Components of Training

Core Training
A minimum of two years core training is required. During this time, the training must have direct and supervised responsibility for inpatient and outpatient care in a rheumatology unit.

Specific Objectives of Core Training in Rheumatology

• Acquisition of knowledge of aspects of basic and applied medical sciences relevant to rheumatic and connective-tissue disease. This would include appropriate aspects of morbid anatomy, chemical pathology, pathophysiology, immunology, microbiology, etc.
  
• Training in statistical methods, research techniques and critical evaluation of the results of investigation, and of the published literature.
  
• Competence in diagnostic and therapeutic procedures appropriate to rheumatology including:
  
  • Knowledge of the indications for and interpretation of various imaging techniques used in rheumatology including skeletal and soft-tissue plain radiographs, scintiscans, CT scanning and MRI.
    
  • Physical methods used in the treatment of patients with musculoskeletal disorders, and an awareness of the value of and indications for physiotherapy, occupational therapy, podiatry and allied forms of management.
    
  • Techniques of synovial, bone and muscle biopsy and interpretation of pathology.
    
  • The application of electrophysiological diagnostic tests.
    
  • The indications for, and an outline of, the operative and perioperative techniques in the surgery of the rheumatic diseases.
    
• A detailed knowledge of, and practical experience in, clinical pharmacology in relation to therapy in the rheumatic diseases.
  
• Assessment and management of chronic musculoskeletal pain, including cognitive, behavioural, and biopsychosocial components.

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Procedural Skills
All rheumatologists will be competent in the technique of joint aspiration and joint and soft-tissue injection and in techniques of synovial fluid examination. Some rheumatologists may develop skills in arthroscopy and synovial tissue biopsy, epidural and other more sophisticated injections sometimes used in pain management, and manipulation, but these are not prerequisites.

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Logbook
Trainees are required to maintain a log of all patient contacts for two months in each of their core training year. This is designed to be used as formative rather than summative assessment. The contents of the log play no role in accreditation of the year. However, production of the log is a requirement and should be submitted to the College by 1 October.

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Elective Training
Approval may be given for work undertaken in a wide range of optional areas such as:

• General medicine, geriatric medicine or paediatrics.
  
• A medical specialty (eg, immunology, haematology, gastroenterology, nephrology or neurology).
  
• Orthopaedic surgery.
  
• A pain management service.
  
• Laboratory medicine particularly immunology.
  
• Rehabilitation medicine.
  
• Epidemiology.
  
• Radiology and/or nuclear medicine.
  
• Clinical pharmacology.
  

Trainees are strongly encouraged to limit their training in one centre to 24 months. Accreditation of longer periods of training in a single unit will only be granted in exceptional circumstances.

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Projects or Case Reports
Advanced trainees must prepare at least one of the following during their period of advanced training:

• A paper to be submitted for publication to an appropriate refereed medical journal.
  
• A paper for presentation at a national or international scientific meeting.

The supervisor's report should indicate whether this requirement has been fulfilled.

In cases where the trainee is writing up a paper or have an abstract due to be considered, but no answer yet as to whether it has been accepted, the trainee is required to submit a copy of the abstract and/or manuscript to the SAC to assess whether it has achieved a satisfactory standard.

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Research
Research is encouraged during all stages of advanced training and knowledge of research methodology, statistical methods and critical appraisal is necessary but it is not considered desirable that advanced trainees spend their whole period of advanced training doing research.

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Training Posts
The SAC will prospectively approve training positions and programs rather than accredit particular institutions.

Trainees should undertake core training in more than one centre. Approval for undertaking all core training in one centre will only be given under exceptional circumstances.

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