Rheumatology is one of the specialities within medicine and retains a very strong reliance on sound clinical skills despite considerable advance in the understanding of the molecular basis of rheumatological disease.
There is considerable demand for rheumatology expertise. Currently there are over 470 consultants and 210 trainees working in the speciality, approximating to 1 consultant per 165,000 of the UK population.
What is Rheumatology
Rheumatology incorporates the investigation, holistic management and rehabilitation of patients with a wide spectrum of disorders of the muskuloskeletal system encompassing the locomotor apparatus, bone and connective tissues and blood vessels. Rheumatic disorders include inflammatory arthritis, complex auto immune rheumatic and multi-system disease, soft tissue conditions including injuries, osteoarthritis, spinal pain, chronic pain syndromes and metabolic bone disease. The optimum investigation and management of such conditions is therefore quite often challenging and rewarding and requires a multi-disciplinary approach linking the application of principles of pathophysiology of disease and advanced therapeutics with sound principles of rehabilitation.
The rheumatology curriculum is oriented around achieving competency in a number of domains including
- A sound knowledge of the epidemiology, natural history, pathophysiology and treatment of these conditions coupled with an ability to apply basic science relevant to rheumatology
- Ability to perform and interpret a full history and clinical examination of patients presenting with such conditions
- Ability to select and interpret the results of the core investigations used in rheumatology, including blood tests and imaging technique
- Ability to choose appropriately and implement the full spectrum of treatments, pharmacological, biological, physical and otherwise, available for managing patients with musculoskeletal and related conditions
- Competence in a wide range of joint and soft tissue injections
- Ability to communicate well with patients and members of the multi-disciplinary team
- Ability to holistically manage patients with musculoskeletal and allied conditions
- Provision of effective team working and leadership skills which increasingly span primary and secondary care
- Designing and implementing relevant clinical audit and responding to audit results
- The management skills necessary to participate in and lead a rheumatology team
- The critical appraisal and interpretation of published clinical research
- Facilitating effective learning by other clinical staff
Choosing a Career in Rheumatology
Rheumatology provides an excellent opportunity to practice clinical medicine in its broadest sense with principles of acute and chronic disease management at its core. This may often result in the building of satisfying and rewarding long term therapeutic and educational relationships with patients.
The speciality may be linked with duties in GIM, particularly in DGH settings and there are ample opportunities to develop sub-speciality interests and research with a developing academic career pathway which followed the Walport proposals. Increasingly strong links with primary care are also being forged through work at the primary/secondary interface. This may prove to be a developing area of focus for the future.