Rheumatology

• Elective and Site Director. Dr. Austin Dalrymple

  • austin.Dalrymple@health.slu.edu

  • (314) 268-2700 ext 1188

• Faculty

  • Dr. Austin Dalrymple

  • Dr. Mara Horowitz

  • Dr. Terry Moore

• Rheumatology fellows

  • Dr. Lena Sabih

  • Dr. Sarah Saeed

  • Dr. Whitney Bembry

  • Dr. Oche Okeke

  • Dr. George Thieroff

• +/- Residents (pediatric, family medicine, internal medicine) and/or fourth year medical student on rheumatology elective (2-4w)

• +/- Third year clerkship or career exploration student (1w)

• Multidisciplinary healthcare team providers: nurses, social workers, physical therapists

• Contact Dr. Dalrymple at least a week before starting (for both Clerkship and 4th year students) to discuss your rotation goals, objectives, strategies, and any schedule requests. Rheumatology activities and schedule are personalized based on interest and can include pediatric, +/- adult rheumatology clinic and consult service.

• Review EPIC for the “clinical landscape” during your time on rheumatology

  • • Clinics (Confirm patients are scheduled. At times clinics get cancelled Eg. faculty vacation, conference, inpatient service or added).

      • Confirm start time. While typically AM clinic starts at 8AM and PM clinic starts at 1PM, both times can vary

      • Read about patients you will be seeing

    • Inpatient/consult service

      • EPIC Systems lists > CG Resident Treatment Teams > CG Rheumatology

  • Review the Learners on Pediatrics Spreadsheet/Rheumatology tab

    • Use the insert comment feature to designate experiences you wish to participate in during a given half day. We will go through to finalize.

      • All Pediatric Rheum clinics take precedent over adult clinics at SLU. You must attend at least 6 half days of Pediatric Rheum Clinics. Attending CSM SLU Adult clinics are optional in addition to the required minimum six half days at the Pediatric Rheum Clinics.

        1. The expectation for all mini electives is a full work week in clinic potentially with a caveat that on half days a clinic is not held, you may be assigned to other tasks (Ranken Jordan visits) etc at the discretion of the site director!

    • Consider touching base with any outgoing learners and/or those scheduled with you.

    • Often multiple options: clinics, intern academic half day (for M4s) are available. Potential considerations include your own goals and interests, presence of other learners, how busy a clinic is (Eg. if two clinics held during a given half day session, you might want to pick one with greater number of patients), variety of experience, and/or continuity with a specific attending. We request no more than 2 learners per clinic/attending.

• Individual Study

  • View Introduction to Rheumatology* Please review before starting!

    • Pediatric rheumatology, Dr. Dalrymple (53 min) recorded presentation and/or

    • Pediatric rheumatology handout

*The presentation and handout cover the same materials

• Review other rheumatology individual study resources

• White coat: optional

Presenting Problems

• +ANA or other abnormal labs

• Arthritis

• Arthralgia

• Multisystem complaints

• Musculoskeletal pain (lower back pain, myalgia)

• Recurrent fevers

• Recurrent ulcers

Diagnoses

• Amplified MSK pain syndrome/fibromyalgia

• Antiphospholipid syndrome

• Behcet syndrome

• Celiac disease

• Fever syndromes (FMF, CAPS, PFAPA, etc.)

• Juvenile idiopathic arthritis (JIA)

• Hypermobility

• MISC (post-COVID19)

• Patellar tracking

• Pes planus (flat foot)

• Polymyositis/dermatomyositis

• Raynaud

• Sarcoidosis

• Spondyarthritides

• Systemic Lupus Erythematosus (SLE)

• Systemic sclerosis

• Vasculitis

*Topics recommended for early review in bold

• • Cardinal Glennon Ambulatory Care Center (ACC)

    • Dr. Dalrymple

      • Ground floor blue hallway. Monday PM, and 2nd and 4th Thursday AM

      • First floor blue hallway. Friday PM

    • Drs. Horwitz and Moore

      • Ground floor yellow hallway. Thursday PM

    • EPIC: CG ACC RHEUM

  • South County (SoCo)

    • Dr. Dalrymple: 1st, 3rd, and 5th Thursday AM

    • 1300 Butler Crest Dr, St. Louis, MO 63128

    • 27min from CG

    • EPIC: CG SOCO RHEUM

  • Anderson

    • Dr. Dalrymple

      • 2nd and 4th Tuesday AM and PM

    • 3403 Healthcare Dr. Edwardsville IL 62025 / 618-288-8350

    • 30 min from CG Hospital

    • EPIC: CG ANDER RHEUM

  • Center for Specialized Medicine (CSM - Adult Clinics)

    • 2nd level, Pod 2

    • Adult and some pediatric patients

    • EPIC

      • Job: AFF SLU

      • Department: AFF SLU RHEUM CSM 2L

• All learners begin as active observers and may begin to see patients independently and document clinic and consultation notes

• Dr. Dalrymple has templates for new patients and f/u visits

• For students on 4 week electives, prepare a 10-15 min discussion of a topic in rheumatology of interest to you. No Powerpoint needed – it will just be you and Dr. Dalrymple discussing the topic.

• The topic discussion is also required for students on 2w elective who miss more than a day due to an excused absence.

• Seeing new consults is a great opportunity to take a history, perform a thorough physical exam, and to work on an assessment, differential, and recommendations. Let the fellow or attending scheduled for consult service (amion.com/cgch) know you will be interested in seeing new consults, share your contact information, and ask him or her to let you know about any consults that might come during your time on rheumatology.

• Document a consult (initial or follow up) for each encounter

• Route note to the supervising physician (fellow or attending)

• End each note with: “Discussed with Dr. X (AI attending)” so the team knows that they can act on plan.

• Support your recommendations citing primary literature, review article, or a textbook.

Rheumatology didactics and clinical cases

• Friday 8:30-11:30 AM

• LRC 112-113 or M112 Schwitalla