Curriculum

Old Library 1944
Researching at the Old Library on Marquam Campus, 1944

Our curriculum is designed to develop critical thinking in rheumatic disease and to foster well-rounded, thoughtful providers. Each component of our program strives to meet high standards by setting specific goals and objectives in the following categories:

  • Medical Knowledge
  • Patient Care
  • Practice-Based Learning and Improvement
  • Systems-Based Practice
  • Interpersonal/Communication Skills
  • Professionalism

Fellows have the opportunity to care for a wide range of patients, while working at OHSU, the Portland VA Medical Center (VAMC), Pediatric Rheumatology at Legacy Hospital, and Warm Springs Indian Health Services Clinic.

Clinics, consults, rotations

Level:  Junior and Senior Fellows
Time:  Continuous
Location:  OHSU, Portland VAMC

These clinics are the core of the fellows' clinical training, allowing competencies to be acquired on a continuum over a 2-year period. Under the close supervision of the rheumatology faculty, fellows will independently evaluate new and follow-up patients with a broad scope of rheumatic diseases, will present their findings, outline a differential diagnosis, generate a plan of treatment, and perform procedural skills fundamental to the practice of rheumatology. Fellows will also have the opportunity to follow patients over time and reassess the success or failure of their treatment intervention. As their patients' advocates, fellows will help their patients navigate the various aspects of living with a chronic rheumatologic condition including for some, medication approval processes, access to assistance programs, and emotional support.

Level:  Junior and Senior Fellows
Time:  6 months at each location
Location:  OHSU, Portland VAMC

The inpatient consult services provide trainees the opportunity to evaluate acutely ill patients in various hospital settings for the presence of rheumatic diseases. The educational purpose is to develop and refine the knowledge base and skills essential for the clinical evaluation and management of hospitalized patients with rheumatic diseases. A wide variety of patients will be seen at both OHSU and the Portland VAMC, and will be referred from various services including internal medicine, ICU, OB/GYN, surgery subspecialties, transplantation, neurology, and psychiatry. The fellow will work under the direct supervision of a faculty member and will actively be engaged in teaching residents and medical students on the team.

Level:  Senior Fellows
Time:  6 months
Location:  OHSU

Patients with SLE and systemic sclerosis in this panel have either been followed for a substantial number of years at OHSU, are newly referred by community primary care physicians, or are referred for second opinions by community rheumatologists. This clinic provides the fellows with a rich experience and grows their ability to manage these complex patients. This clinic builds on basic knowledge acquired during encounters with patients early in the first year, gathered either on inpatient consult service or in continuity panels.

Level:  Senior Fellows
Time:  6 months
Location:  OHSU

Although vasculitis is a rare disease, it represents one of the greatest challenges a graduating rheumatology trainee will face in practice. In this clinic, fellows will evaluate patients with systemic symptoms concerning for vasculitis. Fellows will gain further expertise in the differential diagnosis of vasculitis, and in the diagnostic procedures used in evaluating these syndromes. In patients with established vasculitis, fellows will guide treatment and will use traditional immune-modulating drugs as well as cutting edge therapeutics. Fellows will have the opportunity to participate in research protocols and learn methods of data collection needed to evaluate the disease activity/damage in these various conditions.

Level:  Junior Fellows
Time:  6 months
Location:  Portland VAMC
Clinics:  Regional Rheum Clinic (VA), 

Level:  Senior Fellows
Time/Location:  OHSU
Clinics:  Muscuoskeletal Ultrasound Injection Clinic; Elective time with PM&R, orthopedics, PT/OT

In their first year, fellows participate in the regional rheumatology clinic at the VA. Patients are referred there for evaluation of soft tissue rheumatism and osteoarthritis and are generally seeking injection therapy. In their second year, fellows rotate through the ultrasound-directed joint injection clinic at OHSU. The goal of these rotations is to expand the fellows' knowledge in joint anatomy, joint examination and the diagnosis of regional musculoskeletal disorders. Fellows learn the indications for joint and soft tissue aspiration and injections and rapidly gain the skills necessary to perform them. Fellows additionally learn the basics of musculoskeletal ultrasound and its utility in directing soft tissue and joint injections. Fellows are also encouraged to spend some time with providers in the PM&R clinic and if interested in the orthopedics clinic, and to follow one patient they have referred to PT or OT undergo their initial evaluation.With those activities, fellows will gain additional insight into orthotics and bracing, non-invasive treatment modalities (topical analgesia, ice/heat, TENS unit, iontophoresis), as well as physical and occupational therapy in treating regional musculoskeletal disorders.

Pediatric rotation

Level:  Senior Fellows
Time:  6 weeks
Location:  Legacy Emanuel Hospital

The purpose of this rotation is to understand the scope of rheumatologic diseases in the pediatric population and the impact that juvenile onset rheumatic diseases have onto children's development, physical and mental well-being, functioning in scholastic activities, and transition into adulthood.

Indian Health Services rotation

Level:  Junior and Senior Fellows
Time:  1 day each quarter
Location:  Warm Springs Indian Health Services Clinic

During this quarterly clinic, rheumatology fellows provide direct patient care to an indigent Native American community and gain insight into the challenges encountered when caring for a rural underserved population. This rapidly paced clinic particularly enhances the fellows' efficiency and autonomy. This experience further heightens the fellows' awareness in recognizing and supporting other vulnerable populations within their day to day practices.

Evaluation forms and feedback

We promote a supportive and helping culture by encouraging faculty, patients, and clinical support staff to provide feedback on a regular basis. Focused observations by faculty are integrated in the daily workflow for immediate feedback during clinical activities. Formal evaluations occur every 6 months and/or at the end of a specific activity.

Fellows are able to assess their knowledge by taking the annual rheumatology in-training exam administered by the ACR. Results provide an objective measure of their medical knowledge and helps point to areas where additional learning would be beneficial.

The program director meets with each fellow on a quarterly basis to review progress and make sure objectives and educational needs are being met.