Fellowship Program Structure: Division of Rheumatology

Structure Overview: Fellows rotate their primary location and responsibilities every two months, with regular continuity clinics, sub-specialty clinics, and didactic sessions throughout.

Inpatient rheumatology at Georgetown: The consultation service is run by one of the first year fellows, and consists of approximately 8-13 patients who are actively followed at a given time. Residents and Georgetown medical students also rotate through the service.

Outpatient rheumatology at Georgetown: Fellows rotate through 5 different weekly half-day sub-specialty clinics every 4 months. Rotations include scleroderma clinic, lupus clinic, vasculitis clinic at the NIH, pediatric rheumatology clinic and ultrasound clinic. Each is attended by a faculty member with expertise in that area. In the second year, fellows rotating at Georgetown attend additional clinics with various attendings to enhance their outpatient experience.

Inpatient rheumatology at the Veterans Affairs Hospital:  The consultation service is run by one of the first year fellows, and an average of 3-6 inpatients are followed at a time. The consult service provides a wealth of opportunity for mastering procedural skills, as the rheumatology team serves as the consult team for joint aspirations and injections.

Outpatient rheumatology at the Veterans Affairs Hospital:  Each fellow attends a weekly ½ day continuity clinic at the VA, where they have their own patient panel with continuity over the two years of their fellowship.  Fellows rotating at the VA also attend additional general rheumatology clinics with a heavy emphasis on rheumatoid arthritis, spondyloarthritis, and crystalline arthropathy. In addition, there is a dedicated weekly procedure clinic, where fellows practice their ultrasound skills, and become proficient in diagnostic and therapeutic procedures, including arthrocentesis and tendon sheath injections.

Pediatric rheumatology: Each fellow spends ½ day per week for 4 months in clinic with a pediatric rheumatologist to gain familiarity with the evaluation and management of pediatric rheumatic disease. There is opportunity for this to be extended to 8 months for those interested.

Ambulatory Rotation: Once during the first year, and at least twice during the second year fellows rotate through an ambulatory rotation during which they participate in VA outpatient clinic, their continuity clinic, their sub-specialty clinic, and a once weekly clinic at Howard University Hospital with Dr. Sharon Dowell. The rest of their time is unstructured, leaving protected time for research, elective clinics, or any other experience.

Electives:  There are multiple opportunities for elective clinic experiences based on the individual fellow’s area of interest. Fellows may choose to rotate through a combined dermatology-rheumatology clinic at Georgetown, the dermatology clinic at the VA, the lupus clinic at Washington Hospital Center, the myositis or auto-inflammatory disease center at NIAMS/NIH, or in the orthopedic subspecialty clinics.

Ultrasound: Education in musculoskeletal ultrasound is incorporated into the weekly training. Twice weekly didactic and hands-on practice sessions are held throughout the two year fellowship program. There is extensive opportunity to practice ultrasound skills under faculty guidance during procedure clinic at the VA, ultrasound sub-specialty clinic at Georgetown, and on a day to day basis on the wards.

Didactics:

Summer Lecture Series: At the start of each academic year, fellow trainees attend a city-wide lecture series as an intensive introduction to rheumatology.  This consists of 36 hours of didactics presented jointly by faculty from Georgetown University Hospital, The Veterans Affairs Medical Center, Washington Hospital Center, NIH, Walter Reed Medical Center, and George Washington University Hospital rheumatology programs. This is also an excellent opportunity for fellows to meet and get to know the other local fellows.

Rheumatology Grand Rounds: This is a weekly conference, attended by all fellows, rotating residents and students, faculty from Georgetown, the VA, and Howard University, as well as several community rheumatologists.  Lectures include interesting case presentations, critical evaluation of the literature, and a wide range of visiting speakers.

Fellow Didactics:  A fellow-specific didactic session follows grand rounds each week.

Radiology Conference: One of the most long standing and popular teaching sessions, this weekly 2 hour session focuses on developing skills necessary to interpret musculoskeletal radiologic images. It is co-taught by a musculoskeletal radiologist and one of the VA rheumatologists.

Ultrasound  Didactic Lectures: Twice weekly sessions are held to review joint specific ultrasound, and provide hands on practice with real-time faculty feedback.

Pulmonary-Rheumatology Conference: A bi-monthly conference attended by both divisions, where mutual cases are presented and discussed.

Neuromuscular Conference: A bi-monthly conference attended by Neurology, Pathology, and Rheumatology in which interesting cases are discussed, and detailed pathology is reviewed.

Renal Pathology Conference: An additional optional monthly conference attending by Nephrology, Pathology, and Rheumatology where complex cases are reviewed and treatment plans discussed.

Immunology Series: A weekly seminar in the spring combined with Washington Hospital Center fellows.

Other Educational Opportunities

• All participate in the fellow-lead advocacy training program which includes monthly, case-based educational modules and the unique opportunity to meet directly with Congressional leaders as part of ACR’s annual Capitol Hill Advocacy Day.
• The D.C. Rheumatism Society holds a monthly dinner meeting featuring a nationally known guest speaker, attended by fellows, faculty, and private rheumatologists from throughout the Washington D.C. area.  
• Bone Club is a quarterly dinner meeting held at Georgetown with a focus on bone health, featuring experts in the field and Rheumatologists, Endocrinologists, and Internists.
• The D.C. Rheumatism Society’s annual Fellows Forum is a city-wide event featuring poster presentations by area fellows.
• MedStar Georgetown University Hospital’s Department of Medicine Research Day is an annual poster presentation competition and dinner event attended by all fellows, as well as residents and hospital faculty.
• Opportunity to attend The American College of Rheumatology Annual Meeting and/or the annual State of The Art (SOTA) Rheumatology meeting. Past fellows have attended several other meetings as well, depending on their area of interest.

Research

Fellows are expected to participate in a scholarly activity over the course of the two years. In the past, fellows have participated in projects exploring a variety of diseases.

Over the past several years, fellows have pursued original research projects, literature reviews, quality improvement projects, and published variety of case reports and book chapters. The ongoing research of various faculty members and our participation in several national registries through the VA provide multiple opportunities for scholarly projects. Fellows are expected to present posters each year at the Department of Medicine Research Day and D.C. Rheumatism Fellow’s Forum (see above), but many also present at other local and national meetings.