Curriculum

Established in 1976, our two-year Rheumatology Fellowship Program prepares competent caring specialists in rheumatology who are scientifically based in their approach toward patient care while capable of addressing a patient’s emotional and spiritual needs.   The program incorporates the mission statement of Loma Linda University which serves the medical needs of people around the world, and is committed to health promotion and education for all seeking medical care at the institution. Our main focus areas are: Research, Education, Patient Care and Wholeness.

How do we teach Rheumatology?

Our overall fellowship program curriculum follows what is ascribed by the Accreditation Council on Graduate Medical Education (ACGME) and the American College of Rheumatology (ACR). We have a milestones-based curriculum and evaluation tools based on the 6 competencies defined by the ACGME.

We have clinical program where fellows can participate in outpatient clinics and inpatient consults at three sites: Loma Linda University Medical Center and Faculty Medical Offices, Riverside County Regional Medical Center, and Loma Linda Veterans Affairs Health Service. With core group of key clinical faculty, our division is enhanced by a wide cadre of collaborative faculty. This affords fellows to also engage in research endeavors complementary to the clinical care they provide to patients.

More than just Adult Rheumatology: Current Doctors are more than just about Medical Knowledge.

  • We have structured the program to include exposure to Pediatric Rheumatology, Orthopedics early on and on a more constant basis. We realize fellows need teaching in these areas as early as possible and not be confined to the traditional notion of separate month-long electives in each area.
  • We have collaborative conferences year-long with Dermatology, Physical Medicine and Rehabilitation/Pain medicine/Orthopedics.
  • We have monthly meet-the-expert interdisciplinary conferences, bimonthly evidence-based medicine (EBM) conferences and radiology conferences (that cover also MRI); weekly case conferences that focus on improving presentation of clinical history and physical exam, but also on the development of differential diagnoses and preliminary diagnostic workup;  and structured journal club conferences that cover topics focused on and complementary to rheumatology.
  • We participate in Translational research teaching sessions, and hold immunology meetings that cover research and clinical aspects.
  • We also hold regular quality improvement meetings with our FMO clinic nursing and administrative staff to discuss ways to improve delivery of patient care at our clinics.

Educational Technology

We utilize electronic course management systems to organize our teaching materials.  We teach ultrasound to enhance learning of musculoskeletal anatomy and disease processes (see more below). We have access to the LLU School of Medicine’s Simulation center. We encourage fellows to utilize an electronic portfolio to showcase their evidences of learning.

Active Learning

We focus as much as possible on active learning techniques, and try to harness learning styles of our trainees. We utilize a variety of principles and techniques of active learning including small group discussions, enquiry based learning, spaced learning and team-based learning.

Musculoskeletal Ultrasound

We offer in-clinic hands-on teaching, and separate didactic and workshop sessions. Faculty are involved with national programs involved in teaching fellows and professionals ultrasound. Fellows and faculty have an opportunity to be involved in teaching medical students during the yearly LLU School of Medicine Ultrafest. Fellows also have the opportunity to learn from Orthopedists utilizing ultrasound.

Whole Person Care

We also collaborate with the LLU Schwartz Center to conduct teaching rounds that focus on humanism in medicine. We held last June 17 our rounds focusing on “Invisible Diseases” with two of our nurses and a fellow presenting their perspective on their relationship with patients with rheumatic diseases. We also encourage fellows to consider empathy in their relationships with patients and to focus not only physical implications of diseases but also social and psychological impacts.

These are only some of the highlights of our program. Our curriculum is always in a state of improvement. If you have any specific questions, please feel free to email Dottie Acosta or Dr. Torralba.

LLU Rheumatology Fellowship Schedule at a Glance

 

Monday

Tuesday

Wednesday

Thursday

Friday

AM

Hand-off
HR

0930-1200
EMG Clinic@

MSUS Clinic#
MSK-R Clinic@

HR

0730-0830 – Radiology conference (1st, 3rd W)
- EBM conf (2nd, 4th, 5th)
- Derm/Rh IDC*

0900-1200
PedsRheum Clinic, OSP Clinic@
HR

0730-0830
- Case conference

 

ARMC Clinic@

HR

HR

VA Clinic

PM

1200-1300 Core Curriculum Conf

 

1300-1700 Continuity Clinic (FMO)

1300-1700
MSUS Clinic#

Addl Workshop /Conf, meetings
(varies)

 

1200-1300 -Journal Club (1st W)
- Clinical Conference
- PMNR/Rh IDC*

 

1300-1700 Continuity Clinic (FMO)

ARMC Clinic, HR@

 

 

ARMC Clinic, HR@&

RCRMC Clinic#%, HR%

Hand-off

FMO – Faculty Medical Office (Loma Linda)
ARMC – Arrowhead Regional Medical Center (San Bernardino County)
RCRMC – Riverside County Regional Medical Center; EBM – Evidence Based Medicine; EMG – Electromyography; MSUS – Musculoskeletal Ultrasound; MSK-R, Musculoskeletal Radiology; Derm – Dermatology; PMNR – Physical Medicine Rehabilitation; IDC – Interdisciplinary Conference; HR – Hospital Rounds
*Twice yearly
^ 3-4x/year

AM and PM activities in itals– varies depending on rotation; r
regular font/not in itals = common to all/most fellows regardless of rotation
ARMC Consult Rotation = @; LLUMC Consult Rotation =#; VA + RCRMC Consult Rotation=%; Research/Peds (1mo)/Ortho rotation = &