Curriculum - Rheumatology Training
JRCPTB Specialty Overview and Recruitment - http://www.st3recruitment.org.uk/specialties/rheumatology
Training Programme Director
Dr Devesh Mewar
Royal Liverpool and Broadgreen University Hospitals NHS Trust
Tel - 0151 282 6048
Regional Specialty Advisor
Dr Rikki Abernethy
St Helens & Knowsley Hospitals
St Helens Hospital
Marshalls Cross Road
Tel: 01744 646630
Educational and Clinical Supervisors Duties
All need to be Level 1 trained which consists of a ‘Tools of the Trade’ course (WPBA Assessment Tools and Supervisory Skills in the Workplace) – courses are available via your own Post Graduate Department or via the Deanery.
It is also mandatory that you do the on –line ‘Equality and Diversity course’.
To do this:
- Visit the on line training Equality and Diversity
- Follow the help guide and register as instructed.
Ideally Educational Supervisors should have Level 2 training although at present this is not mandatory – this includes the following courses:
- Effective teaching skills
- Additional workshops (eg. Trainees in difficulty / Supporting struggling trainees
- Accreditation (eg Doctors as Educators peer support network/ collaboration with RCP, educational supervisor module Edge Hill University/Mersey Deanery collaboration).
Educational Supervisors Duties
- To perform regular documented educational appraisals at the beginning, middle and end of each attachment in order to:
- identify educational objectives against the programme curriculum.
- review the trainee portfolio to make sure that they are progressing appropriately.
- facilitate reflection on their performance.
- provide career guidance.
- To fill out an Educational Supervisor’s structured report as the end of each attachment. This is an important document which documents the trainee’s progress and also any cause for concern that the Educational Supervisor may have about the trainee.
- To inform the Head of Training and Programme Director if there are any concerns about performance that could have an adverse effect on patient care.
All trainees must have a named Educational Supervisor at all times during their training programme. Rheumatology trainees should have educational supervisor at the trust in which they are working, and may also have a long term educational supervisor who remains the same throughout their training programme to provide continuity and support for long term planning eg career advice.
Clinical supervisor duties
This applies to all consultants who supervise trainees in the hospital.
The role of the Clinical Supervisor is:
- To provide on the job teaching by directly observing the trainee’s clinical work and provide regular constructive feedback.
- To ensure that no trainee is required to assume responsibility for tasks beyond their level of competence and that patient safety remains paramount at all times.
- To provide written feedback to their Educational Supervisor particularly when there are difficulties or performance concerns.
- To be familiar with the Trainee’s learning objectives and the RCP Rheumatology Curriculum.
- To understand workplace based assessments and to be able to perform them for the trainee.
- To ensure that supervision of the trainee occurs at all times and is appropriate to the trainee’s level, confidence and competence.
- To be available and approachable so that the trainee can report on any issues concerning their training.
- To feed back to educational supervisor any concerns and provide relevant information to educational supervisor to support completion of Educational supervisor structured report at the end of each attachment. This is then submitted to the training panel for the ARCP (annual record of competency progression).
Training Programme Director
Dr Chandini Rao
Blackpool Teaching Hospitals NHS Foundation Trust
Whinney Heys Road
What is Rheumatology?
Rheumatology is a medical specialty that deals with the group of conditions collectively called "rheumatic and musculoskeletal diseases". These are conditions involving joints, bones, soft tissues and muscles. The multi-system nature of many rheumatic diseases provides management challenges and can be extremely rewarding. It encourages multidisciplinary working and relies on close relationships with other medical and surgical specialties.
Rheumatology incorporates the investigation, holistic management and rehabilitation of patients with a wide spectrum of disorders of the musculoskeletal system encompassing the locomotor apparatus, bone and connective tissues and blood vessels. Rheumatic disorders include inflammatory arthritis, complex autoimmune rheumatic and multi-system disease, soft tissue conditions including injuries, osteoarthritis, spinal pain, chronic pain syndromes and metabolic bone disease. The optimum investigation and management of such conditions is often challenging and rewarding and requires a multi-disciplinary approach linking the application of principles of pathophysiology of disease and advanced therapeutics with sound principles of rehabilitation.
Rheumatology provides an excellent opportunity to practice clinical medicine in its broadest sense with principles of acute and chronic disease management at its core. This often results in satisfying and rewarding long term therapeutic and educational relationships with patients. There are opportunities to develop special interest areas and some overlap with metabolic medicine and paediatrics and rehabilitation.
