Rheumatology

FELLOWSHIP TRAINING PROGRAM IN RHEUMATOLOGY 

Accredited by the Philippine Rheumatology Association

Entry Requirement
Board certification in Internal Medicine from the Philippine College of Physicians (see pgh.gov.ph for details about application to the training program)

Description of the Discipline
Rheumatology incorporates the investigation, diagnosis, management and rehabilitation of patients with disorders of the musculoskeletal system, i.e. the locomotor apparatus, bone and soft connective tissues. The rheumatic disorders thus include diverse conditions such as inflammatory arthritis, autoimmune rheumatic disorders, soft tissue conditions including injuries, osteoarthritis, spinal pain and other chronic pain syndromes and metabolic bone disease.  Rheumatology requires interdisciplinary knowledge and awareness of new developments in internal medicine, immunology, orthopedics, neurology, pain management, rehabilitation, psychiatry, nursing and other professions allied to medicine.

Course Description
The fellowship training program is a two-year course which enables an internist to develop his/her knowledge, skills, and attitudes for a holistic, compassionate, and ethical approach in the diagnosis, treatment, and prevention of rheumatic diseases.

Expected Outcomes (based on CHED Memorandum Order 18 of 2016- Policies, Standards and Guidelines for the MD Program)

1. Astute rheumatologist with sufficient knowledge of the subspecialty to make a correct diagnosis and carry out a holistic treatment plan.
2. Effective communicator and educator- able to explain the suspected diagnosis, planned diagnostics and treatment, and need for subspecialty referrals to the patient and his family; facilitates effective learning of medical practitioners and other health workers about the discipline.
3. Effective leader and manager- able to plan, organize, implement and evaluate programs and provide clear direction and motivation to the health care team and community.
4. Competent researcher- able to critically appraise medical literature and apply these findings in patient- care activities; actively generates research findings to contribute to the general body of knowledge in Rheumatology.
5. Effective team worker- able to participate in the interdisciplinary team involved in the care of his patients and to appreciate the roles of each member of the team in comprehensive and well-coordinated management of the patient and his problems. He is also able to work in teams in managing projects, institutions, and similar situations.
6. Effective user of systems-based approach in delivery of care; able to network with relevant partners in solving problems in Rheumatology.
7. Life-long learner- Actively updates oneself through various means for personal and professional growth to ensure quality healthcare.
8. A physician who is ethical, professional, and adherent to legal standards
9. A physician who is nationalistic and dedicated to serve his country and the world
10. A practitioner of social accountability- adheres to the principles of relevance, equity, quality, and cost-effectiveness in the delivery of healthcare.

Teaching & Learning Methods

1. Knowledge acquisition

• • Personal study including effective use of medical literature
  • Preceptorship
  • Didactic Lectures
  • Journal clubs and critical appraisal of literature

2. Clinical skills and attitudes

• • Demonstration of physical examination skills in normal subjects and patients by trainer
  • Observation of consultants managing clinical problems in daily professional  practice
  • Observation of consultants communicating with patients and members of team
  • Presenting history, demonstrating clinical findings and use of investigations on ward rounds or tutorial sessions
  • Delivery of scientific lectures during conferences and research presentations
  • Delivery of lay lectures
  • Planning and/or carrying out of research projects
  • Presentation of critical appraisal of medical literature
  • Writing of medical history, case discussion, research appraisal, research proposal/protocol, and manuscript.
  • Participation in the organization of regular and special activities of the Section.

3. Procedures

• • Demonstration of procedures (including arthrocentesis, injection of joints, drug infusions, ultrasound of joints) by trained operator in patients requiring the procedure.
  • Performance of procedures under observation
  • Reinforce skills through repeated performance of procedures among patients requiring the procedures

Teaching and Learning Activities

1. Lectures
2. Patient Rounds
3. Demonstration-Return Demonstration
4. Conferences

1. • Basic Rheumatology Lectures
   • Critical Appraisal of Literature
   • Case Management
   • Journal Club
   • Research Presentation

5. Special Projects
6. Administrative Tasks

Evaluation of Trainees

1. Monthly performance evaluation
2. Conference evaluation
3. Written examination
4. Evaluation of special projects
5. Evaluation of research projects

Evaluation of Training Program
This is performed at least once yearly by trainees and every three years by the staff of the Division.  An accreditation visit is performed by the Philippine Rheumatology Association every five years.  The last accreditation visit was in December 2019.

