The first year of fellowship is fully committed to inpatient and outpatient clinical activities.
First year fellows are assigned two half-day ambulatory clinics per week. We emphasize continuity of care and fellows assigned to a patient will look after that patient for the duration of their training. All patients are staffed with an assigned faculty member and the same faculty member and fellow will work together in a clinic for either one or two years. We believe this close and continuing interaction with specific faculty has a very positive impact on our fellows’ clinical development and fosters excellence in patient care. Typically, fellows evaluate two new patients and four established patients in each clinic.
In addition to the main ambulatory clinics, fellows are assigned to the VA clinic once every month, to an Urgent New Patient clinic once every three weeks, and to the Scleroderma clinic every six weeks. We also offer elective rotations through Pediatric Rheumatology, Geriatric Rheumatology, Physical Medicine and Rehabilitation, and Musculoskeletal Radiology/Ultrasound.
We assign two first year Fellows to be on the inpatient consult service together and the usual rotation is two to four weeks on-service followed by one to two weeks off-service. Most consultations are for University of Michigan Hospital inpatients, but we also provide inpatient care at the Ann Arbor VA Hospital and travel there as needed (0.7 mile, 5-minute drive). Fellows get exposure to diagnosis and management of the full range of complex systemic diseases and their complications, as well as acute joint-based diseases. One faculty member is assigned as consult service Attending Physician for a two-week period and works closely with the on-service fellows. Fellows are responsible for managing a clinical unit that also consists of junior and senior house officers from the Core Internal Medicine program, fourth year medical students who have chosen a rotation in Rheumatology (acting as sub-interns), and house officers from other services who have chosen a month of Rheumatology training.
First year fellows, when not assigned to the consult service, are able to spend time preparing contributions to the educational programs (Grand Rounds presentations etc.) and being involved in other forms of self-directed learning. Their only rostered clinical activity apart from ambulatory clinics is responsibility for evaluating referrals for urgent assessment of new patients. Fellows have complete autonomy in scheduling and staffing an Urgent-New-Patient clinic that is held every second Friday that was established to evaluate and manage urgent and/or especially interesting referrals.
First year fellows are on-call for urgent inpatient consultations approximately one night in three. All call is from home; fellows do not stay at the hospital when on-call.