Family Medicine Clerkship

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Arthritis/Arthralgia

OVERVIEW

Patients frequently bring concerns about pain in joints and muscles to their family physician first. The primary care provider must be able to distinguish among the range of disorders that may give rise to these complaints. Students should be able to take an adequate history, develop a differential diagnosis, and offer an appropriate treatment plan for arthralgia, osteoarthritis, rheumatoid arthritis, gout, and common soft tissue syndromes.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of osteoarthritis, rheumatoid arthritis, and arthralgia.

OBJECTIVES: Students will be able to:

• Obtain pertinent history to determine correctly the nature of the problem.
• Perform appropriate examination of painful extremities and joints.
• Interpret laboratory data related to rheumatologic disorders.

GOAL: Students will appropriately discuss osteoarthritis / rheumatoid arthritis / arthralgias with patients.

OBJECTIVES: Students will be able to:

• Explain indicators of control and complications of osteoarthritis / rheumatoid arthritis / arthralgias to their patients.
• Describe each patient's condition and goals of management.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes in the management of osteoarthritis / rheumatoid arthritis / arthralgias.
• Develop treatment plans in the context of each patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of osteoarthritis / rheumatoid arthritis / arthralgias in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of osteoarthritis / rheumatoid arthritis / arthralgias including racial, ethnic, and socioeconomic differences.
• Describe the USPSTF recommendations for screening for osteoarthritis / rheumatoid arthritis / arthralgias.

GOAL: Students will understand the pathophysiology of osteoarthritis / rheumatoid arthritis / arthralgias.

OBJECTIVES: Students will be able to:

• Describe how to make the diagnosis of osteoarthritis / rheumatoid arthritis / arthralgias.
• Discuss the initial evaluation of a patient with a new diagnosis of osteoarthritis / rheumatoid arthritis / arthralgias.

GOAL: Students will understand the rationale for treatment plans for osteoarthritis / rheumatoid arthritis / arthralgias.

OBJECTIVES: Students will be able to:

• Describe the appropriate therapy for osteoarthritis / rheumatoid arthritis / arthralgias.
• Discuss the evidence for the role of lifestyle changes in pain management.
• Discuss the side effects and costs of commonly used medications.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

• Recognize the importance of practice analysis for a population with osteoarthritis / rheumatoid arthritis / arthralgias.

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to osteoarthritis / rheumatoid arthritis / arthralgias.
• Use best evidence to answer clinical questions about osteoarthritis / rheumatoid arthritis / arthralgias.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of osteoarthritis / rheumatoid arthritis / arthralgias.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for osteoarthritis / rheumatoid arthritis / arthralgias.
• Include patients and families in the development of treatment plans.
• Demonstrate effective listening skills and empathy to improve patient adherence to lifestyle modifications.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with osteoarthritis / rheumatoid arthritis / arthralgias from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations when patients do not adhere to plans.
• Demonstrate understanding of the relationship of osteoarthritis / rheumatoid arthritis / arthralgias to culture, age, gender, and disabilities.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of osteoarthritis / rheumatoid arthritis / arthralgias.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of osteoarthritis / rheumatoid arthritis / arthralgias using different formularies.
• Analyze barriers to effective integrated treatment of osteoarthritis / rheumatoid arthritis / arthralgias.
• Consider the role of other disciplines (e.g., pharmacy, nursing, social work, or allied health) in the treatment of osteoarthritis / rheumatoid arthritis / arthralgias.

GOAL: Students will understand the role of functional assessment in the patients with osteoarthritis / rheumatoid arthritis / arthralgias.

OBJECTIVES: Students will be able to:

• Describe how to do a functional assessment on a patient with arthritis.
• Consider the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes.

EDUCATIONAL METHODS AND RESOURCES

Web Sites

• American College of Rheumatology
  http://www.rheumatology.org/

Lead Author: Ann O'Brien Gonzales, PhD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

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This page last updated November 6, 2004