Rheumatology is a medical specialty which focuses patient management and research on the manifestations of musculoskeletal disease. Given the origin and aetiology of musculoskeletal disease, the subject matter is necessarily wide.
Conditions which are managed and researched by rheumatologists include autoimmune connective tissue and joint diseases (for example: rheumatoid arthritis, systemic lupus erythematosus), mechanical and degenerative joint diseases (for example: osteoarthritis and disorders of articular cartilage), muscle and tendon disorders, sports injuries, disorders manifest by pain and conditions of bone (for example: osteoporosis).
Rheumatologists have the opportunity to develop sub-specialist interests, in addition to undertaking General Medicine duties, through dual accreditation in Medicine and Rheumatology.
Rheumatology attracts basic science immunologists and cell biologists interested in (chronic) inflammation research. Arguably, the most frequent clinical manifestation and major clinical consequence of chronic inflammation is either autoimmune joint or connective tissue disease. Similarly, bone biologists can appropriately develop relevant clinical links through Rheumatology. Inflammation and bone research scientists wishing to train in a clinical specialty might reasonably choose to train clinically in Rheumatology within the National Clinician Scientist Training Scheme.
Rheumatology out-patient work is extremely varied. There are opportunities to practice a variety of practical skills including joint and soft-tissue and epidural injections. Rheumatologists invariably need to be skilled clinicians, keen on diagnostic dilemmas and stimulated by complex medical disease. They are often the most appropriate medical specialists to 'orchestrate' the long-term holistic care of patients with challenging multi-system disorders.
Below is a testimony from our consultant as to why he chose to both train and take consultant jobs in this region
'My decision to do Rheumatology was fortuitous – great things happen by chance! The reason why I chose East of England was purely because my mum only knows two places in the UK – Cambridge or Oxford. Hence you can imagine my surprise when I was told that I would spend most of my time in Luton! However what a great decision that was. The rotation prepared me for all eventualities as I had the opportunity to see a wide range of pathology, take OOP time to undertake research, learn from great mentors and had relative freedom to choose the area for sub-specialisation. Though the rotation could be over a large geographical area, all my jobs were outlined in advance with focus on easy commuting and sufficient time to plan ahead. All these benefits manifested with final placement at Luton where the department was keen to expand providing consultant job at the right time for me to apply. I'd thoroughly recommend EoE rotation as I feel it complements a wide variety of job interests and provides plenty of opportunities to excel whilst keeping work life balance.’
Muhammad Nisar - Consultant in Rheumatology and General Medicine, Luton and Dunstable Hospital
The programme is provided according to the requirements for generic medical training as laid out by the GMC and following the (ST3+) JRCPTB Rheumatology assessment blueprint and curriculum. The training is based in: Basildon, Bury St Edmunds, Cambridge, Chelmsford, Colchester, Hemel Hempstead, Huntingdon, Ipswich, Luton, Norwich, Peterborough, Southend, Stevenage and Watford. There are currently 20 posts for trainees across the region.
When a trainee is appointed, a rotation is constructed for the trainee taking into consideration training needs, geography and availability of posts on the rotation so trainees can predict where they will need to be over the next few years. Training is usually completed with two to four moves over the training period. However, training post rotations cannot be 'set in stone' at the outset and a degree of flexibility is sometimes required.
The rotation provides dual-accredited training with general internal medicine (GIM) with at least one year of training taking place as a pure rheumatology post at a tertiary centre. The training opportunities among the hospitals on the training scheme are broad.
There is a regular teaching programme for trainees with sessions every two months arranged at a central location.
- A broad general medical interest and knowledge base
- Knowledge and interest in the pathophysiology of auto-inflammatory diseases and metabolic bone disease as well as in biomechanics
- Ability to communicate effectively with patients
- Ability to communicate effectively with medical colleagues and paramedical specialists (for example physiotherapists, occupational therapists, specialist nurses)
- Capacity for working effectively within a team of professionals
- Capacity to be cognisant of the consequences of chronic disease and show sufficient empathy with that situation in applying knowledge and skills
- A commitment to life-long education
Rheumatology Curriculum http://www.jrcptb.org.uk/sites/default/files/2010%20Rheumatology.pdf
General Internal Medicine Curriculum http://www.jrcptb.org.uk/sites/default/files/2009%20GIM%20%28amendment%202012%29.pdf
The Annual Review of Competence Progression (ARCP) takes place each year. This normally covers both rheumatology and general medicine, with the only exception being the Penultimate Year Assessments (PYAs) where the appraisals are separated. Trainees should ensure that their e-portfolio is up-to-date with the required number of assessments at least 2 weeks prior to the ARCP to enable the panel to review the evidence before the meeting.
General Internal Medicine ARCP Decision Aid http://www.jrcptb.org.uk/sites/default/files/2009%20GIM%20ARCP%20Decision%20Aid%20%28revised%2017.11.14%29.pdf
British Society for Rheumatology (BSR) http://www.rheumatology.org.uk/
European League against Rheumatism (EULAR) http://www.eular.org/
American College of Rheumatology http://www.rheumatology.org/
Arthritis Research UK http://www.arthritisresearchuk.org/
National Osteoporosis Guideline Group (NOGG) https://www.shef.ac.uk/NOGG/