‘Definition’ of specialty
Specialty which answers questions others can’t.
Overview of training
Rheumatology offers training in acute and chronic aspects of disease management at its core. The training may be linked with duties in General Internal Medicine (GIM) (five years rotation) or ‘pure’ rheumatology (four years rotation); there are sufficient opportunities to develop sub-specialty interests (connective tissue disease, osteoporosis, paediatric rheumatology, crystal arthropathy etc.) and academic research.
Exam requirements
A Specialty Certificate Examination (SCE) in Rheumatology is required before a Certificate of Completion of Training (CCT) qualification can be awarded. There is no specific exam for GIM accreditation.
Other requirements
Trainees are strongly encouraged to keep logbooks of all patients seen and complete a specific number of assessments to achieve described competencies in order to progress every year. Specialty skills involve joint injections and, depending upon individual interest, opportunities to develop skills for bone health, musculoskeletal ultrasound or paediatric rheumatology etc.
Opportunities for research
Trainees will not be disappointed. There are ample academic clinical fellowship (ACF) jobs and almost all trainees do out of programme research (OOPR). A large majority of these attain MD/PhDs in the process because of extensive ongoing research into aetiology, biomarkers and management of rheumatological diseases.
A typical day in the life of a Registrar
A typical day would involve an outpatient clinic either in the morning or afternoon along with a ward visit to see any inpatients or referrals from other specialties and seeing some patients for urgent reviews and joint injections. There is a fair amount of paperwork and messages/queries from patients and GPs due to disease-modifying anti-rheumatic drug (DMARD) and biologic drug use.
Pros and Cons of working in this specialty
Pros
- It offers a flexible lifestyle, exciting research opportunities, and rewarding long-term patient relationships and has a huge impact on quality-of-life issues
- With new advances in biologics in the last ten years and further on the way, rheumatology is an exciting field to be in
Cons
- Frustration at delay in initial referral, lots of phone calls for advice, potentially little GIM if any at all at Consultant level.
How this specialty differs to others and what made me choose it
- Rheumatology is mainly an outpatient specialty; musculoskeletal complaints can vary from simple back pain to very complex one-in-a-million conditions. It allows physicians to practice the art of medicine in its true sense
- Most of the conditions encountered respond quickly to treatment which is very rewarding
- Also those of us for whom lifelong GIM commitment appears daunting can find solace in rheumatology because of the option of training in pure rheumatology and demand for ‘pure’ rheumatologists
- My reasons for choosing rheumatology are a bit different from the above: I was inspired by a physician who would just walk up to complex patients with multi-system involvement and usually came up with correct diagnoses
Tips for success in applying for this specialty
- Ideally aim for Core Medical Trainee (CMT) rotation which involves a four-month rheumatology attachment, as achieving competence in joint injections should be straightforward
- Also it will offer plenty of opportunities to attend clinics, see patients independently as well as chances to do audits, case reports and presentations
- Try improving different aspects of your CV so as to fulfil the person specifications for ST3 jobs
- There are quite a few ACF rheumatology jobs available which also provide good opportunities to become a rheumatology trainee
For more information
British Society of Rheumatology