Objectives for Rotating Residents and Medical Students
Handbook for Trainees
Welcome
All of the rheumatologists, clinic nurses, and clinic staff would like to give you a warm welcome to your rotation with the Division of Rheumatology at Western University. It is a very exciting time to experience the field of rheumatology with the current advances in therapeutics and patient outcomes.
All of the rheumatologists are aware of your presence in the clinic. Most rheumatologists will book extra patients in their clinic specifically for you to see to improve your learning experience.
Please do the following:
- CLINIC ABSENCE: If you cannot attend a clinic please notify the rheumatologist you will be working with as soon as possible. This way the rheumatologist has time to reorganize the schedule to fit the number of trainees in the clinic. Please also call the front desk of the rheumatology clinic and notify Deborah Fournier by email.
- CALL SCHEDULES: Please review the posted schedule carefully. Please notify the divisional secretary of the days you will be post-call. When you are on call for rheumatology, contact the rheumatology resident you are on call with and ask how the call for the day will work. You are on call until 7 pm.
- VACATION: If you have a planned vacation during your rotation, please advise the divisional secretary as soon as possible with your approved vacation request.
MANDATORY READING
As part of your rheumatology learning you are all asked to complete the modules on Rheumtalks.com (It is free to create an account on this site). There are two modules - one on the rheumatology lab for the non-rheumatologist and the other on differentiating inflammatory, degenerative, and chronic pain conditions. We would ask you to complete these before you finish your rotation and ideally before that. When completed, make sure to print your certificate which should be given to our chief resident for your block end evaluation.
This is a mandatory part of your learning in rheumatology and something we hope you'll actually enjoy.
CLINICS
- SCHEDULE: We make every effort to spread trainees among the rheumatologists in clinic. If you do not find yourself scheduled for clinic it does not mean you have a day off. You should come to the clinic and you will be assigned to a rheumatologist.
- CHARTS: The charts you are using are the property of each rheumatologist. Please respect them and keep them tidy and organized.
- TIMELINESS: Please check the schedule and arrive on time for clinics.
- READING: Please make every effort to read while on your rheumatology rotation to make your experience worthwhile.
- DOCUMENTATION: Documentation including rough notes and dictated notes is extremely important for patient care and for medico-legal requirements. Please make rough notes and take care with your dictations.
OBJECTIVES
The objectives for your rotation can be found in Appendix A
RHEUMATOLOGY CLINIC: IMPORTANT PHONE NUMBERS
The Division of Rheumatology Program Administrator is Ms. Deborah Fournier. Please also let her know if you will be absent or for any issues with your schedule. Her e-mail is deborah.fournier@sjhc.london.on.ca.
The rheumatology clinic is located on D2 of the Monsignor Roney Building.
Important Clinic Phone Numbers:
| Location | Tel | Fax |
| St. Joseph’s | 519-646-6000 | |
| Clinic Reception | 66333 | 519-646-6342 |
| Clinic Stations | 61025/61026 |
THE RHEUMATOLOGY CLINIC
The rheumatology clinic would not function without the hard work of our dedicated staff. Receptionists provide the front-lines for the clinic greeting and registering new patients. They are pivotal in arranging investigations and arranging follow-up appointments. Our clinical reception assistants keep the clinic flowing.
YOUR RESPONSIBILITIES
Clinics:
You are assigned to out-patient rheumatology clinics (Monday to Friday, am and pm clinics). All of the rheumatologists and their medical office assistants are aware of your arrival in the rheumatology rotation. To make your experience more rewarding the rheumatologists often book additional patients for you to see. As you can imagine, if extra patients have been booked and you don’t show up, it makes for a bit of an awkward situation. We don’t mind if you need time off or you are post-call. We do mind if you don’t tell us these things. We would suggest doing the following prior to your rotation:
- Please review your clinic schedule on the first day.
- Note any days where you will be post-call and notify the medical office assistant of the rheumatologist you are working with. This way they do not book extra patients.
- Note any days when you will be away from clinic and notify the medical office assistant(s) of the rheumatologist(s) you are working with.