The clinical workload is varied and there is a strong emphasis on teamwork. The U.K. has one of the lowest rates of rheumatologists per 100,000 population in Europe and there is potential for expansion of the specialty in the future. Research opportunities exist in both clinical and scientific fields related to rheumatology.
What personal qualities are needed?
Rheumatologists are good communicators and enjoy working in a multidisciplinary team. They have an ability to understand the considerable social impact of chronic disease and an awareness of the importance of patient-centred care. They should have a willingness to adopt new methods or working and establish close working relationships with colleagues in both primary and secondary care. Practical skills and manual dexterity are important as joint and soft tissue injections form a major part of rheumatological practice. With expensive biologic drug therapies, rheumatologists require managerial and political skills to secure funding for the appropriate use of these in their patients.
Rheumatology offers many opportunities for both clinical and scientific research. The specialty has used biomedical research to help develop targeted treatments for many of the rheumatic diseases with great success. There a number of funding opportunities to assist research nationally and trainees are encouraged to apply for these.
Manchester has a strong reputation in rheumatology research. The University of Manchester has a Centre for Musculoskeletal Research with affiliations across the Faculty of Medicine and Human Sciences. This encompasses the NIHR Musculoskeletal Biomedical Research Unit, under the directorship of Professor Ian Bruce, the Arthritis Research UK Centre for Epidemiology under the directorship of Dr Will Dixon and the Arthritis Research UK Centre for Genetics and Genomics under the directorship of Professor Anne Barton. Many trainees successfully obtain research grants and take time out of programme to complete PhD or MD theses. Further on from this trainees have opportunities to apply for clinician scientist and lecturer positions.
What challenges lie ahead for rheumatology?
Rheumatology has changed considerably over the last twenty years from being a largely inpatient based specialty with poorly effective treatment options to an outpatient based specialty with scientifically based targeted therapies. Over the last few years, many rheumatologists have seen changes to their way of practise and adopted new methods of working, especially with primary care services. This will continue and rheumatologists must be pro-active in managing and leading this change to ensure the continued high quality care of patients and training of junior doctors.
This shift from a hospital-based environment to a more clinic-based service has made some rheumatologists feel worried about losing contact with acute medicine. The ability to train with G(I)M offers rheumatologists the opportunity to keep strong links with other aspects of medicine in hospitals and ensures junior trainees get more exposure to rheumatology in the future.
Rapid advances in the scientific understanding of disease and the development of novel drug therapies, requires rheumatologists to keep up-to-date. As with other specialties, revalidation requires time and commitment, as does the ongoing supervision and education of junior trainees.
Consultant job prospects remain good despite a large increase in training positions over the last few years. A willingness to adopt new models of care delivery and a flexibility to work in different working environments will help trainees to secure senior appointments. A number of part-time opportunities exist for consultants allowing individuals to strike a happy work-life balance.
A Registrar's view of the training programme
My first exposure to Rheumatology came through an FY1 post. I was able to see the huge variety of clinical presentations and symptomatology, the multisystem involvement of many rheumatological disorders, and the importance of all members of the MDT in the assessment and management of rheumatology patients. The opportunity to get to know patients over time and form a partnership with them, taking a holistic approach to their management was a key attraction of the specialty. In addition, I was keen to pursue some research so was delighted to find a specialty that was so strong in both research quality and opportunities, with active participation not only from those clinicians directly involved in academic work but also those in full time clinical posts. My training in rheumatology continued with clinical and ACF posts during Core Medical training in the West Midlands and I then began my specialty training in the North West. After ST3 I was able to take time out of programme for research (OOPR) to undertake a PhD, which I have now completed. I feel privileged that both the specialty and in particular the region are supportive of and actively encourage OOPR, and always strive to be flexible to meet the specific training needs and interests of individual trainees. As I return to the clinical training programme I have received great support during this transition from the STSC and others. I look forward to the rest of my clinical training and future career in Rheumatology.
Gudie To Specialty Training in Rheumatology
Local points of contact
Academic Lead for Rheumatology
Professor Anne Barton: firstname.lastname@example.org
Dr. Leanne Gray: email@example.com
Dr Charlotte Sharp: firstname.lastname@example.org
British Society of Rheumatology: www.rheumatology.org.uk
American College of Rheumatology: www.rheumatology.org
Arthritis Research UK: www.arthritisresearchuk.org
European League Against Rheumatism: www.eular.org
Royal College of Physicians: www.rcplondon.ac.uk
Journals of Interest
Annals of the Rheumatic Diseases: ard.bmj.com
The Journal of Rheumatology: www.jrheum.org
Current Opinion in Rheumatology: www.co-rheumatology.com