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 specialty, 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 specialty may be linked with duties in GIM if wanted particularly in DGH settings and there are ample opportunities to develop sub-specialty 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.
Competence Based Curricula and Assessment - StRs (for trainees who commenced training from 1 August 2007 to present)
There are two versions of curricula for this training period:
StRs who commenced training between 1st August 2007 and 3rd August 2010 will follow the 2007 version of their specialty curriculum and the 2007 Generic curriculum. Please see the 2007 Curriculum section of this webpage.
StRs who commenced training from 4th August 2010 onwards will use the 2010 version of their specialty curriculum. There is no need to follow the previously known ‘Generic curriculum' as this has now been embedded into the specialty curriculum. Please see the 2010 Curriculum section of this webpage.
The Joint Royal Colleges of Physicians Training Board (JRCPTB) is pleased to announce the 2010 Rheumatology curriculum which has been reviewed and rewritten to:
- meet the GMC's 6 new standards as detailed in their Standards for Curricula and Assessment systems
- keep up to date with medical advances and changes in the service and training
- incorporate the framework documents produced by the Academy of Medical Royal Colleges (AoMRC) detailing Common, Medical Leadership and Health Inequality competencies
- include 5 new assessment methods (Acute Care Assessment Tool, Case based Discussion, Patient Survey, Teaching Observation and Audit Assessment).
This new curriculum has improved content, design and usability compared to its predecessors, and reflects a great deal of hard work and time expended by specialty curriculum groups. This curriculum will become the training manual for all trainees entering ST3 from 4th August 2010.
For further information on the 2010 curriculum it is recommended that you read the Quick Start Curriculum Guide.
If you have any queries or problems regarding the 2010 curriculum please email ptb@jrcptb.org.uk.
Core Training Programmes
Entry into Rheumatology training is possible following successful completion of both a foundation programme and a core training programme.
There are 2 core training programmes for Rheumatology training:
Assessment
The following methods are used as part of the integrated assessment system:
The assessment blueprint, which is embedded in the clinical syllabus, shows the possible methods that can be used to assess each of the competencies in the curriculum. Trainees and trainers should refer to the blueprint 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 ARCP Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
The diagram below describes the training pathway:
Please view the 2010 curriculum for Rheumatology for full details on the training routes and selection criteria.
Entry into Rheumatology training is possible following successful completion of both a Foundation Programme and a core training programme.
Please view the 2007 curriculum for Rheumatology for full details on the training routes and selection criteria.
Assessment
The assessment blueprints show the possible methods that can be used to assess each of the competencies 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 ARCP/RITA Decision Aid. It is not expected that all competencies will be assessed by all methods, rather that there will be a sampling of competencies within a variety of settings, both within formal and workplace-based assessment, from which overall competence acquisition has to be determined.
Further information on the various methods of assessment can be viewed in the Assessment section of this website.
The diagram below describes the training pathways in general terms.
Competence Based Curricula - SpR (for trainees who commenced training between 1 Jan 2003 and 31 July 2007)
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 - SpR (for trainees who commenced training before 1 Jan 2003)
The curricula for trainees enrolling pre 01/01/03 are no longer available on the website but can be obtained by request to ptb@jrcptb.org.uk.
Current members of the Rheumatology Specialist Advisory Committee. Please contact the
Committee Manager for further details.