Welcome to St. Michael's Hospital Rheumatology Rotation 2011

Dear Resident:

Welcome to St. Michael's.

In addition to the information provided by Dr. Louise Perlin regarding the educational programs (clinics, rounds, on call), this sheet will provide you with important information to help orient you to St. Michael's Hospital. Please meet with Dr. Perlin, 3rd Floor Shuter Wing Room 3-028, and the first day of your rotation at 9:30 am. Dr. Perlin can be reached through her secretary, Linda, at 416-864-5550 or mcaugheyl@smh.ca. You may also, contact Dr. Perlin directly at perlinl@smh.toronto.on.ca.

St. Michael's Hospital is one of the premier teaching hospitals in Toronto and for this country. It is a full service institution with considerable expertise in a variety of specialty medical and surgical areas. We hope you find your experience here to be challenging and rewarding.

To register at SMH prior to your Rheumatology rotation, please contact our Medical Education office either via
1. Mr. Bryan Abankwah
c/o Li Ka Shing Institute Student Centre
209 Victoria Street, 5th Floor, Room 575
Phone # 416 864-6060 ext 77514

or

2. On-line information
c/o stmichaelshospital.com
Teaching and Learning, Student Centre Registration.

Your Rheumatology clinic schedule and rounds schedule will be e-mailed to you prior to the rotation by our secretary, Ms Sofia Vasconcelos (vasconceloSo@smh.ca). Please let her know well in advance of the rotation.

Any vacation or other approved days off


Important Contact inform summary

1. SMH Registration:

Mr. Bryan Abankwah
AbankwahB@smh.ca - 416 864-6060 ext. 4176

2. General Internal Medicine (GIM) Call Schedule
Ms Betty Ann Lemieux
Lemieuxb@smh.ca - 416 864-6060 ext 4176

3. Rheumatology Division – St. Michael's Hospital
a) Dr. Louise Perlin – Education Co-ordinator
perlinl@smh.ca - 416-864-5550

b) Ms Sofia Vasconcelos – Education Admin and Schedules
vasconcelosSo@smh.ca - 416 864-5295

c) Ms Fran Badame – PowerPoint presentation questions
badamef@smh.ca - 416 864-5420

Locating is on 4 Shuter Wing. (5431)
The main hospital number is 416-864-6060.

Should you have any questions or concerns, please contact Dr. Perlin or her secretary, Linda. (ext 5550)
Again, welcome to St. Michael's.

St. Michael's Hospital Rheumatology Rotation Expectations 2011

Listed below are the expectations of the Core Medical Resident on the Rheumatology rotation at SMH, as applied to clinics and education.

A) Clinical Experience at SMH:

  1. To attend all ambulatory clinics as per the schedule you will be provided prior to the rotation. Please pay attention to the start times of each clinic. Your schedule has been made to accommodate your ½ day back, vacation etc. If you anticipate other unscheduled absences, you must inform and discuss with Dr. Perlin first, and then the staff whose clinic you will be missing.
  2. You are expected to follow up lab results, X rays etc. of patients you have seen in clinic as per your discussion with the attending staff.
  3. Dictations are done by phone via the hospital dictating system, please register in advance of the rotation with our Medical Education office to obtain a dictation number and instructions – see "Welcome" section for registration details. Dictations should be done on:
    1. All outpatient consultations & follow-up patients
    2. All inpatient consultations patients should have a brief summary at discharge. Some inpatients may require summary of major issues, diagnostic thoughts, and treatment recommendations when first seen in consultation. Please discuss with staff before dictating.
  4. In-patient or ER consults during the day are to be seen in a timely manner by the resident designated on the monthly call schedule. If you make changes with your colleague, please notify locating. If you are in clinic and must see a consult urgently (e.g., ER) please speak to your staff that will facilitate you leaving early. Feel free to 'run the consult by' the clinic MD if you are unsure of the consults urgency.
  5. The consult attending staff changes every 2 weeks. The attending call schedule is posted in your office along with contact numbers. Consult rounds are done by most staff Tues pm and Friday am but may vary and will be clearly laid out by each attending in turn. The attending is available to see ill/urgent patients in between as necessary.
  6. To present one seminar per month at Tuesday noon Rheumatology Rounds attended by Rheumatology staff and the Martin Centre Allied Health staff. You will be designated a date at the beginning of your rotation. Topic choice and content can be discussed with designated staff member. If you need help with Power Point or other technical assistance, please contact Fran Badame. Please save your Power Point in 2002 version or lower. Please ensure that Ms Badame has your presentation either the day before or early on the morning of your presentation. It can be e-mailed to her at; badamef@smh.ca.
  7. To attend all SMH Rheumatology specific rounds unless a conflict with other responsibilities exists.

