Fellowship Program

The Division of Rheumatology within the Department of Medicine at Washington University School of Medicine offers postdoctoral training in clinical care, and clinical and basic laboratory research involving the rheumatic and autoimmune diseases and immunology.

The division is a Missouri Regional Arthritis Center and is affiliated with Barnes-Jewish Hospital and St. Louis Children’s Hospital, as well as St Louis VA Medical Center and Shriner’s Hospital for Children, which are in close proximity.

Our mission

The mission of the Rheumatology Fellowship Program is to

  • Educate the next generation of health care providers, educators and researchers to pursue and maintain clinical excellence in the medical care of patients with arthritis, musculoskeletal, autoimmune and inflammatory diseases
  • Develop behavior conducive to life-long learning
  • Support clinical and basic research in areas related to rheumatologic diseases

The Rheumatology Fellowship Program is designed to train highly qualified, motivated and dedicated physicians in a fully accredited program.

Successful completion will lead to eligibility for the Rheumatology subspecialty board certification examination administered by the American Board of Internal Medicine.

Educational goals

  • Teach the scientific basis for the pathophysiology and treatment of rheumatic diseases
  • Train in the critical evaluation of the medical literature and new treatments
  • Provide didactic presentations and clinical experience that result in consistent high quality care to patients, including those with highly complex management issues
  • Develop in-hospital and out-patient consultant skills, provide long-term care for patients with chronic rheumatic diseases, and coordinate care among health care providers across specialties
  • Teach joint aspiration and injection
  • Teach the rational and efficient use of laboratory, radiographic, ultrasound, pathology and other testing methods, and expert interpretation of results
  • Provide an understanding of the realities and details of managed care and documentation
  • Provide care to socio-economically disadvantaged patients with rheumatic diseases, and families
  • Enhance the development of public presentation skills of clinical and scientific material
  • Provide an opportunity to participate in clinical research protocols to gain an understanding of the processes by which new treatments are evaluated
  • Provide an opportunity to develop clinical or basic laboratory research skills to pursue a career as an independent investigator

Clinical training sites

Washington University Medical Center

Washington University Medical Center, which is home to Washington University School of Medicine, Barnes-Jewish Hospital and St Louis Children’s Hospital, is one of the nation’s largest clinical and biomedical research facilities. The campus includes more than 60 buildings on nearly 85 acres, with more than 2,000 hospital beds. Barnes-Jewish Hospital, the largest hospital in the Medical Center, provides clinical experience and teaching facilities for all clinical departments except pediatrics. It consistently ranks among the top 10 hospitals in U.S. News and World Report. St. Louis Children’s Hospital is one of five top pediatric health centers in the country, offering the complete range from primary to subspecialty care to meet the health needs of newborns through adolescents.

Both hospitals are members of BJC HealthCare, which was formed by the union of Barnes, Jewish, and Christian Hospitals to meet evolving healthcare needs, strengthen healthcare delivery and contain costs. BJC has formal relationships with more than a dozen outlying hospitals, five extended-care facilities, an occupational and preventive medicine affiliate, and the School of Medicine. It is one of the largest full-service, fully integrated, academically-linked health systems in the country.

St Louis VA and Shriner’s hospitals

The division has clinical and research activities at St Louis Children’s Hospital and the nearby John Cochran Veterans Administration Hospital and Shriner’s Hospital for Children. The combination of hospitals provides a wide spectrum of pathology and clinical experiences for outstanding clinical training at one of the country’s premier centers for medical research.

Overview of rheumatology training

The division maintains an outstanding environment for the training of research-oriented physicians for careers in rheumatology. Three fellowship tracks are available: a two year clinical track for those who desire careers in clinical rheumatology, and three year clinical and basic laboratory research tracks for those interested in investigative, academic careers.

