Rheumatology Fellowship Program

There is full participation in all aspects of the fellowship training program curriculum, as outlined below. During the initial two months, there is a conference series designed for first-year fellows as an introduction to rheumatology, with at least two dedicated weekly conferences.

The curriculum in the second year is one of increasing responsibility and challenges, including participation in the design of the educational curriculum.

Conferences are held on a regularly scheduled basis with attendance required of all fellows. These include a bi-monthly Journal Club, monthly Immunology Conference, Basic Science Conference, Research Conference, Rheumatology Case Presentation Conference, Rheumatology Interdisciplinary Conference, Rheumatology Clinicopathologic/ACR Slide Review Conference and Rheumatology Grand Rounds, as well as weekly Medical Grand Rounds.

The fellows are required to participate in at least one research experience and present it formally. They also design, participate and present a yearly Quality Improvement Project. Fellows are also encouraged to submit original or reviews of the literature manuscripts to relevant journals. Time for these endeavors is available through our research rotation. This experience is provided in one-month blocks for a total of six months of research during the two-year fellowship. The fellows’ clinical load during research time is reduced to two, half-day clinics (one at Jackson Memorial Hopsitaland one at the Bruce W. Carter Department of Veterans Affairs Medical Center). They are exposed to ongoing clinical research and interact with the research staff. They are assigned a faculty physician mentor. The mentor will meet with the fellow on a regular basis (at least weekly) and fill out an evaluation at the end of each research rotation. The main areas of interest in our division include the immunology of connective tissue diseases, pulmonary manifestations of rheumatic disease and autoantibodies. Clinical research includes new therapeutic agents for Systemic Lupus Erythematosus. The goal of the research experience is for the fellow to learn sound methodology in designing and performing research studies and the correct interpretation and synthesis of research data.

In addition to participating in the organized didactic conferences established within our program, all fellows become members of the American College of Rheumatology and attend the Annual Scientific Meeting of the ACR. Participation in the continuing medical education activities of these organizations will help foster the standards of professionalism and augment the process of lifelong learning. It will also encourage a sense of responsibility toward, and participation in, the community at large.

The program provides an environment for the fellow that fosters and highly regards the activities of teaching. This includes the education of not only medical students, physicians and other allied health personnel, but also the education of the patients. The types of hospitals used in the training program (public, private, veterans affairs) and our patient populations are diverse, and the fellows are exposed daily to experiences that make them aware of a variety of cultural, social, behavioral and economic issues such as confidentiality of information and end-of-life care.

The fellows assigned to these rotations will be responsible for organizing the activities of the services. Our program has three inpatient rotations. These are: the Jackson Memorial Hospital rotation, the UHealth Tower rotation and the Bruce W. Carter Department of Veterans Affairs Medical Center rotation. These primarily include the supervised evaluation of inpatient consultations and patients admitted to the various hospital services, as well as the continued follow-up of these patients during their hospitalization. There is no dedicated rheumatology inpatient ward as our patients are usually admitted to the medical service wards.

Essential in this role is the development and refinement of clinical-evaluation skills of patients with rheumatic diseases. These skills include the development of appropriate differential diagnosis, assessing the need for hospitalization, diagnostic-evaluation strategies and treatment plans. Also essential in these rotations will be developing skills providing consultation services to include communicating with the referring physicians and ensuring support for continuing care of the patients’ rheumatic condition. The fellows will be called upon to perform literature research on topics appropriate to the case(s) at hand. They will participate actively in the teaching activities of the consultation team. Through this experience, the fellow will also develop a comprehensive understanding of the indications, contraindications, techniques (including ultrasound) and complications of arthrocentesis, as well as the interpretation of results from this procedure. Faculty supervision is provided through multiple, one-on-one teaching interactions with the assigned attending physician and the program director, including three times a week, formal attending rounds.

All fellows attend two half-day clinics, one at Jackson Memorial Hospital and one at the Bruce W. Carter Department of Veterans Affairs Medical Center, both of which are continuity clinics. The fellows follow their own panel of patients for the two years of the fellowship in these “continuity clinics.” This experience continues through the fellowship with progressive responsibility. Each clinic is supervised by at least two, full-time faculty members. Depending on the rotation, the fellows also have a dedicated new patient outpatient consultation experience, two to three half days, per week. The goal of these experiences is for the fellows to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding of the natural history of these conditions over an extended period of time.

The fellows are provided experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases. These disciplines include Dermatology, Ophthalmology, Orthopedic Surgery, Physical Medicine and Rehabilitation, Nephrology, Pulmonary Medicine, Neurology and others.

The goal of these experiences is for the fellow to appreciate the approach to the specific conditions that relate to rheumatic disorders within these subspecialties. This interdisciplinary interaction can occur in the form of a multidisciplinary conference, elective outpatient experience, etc. The monthly Rheumatology Interdisciplinary Conference provides such an opportunity, as well. Clinical experiences should be under the direction of attending physicians in the respective subspecialty who participate fully in the educational goals of the rotation. Rotations are arranged individually by the fellows with the assistance of the program director.