Duke University provides a rich environment for clinical training in rheumatology. Fellows in our training program provide patient care in several distinct settings:

a) Duke Clinic. Faculty and fellows in the Duke University Arthritis Center performed over 3,300 outpatient visits in 2002. The spectrum of rheumatologic disorders evaluated in this clinic includes: rheumatoid arthritis (29%), osteoarthritis (10%), systemic lupus erythematosus (7%), undifferentiated connective tissues diseases (7%), early polyarthritis (4%), gout (4%), psoriatic arthritis (3%), Wegener’s granulomatosis (2%), scleroderma (2%), and the remainder representing an array of rheumatologic disorders. Rheumatology clinics at Duke with a specialized focus include: early inflammatory arthritis, inflammatory eye disease, Sjogren’s syndrome, vasculitis, rheumatic lung disease, and refractory gout. Fellows have a one half-day continuity clinic at Duke each week, caring for patients with a spectrum of diseases similar to those described above. Fellows usually see 1 new and 6 return patients at each clinic. During elective rotations, fellows may elect to see patients with a faculty clinician in the Duke University Arthritis Center.

b) Durham VA Medical Center. Duke rheumatology fellows and rotating internal medicine house officers performed approximately 3,000 patient visits at the VA
medical center in 2002. The spectrum of patients seen in this clinic is similar to that of the Duke Clinic with the exception of a greater percentage of patients with sero-negative spondyloarthritis. Fellows have responsibility for patient continuity at the VA clinic.

c) Inpatient Consultation Services of Duke Hospital and Durham VA Medical Center. First year fellows lead an inpatient consultation team for eight months; with time divided between Duke Hospital and the Durham VA Medical Center. Approximately 7-10 inpatient consultations are performed each week. The spectrum of illness comprises acute manifestations of systemic rheumatic diseases, challenging diagnostic situations, and patients requiring diagnostic and therapeutic arthrocentesis. Each consultation service is supervised by a faculty member who sees patients with the team on a daily basis as needed.

d) Duke Pediatric Rheumatology Clinic. Rheumatology fellows spend one full day per week in the pediatric rheumatology clinic for 4 months during the first year of training. Fellows usually see 6-8 patients per clinic. The pediatric rheumatology division provides care to patients referred from a several state radius.

e) Duke Arthritis Center Outreach Clinics. Faculty in the Division of Rheumatology and Immunology staff outreach clinics in several communities within a 90 mile radius of Durham. Fellows maintain a continuity clinic supervised by a faculty member. On average, fellows devote 2 days per month to outreach activities. This experience is more representative of community-based rheumatology practice. Fellows have an opportunity to develop relationships with referring physicians and function as a consultant sub-specialist in communities without a local rheumatologist.

f) Elective Rotations. First year fellows participate in a multi-specialty rotation comprising one half-day clinics each week in each of the following specialties: osteoporosis/metabolic bone disease, musculoskeletal radiology, and sports medicine. During three subsequent elective rotations fellows tailor clinical training experiences in a variety of clinical specialties related to rheumatology.