The in-patient service at Cedars-Sinai Medical Center is a busy inner-city highly varied and incredibly complex collection of quite sick individuals who, for the most part, are referred to CSMC for a higher level of care not available in the community. Our patient mix is an excellent substrate for teaching – it will vary from strictly community based emergency room admissions to individuals who are flown in to CSMC from all over the world through our outreach efforts. Our surgical programs, including organ transplantation, are among the busiest anywhere in the USA, not just Los Angeles. The hospitalized CSMC patients vary in terms of chain of command – from a house staff based teaching service to purely private patients of individual attendings. All of these cases are available for rheumatologic teaching; the learning experience for the Fellow is greatly enhanced and benefits from the need to navigate through these different systems based variations in care responsibility.
Our outpatient clinic experience is designed and tailored to take advantage of the variety of ways rheumatologic patients are managed in the real world. The CSMC weekly continuity clinic provides the Fellow with followup cases from their inpatient service as well as community based patients in the nearby area requesting rheumatologic consultation. The Harbor-UCLA continuity clinic is attended for an entire year. This gives the Fellow an experience of rheumatologic disease diagnosis and management in the underserved Hispanic community with all of the important issues that need to be addressed including an understanding of the needs of this population in terms of not only disease management and differential diagnosis but issues regarding work and functional loss, compliance, comprehension/understanding, and impact of the disease on the family. The Veterans Administration experience is extremely valuable in terms of the different patient mix found in that setting, and the teaching provided is excellent for our Fellows. Finally, the Free Clinics give our fellows the chance to learn how to practice rheumatology in a setting where advanced imaging and sophisticated laboratory testing is simply not available, and one has to rely on his/her history and physical examination skills in order to take care of the patient.
During the second year our Fellows will join our private practice faculty in their offices for a one-of-a-kind experience – honing their skills in differential diagnosis, joint and soft-tissue injection techniques, and one-on-one experiences with caring physicians and a unique patient population.
The faculty and attending staff of the Cedars Sinai Rheumatology division work tirelessly to provide the fellows with enormous opportunities for exposure to diverse and interesting patient populations with markedly different demographic backgrounds and disease presentations; they provide excellent opportunities to world class thought leaders in Rheumatology; they are always available for mentoring projects and encouraging ideas. Fellows are able to see patients in a private practice setting and in an academic setting. The fellows who complete their training at Cedars are able to go into practice or into a clinical research tract well prepared for the challenges of our profession.