For all fellows, the first year is devoted to direct patient care and conferences. Fellows serve as inpatient and outpatient consultants at Barnes-Jewish and John Cochran Veterans Administration Hospitals. Elective outpatient clinics at Children’s Hospital and the Shriners Hospital for Children provide additional training in pediatric rheumatology and genetics of rheumatic diseases. Fellows attend and present at weekly Rheumatology Grand Rounds, journal clubs, didactic clinical conferences, and monthly journal reviews and are encouraged to attend Department of Medicine Grand Rounds and the Immunology Seminar Series.  (Refer to “Educational Opportunities” for titles of recent Rheumatology Grand Rounds, didactic rheumatology clinical coursework, and examples of the diverse educational opportunities available in the Medical Center.) Fellows also help coordinate clinical activities of medical students and residents on the rheumatology rotation.

The content of the second and subsequent fellowship years varies as indicated in the chart below. An important component of developing a career path is the relationship, developed in the first year, with one or more faculty mentors selected by the fellow.

Proportional time distribution between patient care and research responsibilities as a function of fellowship track and year of training
Fellowship Tract Year 1 Year 2 Year 3
Patient Care (%) Research

(%)

Patient Care (%) Research

(%)

Patient Care (%) Research

(%)

Clinical Fellowship ~95 ~5 ~601 ~40
Clinical Research Fellowship ~95 ~5 ~10 ~90 ~10 ~90
Laboratory Research Fellowship ~95 ~5 ~10 ~90 ~10 ~90

1 For the Clinical Fellowship track, this division of time can vary according to the goals of the individual. 

Overview of clinical research training opportunities

The Institute of Clinical and Translational Sciences (ICTS), Washington University’s umbrella research resource organization, includes a commitment to clinical research training. Established in 2006 as part of the university’s Clinical and Translational Science Award (CTSA), the ICTS encourages collaboration among existing research groups, helps ensure efficient use of the University research organization, and funds new resources. The ICTS facilitates investigator access to state-of-the-art infrastructure, financial support, education, assists in the creation and sustainment of interdisciplinary research collaborations, and supports the progress of research findings from laboratory bench to clinical implementation.

ICTS includes 24 cores. Four cores are potentially most relevant to rheumatology fellows interested in clinical training and research:

Clinical track

The clinical fellowship track is designed for physicians who wish to pursue careers in clinical care.  During the second year, clinical fellows devote a portion of their time to clinical research, and the remaining effort to patient care.  The fellowship program will support matriculation in up to two research related courses through the university’s Clinical Research and Training Center (CRTC).

Clinical research track

The clinical research track is designed for physicians who are committed to an academic career in clinical research. Applicants are encouraged to state their intent to enter the clinical research track at the time of the Fellowship application, although accepted fellows can delay their decision until early in Fellowship Year 1.

During Fellowship Year 1, in collaboration with a research mentor, the fellow develops a clinical project which must be presented to and approved by a University faculty review panel.  The second and third years are devoted primarily to implementation of the approved project, and formal clinical research training.  The fellowship program will support the fellow’s matriculation into either of two master’s degree programs offered by the university’s CRTC. Coursework begins in fellowship year two and concludes in year three.

The CRTC provides didactic curriculum and mentored training in clinical and translational research for predoctoral students, house-staff, postdoctoral fellows, and junior faculty.

The CRTC offers two degree programs relevant to rheumatology fellows pursuing an academic career in clinical research:

In addition, the Postdoctoral Mentored Training Program in Clinical Investigation (MTPCI) includes the ability to obtain a MSCI degree within a broader framework of didactic coursework, structured research mentorship and interactions with a diverse group of peers.

Laboratory research track

The Laboratory research fellowship tract is designed for physicians committed to an academic career as a physician-scientist involved in basic science or translational research.  During the subsequent years, the fellow devotes the great majority of time to a laboratory research project

Contact

For additional information, please contact:

Jill Munoz, Fellowship Coordinator
Division of Rheumatology
Department of Medicine
Washington University School of Medicine
660 S. Euclid Ave., CB 8045
St. Louis, MO 63110
Phone: 314-454-7376
Fax: 314-454-7120
Email: jmunoz@dom.wustl.edu