Rheumatology & Immunology | Teaching

Orientation for Students and Residents

• Introduction
• Clinical Responsibilities
• References
• Weekly Schedule

Introduction

Welcome to the Immunology/Rheumatology elective. We are pleased you have chosen to spend time with us, and want you to know that we are committed to making this rotation interesting as well as educational. We care for a diverse group of patients, and the skills you will learn evaluating them should serve you well regardless of your ultimate goal. It is worth remembering that the study of immunology has a substantial impact on clinical and laboratory medicine.

The learning objectives of this elective can be broadly grouped into four categories.

1. Evaluation of the child with
   • recurrent infections
   • joint complaints
   • autoimmune disease
2. Diagnostic laboratory tests related to #1 and the interpretation of the results
3. Medical management
4. The scientific basis for immunodeficiency, immunogenecity and for autoimmunity

To help make the most of your time, a list of selected texts and reviews are listed below. These materials are available in the St. Louis Children's Hospital library and you should become familiar with this material during your rotation. By design, the Immunology/Rheumatology elective allows significant time for studying, and we expect residents to take full advantage of this opportunity.

Clinical Responsibilities

1. Attend all clinics and conferences as noted on weekly schedule and see patients as directed. Dictations are to be done prior to the end of each clinic using the hospital transcription service.
   
   
2. Assist our nurse-specialist in following up on laboratory studies and making phone calls to families and referring physicians.
   
   
3. Edit dictations from patients seen in clinic.
   
   
4. See consult patients, write consult reports and present findings to the attending.
   
   
5. See infusion patients in 9 South and write a note in the chart. A specific form is available for this purpose, which includes interval history, physical exam, recent pertinent laboratory studies, impression, plan and follow-up. A weekly schedule of patients is posted in the division office.
   
   
6. Prepare a presentation for Rheumatology Grand Rounds, relating to a patient seen on service. This presentation should be one hour in length, and should include a review of the current literature, including relevant basic science papers. The attending will assist you in gathering information and formulating a succinct, pertinent presentation. A prepared handout is required.
   
   

We are looking forward to seeing you in clinic Monday, 8:30 a.m., Suite D. Please feel free to contact us if you have questions regarding your elective at (314) 454-6124.

References

Journals

1. Agle LM, Rosenkranz M, Lehman TJ. Novel therapies for the treatment of juvenil rheumatoid arthritis (juvenile idippathic arthritis)Expert Opin Investig Drugs 2003;12:19-28.
2. Anthony KK, Schanberg LE. Pain in children with arthritis: a review of the current literatureArthritis Rheum 2003;49:272-9.
3. Klien-Gitelman M. Reiff A, Silverman ED. Systemic lupus erythematosus in childhood.Rheum Dis Clin North Am 2002;28:561-77, vi-vii.
4. Patel H, Goldstein D. Pediatric uveitisPediatr Clin North Am 2003;50:125-36.
5. Shulman ST. Ayoub EM. Poststreptococcal reactive arthritis.Curr Opin Rheumatol 2002;14:562-5.
6. Brunner HI, Giannini EH. Evidence-based medicine in pediatric rheumatology.Clin exp Rheumatol 2000;18:407-14.
7. Milojevic DS, Ilowite NT. Treatment of rheumatic diseases in children: special considerations.Rheum Dis Clin North Am 2002;28:461-82.
8. Passo MH, Hashkes PJ. Use of methotrexate in children.Bull Rhuem Dis 1998;47:1-5.
9. Schneider R, Passo MH. Juvenile rheumatoid arthritis.Rheum Dis Clin North Am 2002;28:503-30.
10. Wilkinson N, Jackson G, Gardner-Medwin J. Biologic therapies for juvenile arthritis.Arch Dis Child 2003;88:186-91.

Books

1. Textbook of Pediatric Rheumatology, 4rd Edition, ed. J.T. Cassiday and R.E. Petty, 2002.
2. Pediatric Rheumatology for the Practitioner, 2nd Edition, ed. Jerry C. Jacobs, 1993.
3. Color Atlas of Pediatric Rheumatology, Ansell, B.M., Rudge, S., and Schaller, J.G., 1992.
4. Immunologic Disorders in Infants and Children, 4th Edition, ed. E.R. Steihm, 1996.

Weekly Schedule