Level:  Junior and Senior Fellows
Time:  Continuous
Location:  OHSU (twice per week), Portland VA (weekly)

These clinics represent 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 over the course of 2 years
Location:  OHSU, Portland VA

The inpatient consult services provide trainees the opportunity to evaluate acutely ill patients in various hospital settings for the presence of rheumatic diseases, and guide the management of those with a confirmed rheumatologic illness and related complications. The educational purpose is to develop and refine the knowledge base and skills essential for the clinical evaluation and management of hospitalized patients with suspected or established rheumatic diseases and the attributes needed to be an effective rheumatology consultant. OHSU serves as the only tertiary care center for Oregon and Southern Washington, and in that light, offers our fellows the chance to participate in the assessment and treatment of patients with rare rheumatologic illnesses. Fellows work under the direct supervision of a faculty member and are engaged in teaching residents on the team.

Level:  Senior Fellows
Time:  6 months, weekly
Location:  OHSU

Patients with systemic lupus erythematosus 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. During these 6 months, fellows build on the knowledge acquired in their first year while on the inpatient consult or while caring for patients with these conditions in their own continuity panels. Fellows gain a focused, expert approach and grow their ability to manage patients with these complex diseases and related complications.

Level:  Senior Fellows
Time:  6 months, weekly
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 evaluate patients with systemic symptoms concerning for vasculitis. Fellows 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 participate in treatment decisions and prescribe traditional immune-modulating drugs as well as cutting edge therapeutics. Fellows 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:  Senior Fellows
Time:  Once a month, while on the vasculitis block
Location:  OHSU

While on the vasculitis block, fellows intercalate attending the ILD clinic and the myositis clinic once a month instead of the vasculitis clinic. Fellows gain insight into the multidisciplinary approach required to manage patients with these conditions and further acquire expertise into their evaluation and treatment.  

Level:  Junior Fellows
Time:  6 months, weekly
Location:  Portland VA
Clinics:  Regional Rheum Clinic 

Level:  Senior Fellows
Time: 6 months, twice weekly
Location:  OHSU
Clinics:  Musculoskeletal 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 , PT/OT, and if interested, orthopedics clinic. With those activities, fellows gain additional insight into orthotics and bracing, non-invasive treatment modalities, as well as physical and occupational therapy in treating regional musculoskeletal disorders.

Indian Health Services rotation

Level:  Junior and Senior Fellows
Time:  Quarterly
Location:  Warm Springs Indian Health Services Clinic

During this quarterly clinic, rheumatology fellows provide direct patient care to the Warms Springs Indian Health Services 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 vulnerable populations within their day-to-day practices.