B) Education at SMH

  1. Rheumatology rounds – every Tues 12-1pm (lunch provided) in the MFC except the 2nd Tues each month 12-1 combined Rheum-Radiology rounds (location TBA)
  2. Combined MSK Rounds as per schedule 7:45 am in the Small Shuter Auditorium
  3. Intercity Rounds HSC every other Tuesday as per schedule
  4. Weekly in patient consult rounds- usually Tues pm and Friday am or as per staff
  5. Medical Grand Rounds (as per schedule)-12-1 pm Weds
  6. Metabolic Bone Clinic rounds – Mon noon weekly 61 Queen Street after MB Clinic (lunch provided)
  7. Rheumatology A.M. report Tuesday 8 am every 2 months as per schedule

C) Feedback:
Dr. Perlin will meet with you mid-way and at the end of your rotation. During these meetings you will be given feedback and you will be asked for your feedback.
Please Note: If you will not be available the last 1 or 2 days of the rotation, please inform Dr. Perlin at the start of your rotation so that another meeting time can be arranged.
You will also receive regular feedback from staff you work with daily.

St. Michael's Hospital Rheumatology Rotation 2011
Core Resident Learning Objectives 2011

St. Michael's Hospital provides a 1 or 2 month long ambulatory clinical rotation to Core Internal Medical Residents.

At the end of this rotation the trainee is expected to be able to:

1. Complete a detailed and accurate rheumatologic history and clinical exam in the out-patient clinic and in-patient consultation settings which will enable him/her to:

a) Differentiate between inflammatory and non-inflammatory disease.
b) Formulate a differential diagnosis discriminating according to whether a patient has:

  • an inflammatory vs. non-inflammatory monoarthritis
  • an inflammatory vs. non-inflammatory polyarthritis
  • a regional pain problem
  • a connective tissue or vasculitic condition

c) integrate information into a tentative diagnosis

2. Discuss appropriate outpatient radiologic and laboratory investigation of the above conditions

3. Become familiar with the specialized tests used in Rheumatology:

acute phase reactants and their sensitivity and specificity.

4. Integrate clinical and investigation results to generate and discuss a treatment plan including;

a) Pharmacologic therapies with an emphasis on OA, RA, SLE, Seronegatives, and gout. The resident will be able to state the indications for and the major benefits vs. side effects of NSAIDS, corticosteroids, the most commonly used DMARDS ( including methotrexate, sulphasalazine, hydroxychloroquine, leflunomide, and the biologics)

b) Non-pharmacologic therapies such as physio, OT, and surgical modalities.

5. Demonstrate an organized approach to the analysis of plain films of axial and appendicular skeleton and recognize the major radiologic features of OA, RA, and the Seronegative, spondyloarthropathies.

6. Observe, and then demonstrate the sterile technique of knee joint aspiration and injection, and interpret the synovial fluid analysis including cell count and crystal analysis.

7. Demonstrate an ability to work well with all health care colleagues in the outpatient setting.

8. Relate with compassion to patients and their families.

The above goals will be achieved via assessment of patients in out-patient clinics, on the in-patient consultation service and through attendance of formal and informal seminars and rounds. Each resident will prepare a talk on a topic of his/her choice once monthly for presentation at Rheumatology noon rounds. Residents are expected to build their Rheumatologic knowledge base by reading around cases and via self-directed learning.

Dear Medical students, Residents, and Fellows,

My name is Sofia, and I am currently working on next month's Rheumatology Schedule.

Can you please email me the following: (If it doesn't apply to you please disregard)
1. Your ½ day back
2. Your pager number along with ID if there is one
3. Vacation time/lieu days that you have booked off and that have been pre approved by the GIM medical education office
4. Crisp or other scheduled education related dates
5. Post call dates if they are available to you yet

Residents: Your rotation will begin on__________________. You are scheduled to report to Linda McAughey, Dr. Perlin's assistant at 9 a.m. in the Rheumatology department on the 3rd floor of the Shuter wing, room 3-020. Linda will give you your schedule, show you around, and let you know when you will meet with Dr. Perlin for orientation. If you are delayed, please call Linda at 416-864-5550.

You will need a SMH ID badge, and access to our hospital data base and the dictating system. Please call Brian in our Medical Education office to arrange for these: 416-864-6060 #2767, preferably before the rotation.

Note: If you are ill or post call, it is your responsibility to inform the respective physician of your absence. I have attached a contact list which includes email and telephone contact numbers for the Division of Rheumatology.

Thank you very much for your time. I look forward to meeting you next month.

Sofia Vasconcelos
Medical Secretary
30 Bond Street., 3-002b Shuter Wing
Toronto ON M5B 1W8
T.: 416-864-5295
F.: 416-864-5139
E.: VasconceloSo@smh.ca

St. Michael's
Inspired Care. Inspiring Science.
A teaching hospital fully affiliated with the University of Toronto

www.stmichaelshospital.com


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