To say that rheumatology fellows receive comprehensive inpatient and outpatient clinical training is an understatement. The inpatient service is a busy, complex, inner-city collection of patients who often are referred to Cedars-Sinai for a level of care higher than is available elsewhere in the community. Our patient mix is an excellent substrate for teaching — it varies from strictly community-based emergency room admissions to individuals who are flown to Cedars-Sinai from all over the world. Our surgical programs, including organ transplantation, are among the busiest anywhere in the United States. Cedars-Sinai patients vary from the house staff-based teaching service to private patients of our individual attending staff. All these cases are available for rheumatologic teaching; fellows benefit from the learning experience of navigating through the systems-based variations in responsibility of care. This training better prepares them for any path they choose after their fellowship.
The outpatient clinic experience is designed to take advantage of the variety of ways rheumatologic patients are managed in the real world. Fellows participate in the Cedars-Sinai weekly continuity clinic as well as community outpatient continuity-of-care clinics, including Harbor-UCLA Medical Center continuity clinic, Veterans Affairs (VA) Sepulveda Ambulatory Care Center, Wadsworth VA Hospital and free clinics such as the Saban Community Clinic and Venice Family Clinic. Additionally, fellows are encouraged to work in the clinics of private attendings in order to garner "real world experience."
The Cedars-Sinai weekly continuity clinic provides follow-up cases from the inpatient service, as well as community-based patients from the area who request rheumatologic consultation.
The Harbor-UCLA Medical Center continuity clinic provides experience diagnosing and managing rheumatologic diseases in the underserved Hispanic community. Fellows learn about and address important issues, including an understanding of the needs of this population, not only in terms of differential diagnosis and disease management, but also in work and functional loss, compliance, comprehension/understanding, the role of depression and other psychosocial factors on disease outcome, and impact of the disease on the family.
The VA experience provides an extremely valuable teaching and patient mix experience, and the free clinics give our fellows the chance to learn how to practice rheumatology in a setting where advanced imaging and sophisticated laboratory testing are not readily available. Fellows must rely on history and physical examination skills in order to care for the patient.
During the second year, fellows join our private practice faculty to hone skills in differential diagnosis and joint and soft-tissue injection techniques, and they gain one-on-one experiences with caring physicians and a unique patient population. In the second year, fellows learn the nuances of a consultant rheumatologist, assessing not only the issues facing the patient but also how to understand and address the unique needs of the referring physician.
The faculty and attending staff of the Cedars-Sinai Division of Rheumatology work tirelessly to provide fellows with opportunities for exposure to diverse and interesting patient populations with markedly different demographic backgrounds and disease presentations. In addition, fellows are able to see patients in both academic and private practice settings and have continuous access not only to Cedars-Sinai rheumatology faculty but to world-class thought leaders and educators in rheumatology. Our fellows are able to go into practice or a clinical research track well-prepared for the challenges of our profession.