Rheumatology Subspecialty Education Program
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The Adult Rheumatology Training Program at the University of Manitoba follows the guidelines of the Specialty Committee for Rheumatology of the Royal College of Physicians and Surgeons of Canada. It is a two-year program undertaken by candidates with training in Internal Medicine. Residents must have completed 3 or 4 years of General Internal Medicine training prior to entering the program. Royal College guidelines allow for simultaneous completion of the fourth year of internal medicine and the first year of rheumatology training.
The current program is divided into 26 four-week periods as set out by the Postgraduate Office at the University of Manitoba. The current collective bargaining agreement allows for one four-week period per year to be taken as vacation. The rotations are as follows:
- Arthritis Centre Clinics Consults - 12 periods
- Community Practice - 2 periods
- Pediatric Rheumatology - 2 periods
- Laboratory Investigations and Pathology in Rheumatology - 1 period
- Non-inflammatory musculoskeletal Diseases - 1 period
- Electives - 6 periods
- Vacations - 2 periods
Total: 26 periods
In addition to the various rotations, residents will participate in several longitudinal activities. These include a weekly Subspecialty Residents Clinic, Academic Half Day - Rheumatology, Journal Club, and Radiology Rounds. Further, residents will be expected to undertake and present a research project appropriate for their level of training. Call duties never exceed 1 in 4. The Academic half day and the Subspecialty resident’s clinic continue throughout the whole two years of training whether the resident is doing mandatory rotations or electives.
Arthritis Centre Clinics. The Arthritis Centre Clinic and Consults block consists of 12 periods in the first year of training. Under the supervision of the GFT section members, the resident will attend 4 – ½ day outpatient clinics per week. The resident will see both new consultations as well as patients with established rheumatic diseases. New patients requiring follow-up will be seen in the resident’s weekly longitudinal follow-up clinic (“Fellow’s” clinic) on Friday morning . This clinic is in addition to the 4 scheduled clinics for that week. During these periods the resident will gain exposure to patients with inflammatory arthritides, complex connective tissue diseases, systemic vasculitides and rheumatic complications of systemic diseases encountered in a tertiary care centre. The “Fellow’s” clinic allows for longitudinal exposure to the management of these patients. Fellows will continue to attend Academic Half Day - Rheumatology during these periods.
Arthritis Centre Consult Service. This experience is combined with the first 12 periods of Arthritis Center Clinic block. During these 12 periods the resident will learn about inpatient management of rheumatic diseases at the tertiary centres (Health Sciences Centre and St. Boniface Hospital). The resident will have an invaluable experience in evaluating patients for possible rheumatic diseases or flares/relapses and complications of their known rheumatic illness admitted at these institutes as either inpatients or presenting to the emergency department. Along with the rotating internal medicine residents and medical students the resident will provide consult service on these patients and report to the rotating attending rheumatologist. It is expected that the resident will progress from being very “hands-on” to a more supervisory role as the periods progress and their knowledge base grows.
The “Subspecialty resident” clinic will continue through these periods and any unassigned inpatients requiring follow-up will be seen by the resident in “Subspecialty resident” clinic.
Community Practice. These periods consist of several clinics each week in a variety of community practice settings under the supervision of community practice members of the section. These periods provide exposure to different types of clinical rheumatology cases while giving insight into the operation of an office in community practice.
Pediatrics. Residents complete a minimum of 2 months on the pediatric rheumatology service. This consists of 3.5 ½ day outpatient clinics per week, inpatient consults at the Children’s Hospital and specific teaching sessions. Residents will gain exposure to pediatric rheumatic diseases and the unique circumstances related to care of the pediatric patient.
Non-inflammatory musculoskeletal rotation. Residents will spend one period attending outpatient clinics with a variety of musculoskeletal specialists focusing on soft tissue problems such as myofascial pain, mechanical spine problems, fibromyalgia, occupational and sports-related injuries.
Laboratory and pathology Rotation: One four week period is dedicated to learning hands on about the various immunologic tests done in rheumatology. The resident will also spend time reviewing muscle, skin, lung and renal pathology with dedicated experts in these areas.
Electives. Ample elective time is allotted for the resident to explore areas related to their career pathway. External elective rotations are encouraged. These may be research-based, clinical or a combination. Orthopedic, dermatology, ostoporosis, are some of the many possible elective opportunities. If desired, residents may spend extra time in some of the compulsory rotations described above. Where possible, electives will be done in the last 6 months of the training program.
The interdisciplinary core curriculum half day offered by the PGME office for all residents. When the topic is of value to the rheumatology residents they will be expected to attend. The Practice Management session is considered compulsory by the PGME office. Is this the Academic Half Day - Core Internal Medicine or something else? It's mentioned in several subspecialties...
Subspecialty Resident’s Clinic. The “Fellows” clinic allows trainees to follow their patients for the course of the training program. This allows trainees to follow the evolution of rheumatic disease and its treatment over time. This clinic occurs weekly under rotating supervision from the attending rheumatologists. For continuity, patients initially reviewed with one rheumatologist will be scheduled for clinic when that same rheumatologist is present.
Journal Club. Trainees are expected to attend and contribute to a monthly Journal Club held as part of the Academic Half Day - Rheumatology. This is an opportunity to review interesting research papers. Both basic science and clinical topics will be reviewed.
Radiology. Prior to each “Subspecialty Resident’s” clinic, films from the previous week will be reviewed with the attending rheumatologist. Trainees will be responsible for pulling films in advance of these rounds. The program owns an ultrasound machine with one faculty member trained in performing musculoskeletal ultrasound including ultrasound guided injections. Introduction to musculoskeletal ultrasound will be done at one of the tutorials at academic half day. Longitudinal exposure will be available through the Subspecialty Resident’s clinic.