Clinical expertise comes not only from experience, but from a commitment to lifelong learning; establish these patterns in your daily & monthly routines, & plan to carry them beyond graduation day.
4) Become an Expert—Now
It’s important to recognize that you are a highly educated and skilled professional. Fellows can accomplish impressive things, even while in the training environment.
No one is an expert in all areas, even within a specialty. You can quickly gain specific, micro areas of academic expertise that distinguish you from your colleagues and faculty; one relatively easy way to start is to become the local expert in an uncommon disease or manifestation or to become the liaison with another specialty, ideally in an area that is missing in your current practice environment. (Think Chikungunya arthritis or retinal vasculitis, not osteoporosis or lupus.) Studying the literature in a relatively limited field can make it clear how that field has evolved, what knowledge/research gaps still exist and what lessons you can share with your colleagues. This can then become your model for developing expertise in larger fields of study.
If, or when, you identify a larger area of subspecialty interest within rheumatology, you can start to develop expertise, not only by reading but by connecting with a regional or national network of others with similar special interests. Many research or educational networks value the participation of junior colleagues and are enthusiastic about sharing their passions.
Trainees, especially fellows, who are often seeing high volumes of patients and are well connected with other specialties within their institutions, are also crucial for identifying potential best practice and quality initiatives or opportunities for advocacy. These projects often require an idea and an energetic leader, more than years of experience. Fellows can lead meaningful change for patients within an individual practice or community.
5) Embrace What Makes Our Field Unique
On a busy inpatient rheumatology consult service, many of us appreciate a straightforward, satisfying case of gout. Many of the consults we receive, however, can represent a diagnostic challenge, and our evaluation may reveal a non-rheumatologic etiology. It’s often a rheumatologist’s job to sort through the weeds of a difficult case, leaving no stone unturned.
Sterling G. West, MD, MACP, MACR, professor of medicine at the University of Colorado School of Medicine, Aurora, and co-director of the Metabolic Bone Disease Clinic, is fond of saying, “Rheumatology represents the last line of defense.” The practice of rheumatology requires an attention to detail and a desire to solve complicated problems. Hoping for straightforward cases where the diagnosis is known and treatment plans can be looked up on UpToDate may lead to frustration and resentment, and increase your chances of burnout. Many of our colleagues call us because they recognize our skills as diagnostic sleuths. Take consults as an opportunity to hone your skills in investigating the unknown, as well as practicing clinical reasoning and complex decision making.
Ultimately, the patient benefits from our expertise in helping to decipher the cause of their symptoms, regardless of whether a rheumatologic etiology is uncovered.
