Rheumatology Fellowship Clinical Training

Our fellows learn the clinical science of rheumatology at three principal training locations: Yale New Haven Hospital’s York Street Campus (YSC), Yale New Haven Hospital’s Saint Raphael's Campus (SRC), and the VA Connecticut Healthcare System, West Haven Campus. These venues are leading medical centers in southern New England and provide state-of-art clinical care and education.

Yale’s rheumatology clinical fellowship training program lasts two years.

During your two years as a rheumatology fellow, you will learn and participate in the diagnosis and management of patients with a wide variety of rheumatic diseases and other diseases with rheumatologic manifestations. Partaking in musculoskeletal ultrasound training and subspeciality clinics bolster your clinical experience. You become the integral part of a resident, student, and faculty team who supervises the practical aspects of patient care and provides didactic teaching of the scientific disciplines that underlie the practice of rheumatology.

Over the fellowship program, you are assigned to the inpatient consultation service interspersed with elective months. The fellow on service for each training location responds to calls and consults during weekdays, whereas weekend coverage is divided equally among your first- and second-year co-fellows. You are provided a cellular phone with Mobile Heartbeat, a smartphone app that enables HIPAA-compliant texting, telephone communications, EMR access and management, and patient-specific alerts, as well as ease of communication with attending physicians and as-needed consultants.

In additions to inpatient consultations, you will attend selected outpatient clinics throughout your training. Outpatient clinics are held weekly and include:

• Fellows' General Rheumatology Clinic at Yale New Haven Health’s North Haven Medical Center at the Interventional Immunology Center and YNHH SRC’s Orchard Street Clinic where you will see a diverse range of patients with rheumatic diseases
• Bone and Joint Clinics at the VA Connecticut Healthcare System, with a large number of patients with inflammatory and mechanical arthritis, and training in joint injections, arthrocentesis, and musculoskeletal ultrasound
• Subspecialty clinics at YNHH Interventional Immunology Center and YNHH SRC offering specialized care (including specialty clinics) for patients with lupus and related autoimmune diseases, rheumatoid and other inflammatory arthritis, systemic sclerosis, rheum-derm, spondyloarthropathies

Subspecialty elective opportunities in the second year allows you to develop skills needed for an individualized career paths, including but not limited to, rotations in hand surgery, radiology, and pediatric rheumatology.

Wellness mentors are assigned to each fellow. Mentors are selected from faculty that are not directly involved with your supervision. Sectional wellness activities will occur throughout the year where fellows and faculty can interact in a social setting.

The core curriculum topics will be incorporated into the following teaching conferences and experiential activities:

Educational conferences sponsored by our program include weekly Rheumatology Grand Rounds and monthly combined conferences with Allergy & Immunology, presented by Yale faculty members and/or other nationally or internationally recognized speakers.

As a fellow, you will manage the post Grand Rounds conference. These are teaching forums in the form of a case presentation or relevant Journal Club. This is an opportunity for fellows and faculty to gather and discuss challenging clinical cases in depth.

You are expected to present and participate in a clinical pathology conference and a mortality and morbidity conference at least once during your two years of clinical training. These are mentored activities designed to improve clinical acumen and quality of care. Once a month, the post Grand Rounds conference is dedicated to a basic immunology review that is relevant to a case presented by the trainee. Select scientific faculty will work with the presenting fellow to build the scientific foundation necessary to develop rheumatology scholars.

The summer lecture series is held weekly and consist of both clinical and basic science lectures, as well as physical exam practicals for all fellows. These lectures are normally held on Wednesdays and Fridays in July and August. The summer lecture series culminates in a rheumatology-focused Objective Structured Clinical Examination (OSCE).

You will participate in a weekly interdisciplinary lunchtime conference with orthopedics and physiatry at the VA Bone and Joint clinic. The schedule alternates between journal club, case presentations, and musculoskeletal radiology review. During the summer months, the noontime sessions are focused on musculoskeletal exam skills. Each month, you will present a rheumatology topic as a 30-minute review to the group. Journal club topics are focused on sports medicine, relevant orthopedics, rehabilitation, and related disciplines.

You will attend conferences that aim to supplement materials and knowledge learned on rounds and in the clinic, following ACGME Review Committee guidelines for training in rheumatology and the American College of Rheumatology core curriculum standard. Medical image mystery, board review questions, literature review, e-Based learning (in the form of videos), and difficult case scenarios are presented and used as teaching tools during the exercise.

Interdisciplinary conferences are held quarterly with rheumatology and other subspecialties:

• Rheumatology-Dermatology Comprehensive Conference
  
  • The rheumatology-dermatology conference brings together faculty members from rheumatology, dermatology, and dermatopathology, along with their trainees, to discuss the diagnosis and management of challenging cases seen in consultation.
  • The conference details cases with dermatologic and rheumatologic overlap, covering key clinical and pathologic findings followed by group discussion.
  • The cases are co-presented by dermatology resident(s) and rheumatology fellow(s).
• Rheumatology-Pulmonary Comprehensive Conference
  • These conferences are attended by interstitial lung disease experts and pulmonary fellows, a chest radiologist, along with rheumatology faculty and trainees.
  • As the rheumatology fellow, you will present an interesting case and experts will discuss their approach to the patient in terms of diagnosis, treatment, and prognosis.
• Musculoskeletal Radiology Conference
  • The musculoskeletal (MSK) radiology conference is attended by a dedicated MSK radiologist who joins the rheumatology faculty and trainees for a themed case-based review of different radiographic images of rheumatologic conditions.
  • These include sessions dedicated to rheumatoid and other inflammatory arthritides, crystalline arthritis, and metabolic bone disease.

The monthly Research in Progress seminars are for both faculty and research fellows to present fundamental laboratory studies in the rheumatic diseases. This didactic and interactive seminar series is aimed at defining key questions in the biology of rheumatic diseases, the approaches to studying these questions in the laboratory, and discussing experimental results.

The program is designed to provide constructive criticism and research direction to the speaker with an emphasis on establishing research interactions among investigators in rheumatology. The topics presented range from basic research, including preclinical models of disease, molecular and cellular immunology, pathology, and mechanisms of disease, to translational research including studies using human tissue, computer and data science, and imaging to better understand rheumatic diseases, and patient-reported outcome instrument studies.

The Musculoskeletal Ultrasound course is an important diagnostic and therapeutic tool that many rheumatologists use in daily practice. A longitudinal course for the fellows begins every September, and consists of a monthly Wednesday afternoon four-hour didactic and hands-on scanning session. There are eight sessions per academic year with a required 75% attendance for fellows. The ultrasound-directed joint injection clinic at the VA Connecticut Healthcare System occurs weekly and is managed by the VA attending and the fellow covering the VA.