OHSU

Fellowship

Arthritis and Rheumatic Diseases Fellowship Program

housestaff-rounds

OHSU ARD Fellowship Curriculum
OHSU ARD Fellowship General Policy Statement

How to Apply

The Division of Arthritis and Rheumatic Diseases seeks the most outstanding candidates regardless of race, gender, or country of origin. We are use the ERAS system to accept Fellowship Applications. Please go to the ERAS Fellowship Application Site for more information and to apply. Please contact us as well with additional questions.

Curriculum

The subspecialty of rheumatology includes evaluation and treatment of a wide array of inflammatory, non-inflammatory, and degenerative diseases that affect the musculoskeletal and other organ systems. The purpose of our rheumatology fellowship program is to train fellows to be accomplished and compassionate practitioners and consultants in the rheumatic diseases; to encourage their professional and scholarly pursuits to remain up to date in the field of rheumatology and immunology; and to foster their interest to contribute to future advancement of the field.

During the course of their 2 year training, fellows will participate in a series of activities during which they will acquire core competencies necessary to become accomplished rheumatologists. Fellows may also elect to extend their training to a third or fourth year with the mutual agreement of a faculty mentor. Fellowship extension is generally chosen for fellows who wish to become proficient in independent research (see below). Although acquired over a continuum, the expected goals and objectives per period of training are outlined in the ARD fellowship curriculum.

Brief Overview of Clinical Activities

The division currently trains 3 fellows but a request to expand to 4 fellows (or 2 fellows per year) is underway.

Both first and second year fellows participate in 3 weekly continuity clinics, 2 at OHSU and 1 at the Portland VA throughout the course of their two years of training. During those clinics, fellows have a chance to evaluate and treat a broad variety of patients with genuine rheumatologic conditions including rheumatoid arthritis, spondyloarthropathies, gout, vasculitis, lupus, inflammatory myositis, and other connective tissue diseases.

Specialty clinics include a six-month weekly regional rheumatology clinic with the goal of becoming proficient in soft tissue and joint injections; a four-month weekly pediatric rheumatology clinic to gain knowledge in the basic principles of evaluation and management of rheumatologic conditions in pediatric patients; a six-month musculoskeletal ultrasound clinic held every other week to learn the basic use of ultrasound both for the diagnosis of musculoskeletal disorders and guidance of joint injection procedures; and a six-eight month weekly lupus/scleroderma clinic to alllow a more in-depth understanding of these difficult diseases and their management. Additional elective rotations in orthopedics, sports and rehabilitation medicine, podiatry, and neuromuscular diseases are encouraged and are set up on an individual basis.

Fellows additionally gain rheumatology consultative skills by rotating on the OHSU and VA inpatient rheumatology consult services. Patients with complicated and life-threatening rheumatologic conditions are routinely transferred to OHSU which allows fellows to gain competence in assessing and managing these patients.

Fellows are on average expected to be on week-end call once a month with the support and supervision of one of the faculty members. Call responsibilities start at 5pm Friday and end at 8am Monday and include covering the rheumatology consults both at the VA and at OHSU as well as fielding phone calls regarding rheumatology patients enrolled in the outpatient clinics. During the week, the OHSU consult fellow is expected to take first page for OHSU and VA after-hour rheumatology calls. These calls are typically sparse and are taken from home, although fellows are expected to come in to the hospital at times when necessary.

Educational Activities

Every Wednesday morning, all rheumatology faculty and fellows meet for rheumatology grand rounds during which speakers from outside or within the division are invited to discuss topics relevant to rheumatology.  

Additionally, fellows are asked to present clinicopathology cases with the relevant literature review. Grand rounds are then followed by journal club during which one immunology and/or one clinical rheumatology article are presented and discussed.  

Subsequently, a radiology conference is held with the OHSU musculoskeletal radiologists, during which radiographs relevant to ongoing patient care activities as well as classic teaching cases are reviewed. 

Every Friday afternoon, fellows and residents on the rheumatology rotation meet with faculty members for a didactic session on various core rheumatology topics and other specialty topics relevant to the practice of rheumatology and rheumatology board preparation. 

During the summer months, a condensed immunology course is held covering chapters in Janeway’s Immunobiology.  

Throughout the year, fellows are expected to read a major rheumatology textbook as well as seminal papers and reviews relevant to cases encountered.

Research

The first year fellow is expected to meet with the various faculty members early on to identify a research project (laboratory based, clinical, or translational) which could be completed during the second year of training.

If interested in an academic career in clinical research, fellows are encouraged to apply to the Human Investigator Program available at OHSU. The program is a one to two-year certificate program providing training in all phases of clinical research including epidemiologic research methods, biostatistics, evidence-based medicine, outcomes research methods, and medical informatics methods.

Fellows can choose to complete the program or audit specific classes. A third (or fourth) year of fellowship can be arranged for fellows who wish to pursue an academic career and who seek to gain in depth knowledge and experience in a particular area within rheumatology. Such an arrangement is contingent on available funding.


Evaluation forms and feedback

We are a relatively small division, and we encourage a supportive and helping culture. Fellows receive formal evaluations every 6 months and/or at the end of a specific activity. Focused observations are also integrated in the daily work flow for immediate feedback during clinical activities. Patients and support staff are also asked to provide feedback to the fellows relating to professionalism and communication skills.

The program director meets with each fellow on a quarterly basis to review progress and make sure objectives are being met. Fellows are also expected to take the annual in-training exam administered through the ACR as it provides an objective measure of their medical knowledge and areas needing further learning.

Meetings

Fellows are expected to attend the annual national meeting of the American College of Rheumatology. This opportunity is fully funded by the division or its sponsors. Fellows will also be sponsored to attend the yearly Rheumatology and Orthopedics CME course organized by the division in Sunriver, OR as well as the Northwest Rheumatism Society annual meeting. Finally the senior fellow will be permitted to attend the yearly SPARTAN meeting if funds are available. Fellows should work towards presenting a research abstract at the ACR meeting in their second year of fellowship.

Opportunities to speak

In addition to Wednesday morning conference, fellows have ample opportunities to speak publically either to physicians in the community (Rheumatology and Orthopedics CME course organized by the division in Sunriver, OR), to peers (internal medicine residents during the rheumatology core curriculum series), to other learners (physician assistant students), and to lay people (medical coders or others). We feel that the ability to present to the medical community or to the public is an important skill needed to become a proficient consultant.

General Policies

Please view the ARD General Policy Statement.

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