Rotations

Inpatient Rotations

Fellows assigned to inpatient rotations are responsible for the evaluation of inpatient and emergency room consultations and the continued follow up of these patients during their hospitalization. In this process they develop and refine clinical evaluation skills including the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans. Fellows also develop skills in providing consultation services, including communicating with patients and families, the referring teams and ensuring support for outpatient care. Fellows will develop a comprehensive understanding of the indications, contraindications, techniques, and complications of arthrocentesis as well as the interpretation of results from this procedure. Inpatient rotations are completed through the Montefiore Health System, the university hospital of Albert Einstein College of Medicine and through the Einstein teaching affiliates of Jacobi and North Central Bronx Medical Centers.

West Campus:

The Henry and Lucy Moses Division is the main campus of the Montefiore Health System, a regional health system that is composed of 11 hospitals and over 180 clinical locations throughout the Bronx and lower Westchester county, NY. The Moses division is a 726-bed tertiary care hospital offering state-of-the-art care ranging from comprehensive cancer care to advanced transplant services, all while serving a significantly under-resourced population. Patients will often be transferred to Moses from smaller affiliates and regional partners given our advanced level of care. All rheumatology admissions and consultations are seen and followed by 2 Rheumatology fellows and 1 faculty member assigned to the Moses campus for the month. On this campus, fellows will get incredible exposure to the most complicated rheumatology cases given the breadth of the specialties and services provided at this campus.

The North Central Bronx Hospital is owned and operated by the New York City Health and Hospitals Corporation serving the north Bronx and is physically connected to Montefiore Medical Center. It is a 232-bed facility with approximately 90 medicine beds, an ICU and stepdown unit, a surgical unit, pediatric service, and a busy OB/GYN service. The rheumatology fellows rotating on the west campus are responsible for in-patient consultations at NCB and for covering the NCB emergency room. In-patient consults are seen and followed by the fellow and either an attending from the Moses service or a Jacobi faculty member rotating at NCB.

East Campus Map:

Montefiore-Weiler Campus is owned and operated by the New York City Health and Hospitals Corporation serving the north Bronx and is physically connected to Montefiore Medical Center. It is a 232-bed facility with approximately 90 medicine beds, an ICU and stepdown unit, a surgical unit, pediatric service, and a busy OB/GYN service. The rheumatology fellows rotating on the west campus are responsible for in-patient consultations at NCB and for covering the NCB emergency room. In-patient consults are seen and followed by the fellow and either an attending from the Moses service or a Jacobi faculty member rotating at NCB.

Jacobi Medical Center, is also owned and operated by the New York City Health and Hospitals Corporation and acts as a safety-net hospital for the surrounding community. A major teaching affiliate of Albert Einstein College of Medicine, it has 457 acute patient beds, and an active emergency room in addition to being a level 1 trauma and burn center. The Division of Rheumatology provides consultative services for in-patients hospitalized at Jacobi and for patients referred by emergency room. All rheumatology admissions and consultations are seen and followed by the Rheumatology fellow and faculty member assigned to the Jacobi campus for the month. Here fellows will see an enormous breadth of rheumatology given the incredibly diverse surrounding population.

Outpatient Rotations:

All fellows, regardless of year in the program, maintain 3 half days of ambulatory continuity clinics. This experience continues with progressive responsibility through the fellowship and is supervised by dedicated attending faculty members assigned to each individual clinic. Each fellow will have 1 lupus clinic and 2 general rheumatology “arthritis” clinics each week where they will be exposed to the full breath and scope of the practice of rheumatology. The fellows will gain expertise in the outpatient evaluation and management of rheumatic diseases will gain an opportunity to develop an understanding for the natural history of these conditions over an extended period of time.

  • Patients seen by a rheumatology attending, first year fellows rotating through Weiler and Jacobi
  • Triage clinic of patients with acute or sub-acute issues such as mono-arthritis, tendonitis, gout and evaluation for possible injection
  • Typically patients are seen for 1-2 visits and then might be discharged from clinic or referred to one of our more specialized clinics
  • Dedicated to assessing and treating arthritic conditions via ultrasound
  • Patients are referred from both within our hospital systems and from the community for injections and evaluations
  • These are teaching clinics attended by 1 rheumatologist and 1-2 second-year fellows
  • Patients seen in these clinics include those with prior diagnoses of:
    • Systemic lupus erythematosus
    • Discoid lupus
    • Mixed Connective Tissue Disease
    • Antiphospholipid Syndrome;
  • Recent hospitalization for flares of above diseases
  • A new diagnosis or strong suspicion for these diagnoses
  • Several attendings, fellows, and rotating residents and medical students attend this clinic
  • These are teaching practices and as such, the primary caregivers are the fellows and these count as a continuity clinic
  • These are general rheumatology clinics where the majority of the patients in the teaching practices are seen
  • Patients are suspected or known to have rheumatic diseases, including but not limited to:
    • Rheumatoid arthritis
    • Vasculitis
    • Systemic sclerosis
    • Inflammatory myositis
    • Spondyloarthropathies
    • Gout
    • Osteoarthritis
  • Patients are referred to these clinics by both internal and community primary care practices, subspecialists and the emergency room
  • All non-lupus new patients seen in the hospital by the teaching service that have a need for outpatient follow up, are seen in these clinics
  • Clinics are attended by several attendings, first-and second-year fellows and rotating residents and medical students.
  • As above, the primary caregivers in these teaching clinics are the fellows and are part of their continuity clinic structure.

Weekly Rotation Schedule

Rheumatology Fellow Clinical Schedule**
  Monday Tuesday Wednesday Thursday Friday
Morning

Joint Pain Clinic:
Rotating 1st year JMC and Weiler fellows

MSK Ultrasound Clinic*:
Rotating 2nd year fellows

Montefiore SLE Clinic*:
ALL 1st year fellows and designated 2nd year fellows

NCB General Rheum Clinic*:
Designated 2nd year fellows

 Montefiore Arthritis Clinic*: 
ALL 1st year fellows and designated and 2nd year fellows		 Jacobi Arthritis Clinic*: 
ALL 1st year fellows and designated and 2nd year fellows		  
Afternoon Jacobi SLE Clinical*: 
Designated 2nd-year fellows		       Montefiore Arthritis Clinic*: 
Designated 2nd year fellows

*Continuity Clinic for at least year where the fellow is assigned to that clinic 
**All fellows do 1 lupus clinic and 2 arthritis/general rheumatology clinics as continuity clinics per year