculty mentor who will support them in their clinical and scholarly activity. The mentor will work with the fellow in helping to guide them in their research and case study reports by helping them identify cases, collect data, and point out significant findings. At the beginning of the academic year, the fellow is assigned to the preceptor of their continuity clinic as their mentor. The assignment can change based upon the availability of the faculty member. 

Note Writing

Note writing is essential in the comprehension and the development of critical thinking skills for the fellows. The fellows' notes will be monitored closely by the attending and encouraged to use note writer in practice and or develop their own style of which does not include copy and pasting. All fellows will be required to sign an attestation stating that they have read and understood the institution’s policy on copy and pasting EMR notes.

Monthly Case Study

Each fellow will perform a monthly clinical case study. The fellows can choose the topic and patient for the study and the attending that they will present to. The presentation will occur either at the Friday Didactic sessions or independently with the attending and the fellow can use write it in EPIC. The clinical case study will include differential diagnosis, diagnostics, and clinical research. The fellows will be required to track their cases and/or report them to the fellowship coordinator.

Role as Teachers

The program provides an environment for promoting active teaching of medical students, residents, and other allied health personnel, as well as education of patients by the fellows. Fellows receive instruction and feedback in counseling and communication techniques. This includes cultural, social, behavioral, and economic issues such as confidentiality of information and indications for life-support systems. Fellows learn about cultural, social, and other issues by their clinical inpatients and outpatient experience under the close supervision and teaching of the Attending. These topics are also discussed during clinical management of the patients by the Attending and in conferences.

Fellows are responsible for teaching and supervising medical students and internal and PM&R residents while on the Inpatient Consult Rotation, in conjunction with the attending. They have a lesser role in outpatient teaching, as this is handled almost exclusively by the attending. The fellows have a major role in teaching and supervising the other trainees to prepare topics for the various conferences, particularly the weekly Rheumatology Grand Rounds. Fellows are strongly encouraged by the attending to develop effective teaching and communication skills.