The inpatient consultation service is a crucial component of your clinical training as a fellow in NYU Langone’s Division of Rheumatology. During your fellowship, you consult on a wide range of rheumatic diseases and gain valuable experience with acutely ill patients, helping with diagnosis, management, procedures, and rheumatologic education.

In compliance with the requirements of the Accreditation Council for Graduate Medical Education, you devote at least 12 months to the inpatient consultation service during our two-year fellowship program.

First-Year Rotations

During your first year, you spend 10 to 11 months rotating monthly through 3 primary training hospitals: NYU Langone’s Tisch Hospital and Kimmel Pavilion, NYC Health + Hospitals/Bellevue, and the Manhattan campus of the VA NY Harbor Healthcare System. You may also occasionally provide coverage at NYU Langone Orthopedic Hospital.

Your first year on the inpatient consultation service is divided into three training blocks of four months each.

During block 1 (July through October), you rotate through the three primary training hospitals, spending one month at each plus an additional month at Bellevue. Your goal is to become acquainted with our training sites and to develop a basic understanding of inpatient consultation processes under the close supervision of attending physicians. You present all cases to your attending physicians before providing recommendations to the house staff. You also receive training in common procedures, particularly joint aspirations and soft tissue injections.

In block 2 (November through February), you rotate through the three primary hospitals, spending one month at each. The fourth month, considered a specialty rotation, is devoted to a research elective. During this block, you begin to consolidate your basic understanding of rheumatic diseases and develop an early sense of autonomy. You present cases to attending physicians with a formulated plan of action for consideration. Our instructors emphasize differences among patient populations and healthcare systems, and you perform common joint procedures under indirect supervision; less common procedures still require direct supervision.

During block 3 (March through June), you rotate through the three primary hospitals, spending one month at each. The fourth month, a specialty rotation, is an ambulatory experience at NYU Langone Orthopedic Center. You perform straightforward consultations independently, making recommendations that you subsequently report to your attending physicians for discussion. As you progress in your learning and gain competence in clinical decision-making, you continue to present all of your cases.

Second-Year Rotations

As a second-year fellow, you typically provide one to two months of inpatient consultation service covering NYU Langone Orthopedic Hospital and the VA NY Harbor Healthcare System’s Manhattan campus. If you want more inpatient clinical experience, you may ask to rotate through other training sites, such as Tisch Hospital or Bellevue.

During the first part of the second year, you begin to practice nearly independently for straightforward diagnoses and most procedures; for complex diagnoses, you should have comfort with some but not all possible diagnostic and management issues. By the end of your second year of rotations, you should be broadly capable of practicing independently.

Inpatient Consultation Clinical Training Sites

Each inpatient facility provides a unique training experience, exposing fellows to a wide range of patient populations.

Inpatient Consultation at Tisch Hospital and Kimmel Pavilion

During your rotation here, you consult on inpatient and emergency room cases under the supervision of the designated consultation attending physician or, less commonly, under the supervision of a private attending physician serving as the consultant.

Inpatient Consultation at NYC Health + Hospitals/Bellevue

Bellevue provides an extraordinary opportunity for fellows to learn about rheumatic disease in a diverse patient population. This consultation service is one of our busiest, with a high volume of patients and high-acuity, complex cases. During your time here, you consult strictly on inpatient, emergency room, and urgent care cases under the supervision of a designated attending physician. In high-acuity cases, you must communicate closely with the attending, often in consultation with other attendings or faculty with particular expertise.

Inpatient Consultation at the VA NY Harbor Healthcare System

At the VA NY Harbor Healthcare System’s Manhattan campus, you perform inpatient consultations and point-of-care consultations in the primary care clinics, urgent care facilities, and emergency room.

Inpatient Consultation at NYU Langone Orthopedic Hospital

At NYU Langone Orthopedic Hospital, you gain valuable exposure to tertiary inpatient musculoskeletal care and perioperative management of rheumatic diseases. Inpatient consultation at this site differs from that at other hospitals in that NYU Langone Orthopedic Hospital has an inpatient rheumatology service, meaning that patients can be directly admitted to the service. There is also the possibility of admission of private rheumatology patients and consultation on cases of patients admitted to surgical services.

Responsibility for patient care is shared between you and an experienced rheumatology nurse practitioner, always with the oversight of an assigned attending physician. In conjunction with the attending physician, you act as the primary decision maker for rheumatology service patients. Hospitalists are on-site at all times and play an important role in patient care.

Pediatric Consultations

While on the inpatient service, you may be called to consult on pediatric rheumatology cases. Because we recognize that our fellows are not pediatricians, you see pediatric patients under the supervision of a pediatric rheumatologist. We consider this experience to be an important part of your education and potentially useful in your career as a practicing rheumatologist.