Rheumatology

Background

Rheumatology is one of the specialities within medicine and retains a very strong reliance on sound clinical skills despite considerable advance in the understanding of the molecular basis of  rheumatological disease. There is considerable demand  for rheumatology expertise. Currently there are over 470 consultants and 210 trainees working in the speciality, approximating to 1 consultant per 165,000 of the UK population.

What is Rheumatology

Rheumatology incorporates the investigation, holistic management and rehabilitation of patients with a wide spectrum of disorders of the muskuloskeletal system encompassing the locomotor apparatus, bone and connective tissues and blood vessels. Rheumatic disorders include inflammatory arthritis, complex auto immune 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 therefore  quite 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.
Core competencies required for a Rheumatologist
The rheumatology curriculum is oriented around achieving competency in a number of domains including
• A sound knowledge of the epidemiology, natural history, pathophysiology and treatment of these conditions coupled with an ability to apply basic science relevant to rheumatology
• Ability to perform and interpret a full history and clinical examination of patients presenting with such patients
• Ability to select and interpret the results of, the core investigations used in rheumatology, including blood tests and imaging techniques
•Ability to choose appropriately and implement the full spectrum of treatments, pharmacological , biological, physical and otherwise, available for managing patients with musculoskeletal and related conditions
• Competence in a wide range  of joint and soft tissue injections
• Ability to communicate well with patients and members of the multi disciplinary team
• Ability to holistically manage patients with musculoskeletal and allied conditions
• Provision of effective team working and leadership skills which increasingly span primary and secondary care
• Designing and implementing relevant clinical audit and responding to audit results
• The management skills necessary to participate in and lead a rheumatology team
• The critical appraisal and interpretation of published clinical research
• Facilitiating effective learning by other clinical staff

Choosing a Career in Rheumatology

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 may often result in the building of satisfying and rewarding long term therapeutic and educational relationships with patients. The speciality may be linked with duties in GIM  if wanted particularly in DGH settings and there are ample opportunities to develop sub-speciality interests and research with a developing academic career pathway which followed the Walport proposals (http://www.mmc.nhs.uk/pages/academic). Increasingly strong links with primary care are also being forged through work at the primary/secondary interface. This may prove to be a developing area of focus for the future. A ratio of 1 consultant rheumatologist per 85000 population is the stated goal and the RCP estimates a 61% expansion in consultant numbers by 2010 so job prospects are good.

Training in Rheumatology

As a speciality of medicine (weblink to MMC site) , training will develop through the Foundation stage (http://www.mmc.nhs.uk/pages/foundation) to Core Medical Training (http://www.jchmt.org.uk/specialtyHome.asp) and then to Rheumatology or rheumatology and GIM at ST1. The detailed entry requirements and outline of training can be found in the Rheumatology Curriculum (weblink)

Updated Feb 07

Due to regular revisions, arising from changes in the training environment and the requirements of the PMETB, the JRCPTB are currently running various curricula for trainees in each specialty. All relevant curricula are listed at the bottom of this page under Documents. Use the filter option on the right-hand side, together with the guidance notes below,to help you select the correct document. In summary:

•If you are a run-through (Specialty Registrar [StR]) trainee, you will follow the curricula tagged as ST3+

•If you are an ‘old style’ SpR, you are following the curricula tagged as SpR

•If you enrolled prior to 01/01/03, you will be following the original curricula which are no longer available for download, see note below

Competence Based Curricula and Assessment – StRs

PMETB has received the assessment system (blueprint and RITA/ARCP grid) for Rheumatology and this has been approved.  

The assessment blueprints show the possible methods that can be used to assess each of the competences in the curriculum. Trainees and trainers should refer to the blueprints for guidance on the appropriate assessment methods for each aspect of the curriculum, and so plan the training programme according to the criteria set by the RITA Decision Aid. It is not expected that all competences will be assessed by all methods, rather that there will be a sampling of competences within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.

 Acute care common stem (Medicine) trainees will also follow the ACCS training manual.

Competence Based Curricula – SpR (for trainees enrolling after 1 Jan 2003)

The JCHMT introduced revised curricula for all the medical specialties together with a generic curriculum that applied to all trainees back in 2003. These are competence-based and set out the knowledge, skills and attitudes to be acquired by trainees before they may be awarded a CCT.

Curricula (for trainees enrolling before 1 Jan 2003)