St. Michael's Hospital Division of Rheumatology
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 ComprehensiveCare
* 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 (2 nd Floor CCW) and all results and reports are recorded and 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 , Rottapel, and Shupak) rotate on-service for two week blocks. On weekends and Holidays new Rheum consults are seen first by the SAR on call who then contact the staff attending for review. 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 are responsible for in-patient consultations and review with the staff. 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.
Faculty:
The GFT Rheumatologists currently located at SMH are:
Dr. Doreen J. Campbell
Rheumatologist and physiatrist Lecturer in the Division of Physiatry, Department of Medicine, University of Toronto, teaching medical students and residents interdisciplinary assessment and management of chronic spinal and soft tissue rheumatology pain disorders, community-based care of Arthritis and musculoskeletal medicine.
Dr. Dharini Mahendira - Clinical Associate
Dr. Dharini Mahendira joined the Division of Rheumatology in July 2011 as a Clinician Teacher. She is currently enrolled in the Master Teacher Program, through the Faculty of Medicine at the University of Toronto. Additionally, she is undertaking a Masters in Health Professionals Teacher Education at the University of Toronto. Her clinical interests include general rheumatology and maternal fetal medicine.
Dr. Erin Norris – Assistant Professor of Medicine
Dr. Erin Norris joined the division in Sept 2009 as a clinician-teacher. She has completed the Master Teacher program of the Faculty of Medicine, University of Toronto. Her clinical interests include general rheumatology, osteoporosis, maternal-fetal medicine and transitional care. She is the Medical Director of the Osteoporosis Exemplary Care Inpatient Program at St. Michael's Hospital.
Dr. Perlin is a clinician-teacher who is recognized for her outstanding teaching skills at the bedside both in the clinic and on the consultation service. She has 7-half days of clinics per week (on 3 Shuter), which are attended by house staff. She has won numerous teaching awards at the under and post graduate levels. Dr. Perlin's practice encompasses the broad spectrum of rheumatic disease, with a strong emphasis on inflammatory disorders, and her ambulatory activities take place on 3-Shuter
Dr. Robert Rottapel - Professor of Medicine
Dr. Rottapel is a clinician-scientist (CIHR Scholar) whose clinical base is at SMH. He spends Wednesday after noon once a month at SMH where he runs a clinic (MFC) and teaches core residents in rheumatology. He attends weekly rheumatology noon seminars and gives morning reports to core residents on rotation. His teaching focus is on utilizing basic science principles to elucidate the pathophysiology and rationale for treatment of rheumatic disorders. He has a special interest in the rheumatic manifestations of Hepatitis C.
Dr. Laurence Rubin - Professor of Medicine
Dr. Rubin is a clinician-scientist who combines research in genetics of Metabolic Bone Disease/Osteoporosis and rheumatic inflammatory disorders with a broad-based clinical practice in Rheumatology (MFC) and Metabolic Bone Disease/Osteoporosis (61 Queen Street, 7th Floor- Centre for Diabetes and Osteoporosis). Fellows attend the Metabolic Bone Disease/Osteoporosis program weekly (Monday am) and rheumatology clinics are scheduled on Monday, Tuesday afternoons and Friday morning. He is also a participant in the in-patient consult service.
Dr. Rachel Shupak - Associate Professor of Medicine
Dr. Shupak is a clinician-educator. She has half-day clinics per week attended by undergraduate student, core residents and fellows. Her clinics take place on 3- Shuter or MFC. Her interests span the range of MSK issues, but her particular interests include myopathies and a unique Hemophilia - Arthritis program which she developed at SMH. As part of this latter program, Dr. Shupak is the only rheumatologist in Toronto offering radiation synovectomies of a variety of affected joint (P 32). Dr. Shupak continues to be the referral source for adolescents with inflammatory muscle disease in transition from the HSC. She is also a consultant on the in-patient service. She has won 5 outstanding teaching awards at SMH, including post grad and undergrad. As clinician educator she is involved in creating numerous educational programs at SMH.
- ACPAC (Advanced Clinical Practitioner in Arthritis Care) - award winning - see www.smh.ca Mobility Program
- Arthritis Day for Primary Care Practitioners -9 annual events in CE held at SMH
- Prescription in Education - A 1 day program (award winning) to education patients with inflammatory arthritis about their disease, its treatment and impact on patient.