5 Rheumatology Resources Every Internal Medicine Resident Should Know

When you’re an internal medicine resident, starting a rotation in a field you’re unfamiliar with can be stressful, and rheumatology is no exception. Many trainees have limited exposure to the rheumatology field during medical school, and seeing patients without a sense of direction can be challenging.

I still remember the first day of my rheumatology rotation: I read as much as I could about systemic lupus erythematous and rheumatoid arthritis on UpToDate, thinking this would give me a good foundation for my rheumatology rotation. As I’ve gained experience in treating patients with rheumatologic conditions, I’ve found more resources and strategies to support my learning.

When I began my residency, I asked my program’s rheumatology faculty and fellows about the field. I attended various national rheumatology meetings to gain effective strategies for learning about the many rheumatic conditions I could expect to encounter. Today, I am training on the dual pathways of rheumatology and medical education, and one of my areas of interest is how we residents can better learn about rheumatology.

During ACR Convergence 2024 in Washington, D.C., I discovered the many resources the ACR offers to support fellows and residents during their rheumatology training. I’m pleased to share them with you.

1. Rheum2Learn modules

These modules are excellent for learning the clinical aspects of rheumatology. The Rheum2Learn 2.0 series includes 13 modules containing cases, diagrams, tables, pictures, activities and questions that support an active learning process, which is key to retaining the concepts presented. The modules are focused at a resident level and include topics such as crystalline arthritis, systemic vasculitis, systemic lupus erythematous, rheumatoid arthritis and more. Every internal medicine resident should complete these modules to have a baseline knowledge of rheumatic diseases.

2. Rheum4Science modules

Similar to the Rheum2Learn modules, the 11 Rheum4Science modules focus on basic science and research, including innate immunity, neutrophils, toll-like receptors, B cell immunobiology, T cells and more. These modules help residents develop a deeper understanding of research designs, research analysis, the role of immunology, and the pathophysiology of rheumatic diseases.

3. Guidelines & Criteria mobile app

I have found this app invaluable. It allows users to access ACR guidelines and classification criteria, including the full manuscripts. The Tools section offers a criteria calculator that can be used with patients. Although the classification criteria are intended for research and are not diagnostic, I still consider the app helpful. It allows residents to get familiar with what to look for in each rheumatic disease, using the individual factors evaluated as part of the criteria and applying them to a patient’s history and physician exam. Download it from your favorite app store.

4. Rheumatology Image Library

We can use this great resource to train our eyes for pattern recognition. This vast array of clinical pictures features a variety of skin tones and patients with diverse ethnic backgrounds, which help identify rheumatic changes in under-represented minorities. The Image Library also includes key radiographic findings and pathology slides, which I have turned to after seeing a patient with a specific rheumatic disease. During a rheumatology consult service or clinic, I have searched for pictures associated with the potential disease to view variations of the clinical presentation. The Image Library also helps me solidify visual cues related to the rheumatic disease of interest.

5. Virtual Rheumatology Program (V-FIT)

This program presents a series of video lectures from renowned rheumatologists covering essential topics. The content is targeted to fellows, but residents can use the videos to develop a good foundation before fellowship. Learners can familiarize themselves with the epidemiology, pathophysiology, clinical presentation, diagnosis and management of simple and complex rheumatic diseases. The videos include pictures of the clinical manifestations and provide references for important clinical trials and research articles that you can save and read later to understand the evidence behind each recommendation. This resource has had the most significant impact on my growth within rheumatology. If I had to pick the top five essential videos everyone should watch, I would recommend MSK Exam, Rheumatology Labs, MSK Radiology, Rheumatology Emergencies and Patient Care Sections. For interested residents, I would add Succeeding in Fellowship, Clinical Study Design, and Therapeutics and Injections. I encourage all readers to explore the vast topics covered, as all provide valuable information.

Bonus Recommendation

RheumaHelper: This app, which is not from the ACR, is similar to the ACR’s guidelines and criteria app. It provides classifying criteria and assists in calculating the disease activity of various rheumatic diseases. The app allows users to practice determining the therapeutic response and disease course of patients in follow-up appointments. One of my attendings recommended this app, and it has helped me understand how to use classification criteria and disease activity calculations so I know what to look for in clinical interactions with rheumatic patients. Download it from your favorite app store.

These free resources will help resi­dents navigate the field of rheuma­tology. As part of my medical education pathway and rheumatology pathway, I plan to restructure the current rheuma­tology pathway and integrate the ACR’s resources to offer aspiring rheuma­tologists more practical education so they have a solid foundation before fellowship.

Sergio M. Maldonado-Chaar, MD, is a third-year internal medicine resident completing a dual pathway in rheumatology and medical education at the University of Miami and Jackson Health System Residency Program.