Clinic Hours of Operation:
The hours of operation of the clinic vary slightly from rheumatologist to rheumatologist. It is a good idea to check what time the clinic is starting the day before (If in doubt call the clinic at 646-6333). Rough guidelines for clinic starting times for each rheumatologist are below. These will change as clinics are sometimes added or removed. PLEASE CHECK YOUR CLINIC SCHEDULE DAILY. If in doubt assume the clinic starts at 0800 am.
Clinic Forms:
To help standardize your history and physical examination and maintain consistency throughout the clinic special history and physical examination forms have been prepared for each patient. Please look through the appendices so you understand how each form is structured. On arrival to the clinic every patient receives two forms to fill out:
- A Patient Assessment Form – Initial Visit OR Follow-up Visit
- Health Assessment Questionnaire.
Documentation:
Documenting patient interactions is very important in providing quality care and for medicolegal reasons. Please document on the clinic forms provided in legible handwriting. Dictated notes are great, however, sometimes they get lost or misplaced and we have nothing to review if this happens. If you do not know how to use the clinic forms – please ask.
Dictation:
Unless otherwise specified it is your responsibility for the dictations of patients you have seen during your rheumatology rotation. To dictate please dial 66080 and wait for the beep, following the beep enter your dictation code followed by the # .
Then enter the site code (which is 3 for St. Joes) followed by the #.
Then enter the work-type followed by the #.
| Work Type | Dictation Code |
| New Consult | 34 |
| Follow-up | 42 |
Then enter the patients 7 digit ID number located on the top right corner of the stickers provided for each patient followed by the #.
Press “2” to dictate, “4” to pause, “5” to sign-off the system, “8” to end the dictation and dictate another record, and “6” for a “high priority” dictation.
Please dictate all New Consults as “High Priority” by Pressing “6” anytime during the dictation.
When dictating please use the templates for your dictations found in Appendix B.
On-Call Duties:
Your on-call responsibilities are from 0800-1900 hours each day. You are not responsible for night or weekend coverage. While on-call you may be asked to see patients in other locations throughout the city such as London Health Sciences Centre (University, and Westminster Campus). In general, consults should be done after clinic or early in the morning. Contact the fellow who you are on call with the get more instructions.
Rheumatology Academic Half-Day:
The Rheumatology Academic Half-Day is held every other Friday morning throughout the academic year. The Half-Day schedule is posted in the clinic but the general layout is as follows: Contac the chief resident and consult the emails sent during your rotation for more details.
| Time | Location | Event |
| 0800-0900 | Shuttleworth Auditorium | Rheumatology Grand Rounds |
| 0930-1020 | D2-181 Monsignor Roney Bldg | Journal Club |
You are expected to attend Thursday AM physical exam teaching as well. Please consult the scheduling emails as well as the chief resident for more details.
Useful Resources for your Rheumatology Rotation:
Computer Access: Computers can be found in the resident’s room. A computer login account for rheumatology trainees has been created: Login ID: westusr, Password: usrwest
Internet Resources:
www.UWORheumatology.com: Our homepage.
www.RheumInfo.com: A useful site for obtaining forms for use in daily clinical practice.
www.RheumBook.com: The site for Thompson’s Rheumatology Pocket Reference.
www.arthritis.ca: The Arthritis Society of Canada
www.Rheum.ca: The Canadian Rheumatology Association
www.rheumatology.org: The American College of Rheumatology
Textbooks & Handbooks:
- The Primer of Rheumatic Disease
- Kelly’s Textbook of Rheumatology (Kelly): Can be viewed on-line through the CMA portal to MD Consult
- Rheumatology (Hochberg, Sliman, Smolen, Weinblatt, Weisman)
- Arthritis & Allied Conditions (Koopman)
- Thompson’s Rheumatology Pocket Reference: www.RheumBook.com
- Rheumatology Secrets (West)
- Hoppenfeld Guide to Physical Examination
- The Journal of Rheumatology
- Arthritis & Rheumatism
- Arthritis Care & Research
- Annals of Rheumatic Disease
- Rheumatic Disease Clinics of North America
- Current Opinion in Rheumatology
- Journal of Clinical Rheumatology
- Seminars in Arthritis & Rheumatism
- Rheumatology
