Introduction:
St. Michael's Hospital is a major teaching hospital of 550 beds
in downtown Toronto, fully affiliated with the University of Toronto.
The hospital Strategic Plan identifies 6 spires of excellence:
- Inner City Health
- Diabetes Comprehensive Care
- Mobility (Arthritis, Fracture, MS)
- Minimally Invasive Surgery
- Trauma
- Cardiovascular
The Division of Rheumatology is part of the Arthritis Program in the Mobility Spire.
Outpatient clinical activities take place in both the Martin Family Arthritis Care
and Research Centre (Ground floor, Queen Wing), a multidisciplinary ambulatory unit, or on 3-Shuter,
where the staff offices are located.
In the Martin Family Centre (MFC), rheumatology clinics may
occur concurrently with specialized orthopedic, plastic and
neurology clinics, thus facilitating interdisciplinary interaction
at all levels. The unit also contains outpatient surgical suites,
where procedures such as needle arthroscopy are performed. With
the assistance of the nursing staff and front desk group who
manage in patient intake and assessment, referral and test bookings
the MFC provides an effective, timely and efficient environment
for ambulatory care. Each exam room is stocked with the necessary
equipment for joint aspiration and injection, including corticosteroid
preparations ands anaesthetic solutions. Two polarizing microscopes
are located in the physician offices on 3-Shuter for synovial
fluid analysis. An X-ray machine is located in the Fracture
Unit (across the hall on Queen Ground) thus facilitating diagnostic
X-ray services on a timely basis in many cases. The hospital
blood letting station and laboratory facilities are located
nearby (2nd Floor CCW). All x-rays and lab results are available
by secure password on the hospitals Clinical Database accessible
by computer in the MFC.
Rheumatology in-patient and emergency room clinical activities are consultative. The staff (Drs.
Perlin, Rubin and Shupak)
rotate on-service for two week blocks. Weekend and Holiday calls
are the primary responsibility of the staff, but the fellows will
take calls as arranged approximately once per month.
Patients with rheumatologic disease who require hospitalization are admitted
under one of the four general medicine teams who have primary responsibility
for their care (beds located on the 14th floor, Cardinal Carter Wing). The
rheumatology rotation is very highly rated by the core medicine residents at
the University of Toronto and we are generally assigned 2 core medical residents
per month and several elective medical students in total each year.
The core medical residents assigned to the division for one or two-month blocks participate both on the in-patient consultation service as well as attend the various ambulatory clinics.
Formal in-patient rounds are held twice weekly, but cases may require more urgent attention in the interval.
Divisional educational activities (both formative and as part
of the ambulatory clinical activities) take place in a variety
of venues (see attached schedule). The rheumatology staff also
participate in specific internal medicine postgraduate inpatient
educational activities such as Morning report and bedside teaching
sessions. In addition to our significant commitments in the undergraduate
teaching program, our rheumatologists give both the Tovee lecture
for 4th year students and the Royal College Review lecture for
PGY4 residents (by invitation) each year
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