RESIDENCY TRAINING IN INTERNAL MEDICINE

Subspecialty Rotation in Rheumatology

General Description
The second and third year residents will rotate in the different subspecialties of the Department of Medicine for 2 weeks  as part of the requirements for training as detailed by the Philippine College of Physicians.  This will expose the trainees to subspecialty cases and to the details of diagnosis and management that are often not seen in the general services. This will also strengthen their confidence in diagnosing and managing common medical cases through their discussion of these cases with the subspecialty consultants and fellows.

Objectives
At the end of their residency training, the residents are expected to be able to:

1. Diagnose and manage rheumatic diseases that are common in the country and globally.
2. Recognize and give appropriate management for emergencies in Rheumatology and for complicated or uncommon rheumatic diseases.
3. Interpret the results of laboratory tests that are commonly used in managing patients with rheumatic diseases.
4. Discuss the indications, contraindications, benefits, and adverse effects of procedures that are commonly used in managing patients with rheumatic diseases.
5. Ascertain the appropriateness of referring to and co-managing patients with the rheumatologist and other specialists handling musculoskeletal diseases.
6. Adequately communicate with the professional teams co-managing his patients with rheumatic diseases.
7. Adequately communicate with his/her patients and the family about the diagnosis, treatment, prognosis of the rheumatic disease, and the appropriate health systems in place that can be explored for assistance.
8. Appraise and apply evidence from medical literature to the management of patients.
9. Demonstrate professionalism, nationalism, integrity, compassion, and respect for others’ values and preferences.
10. Demonstrate willingness to advocate for patients with rheumatic diseases.
11. Appreciate the relationship between the subspecialty of Rheumatology and General Internal Medicine.

Expected Outcomes

1. Astute general internist with sufficient knowledge of rheumatic diseases to diagnose and manage them, the extent of these dependent on the prevalence and complexity of the cases.
2. Effective communicator- able to explain the suspected diagnosis, planned diagnostics and treatment, prognosis, and need for subspecialty referral to the patient and his family
3. Critical in applying information obtained through research in patient care.
4. Effective team worker- able to appreciate the roles of the general internist and the subspecialist in comprehensive and well-coordinated management of the patient and his problems.
5. Effective team leader in clinical work and other health-related activities for health promotion.
6. Efficient user of resources and existing systems for health promotion
7. A patient advocate
8. Ethical physician
9. Nationalistic health professional
10. Health educator

Content
Refer to the Philippine College of Physicians Residency Training Committee Manual

Activities

• Rounds with subspecialty staff
• Subspecialty Conference
• OPD Clinics
• Procedures

Requirement

• Charting of inpatient and outpatient cases
• Attendance in subspecialty rounds, OPD, conferences, procedures
• Calendar of rotators’ general IM and subspecialty schedule of activities
• List of cases seen and procedures done (to be countersigned by supervising fellow or consultant)

Evaluation

• Performance Evaluation
• Conference Evaluation
• Attendance (based on calendar of scheduled activities)
• Resident’s evaluation of the rotation

Undergraduate Teaching at the College of Medicine, University of the Philippines Manila

LEARNING UNIT 4 (Second Year MEDICINE)
OS212: Human Disease and Treatment 2 (Locomotion and Sensation)
Course Description: Pathophysiology, Symptomatology, Diagnosis, Prevention and Principles of Treatment of diseases of the Musculoskeletal and Sensory Systems
Credit: 180 hours

LEARNING UNIT 5 (Third Year MEDICINE)
MUSC 250: Integrated Clinical Clerkship in the Musculoskeletal System
Course Description: Rotation in the Orthopedics, Rehabilitation Medicine, and Rheumatology Clinics with supervised participation in the diagnosis, management and prevention of common musculoskeltal conditions.
Credits: 2 weeks per group

LEARNING UNIT 6 (Fourth Year MEDICINE)
MED 251: Integrated Clinical Clerkship II in Medicine
Course Description     The course includes comprehensive training in the clinical management of common and important medical diseases in a setting that may require ward or critical care unit admission with focus on diagnosis, treatment, prevention, control.
Credits: 6 weeks per group

LEARNING UNIT 7 (Fifth Year MEDICINE/INTERNSHIP)
MED 260: Integrated Clinical Clerkship in Medicine
Course Description: This program is intended to allow the medical students to actively manage patients in the charity medical wards, medical outpatient clinics, emergency room and medical intensive care units under the direct supervision of medical residents and consultants.
Credits: 8 weeks per group

LMLR 2023: Life to the Max, Living with Rheumatic Disease