The University of Puerto Rico (UPR) Adult Rheumatology Training Program is fully accredited by the American Council for Graduate Medical Education (ACGME). We recruit two fellows yearly. The two-year training program provides the knowledge, skills, exposure and attitudes that will enable trainees to perform with proficiency as rheumatologists in diverse settings such as academic medicine, clinical research and private practice.
UPR RHEUMATOLOGY PROGRAM SALIENT FEATURES
- It is the first Rheumatology Training Program to be organized in Puerto Rico. Over the past 58 years, 74 rheumatologists have been trained.
- It is the only Rheumatology Training Program in Puerto Rico.
- Our ABIM Rheumatology board pass rate for first time takers is 97% (29 out of 30 graduates) since 2002, which is above the national average for Rheumatology Fellowship programs.
- Being the major referral medical center in Puerto Rico for autoimmune connective tissue diseases, the number and scope of patients seen is very ample and large.
- Active collaboration with all Department of Medicine sections as well as other departments in the UPR School of Medicine.
- Opportunity to rotate in community-based rheumatology practices.
- Consistent source of good applicants for training.
- Excellent Faculty/Trainees ratio. All key faculty members are board-certified in Rheumatology and Internal Medicine, and are actively involved in clinical research.
- Participation in NIH-sponsored muticenter clinical research projects
RHEUMATOLOGY CURRICULAR ACTIVITIES
In order to achieve the goals and objectives for the training program the following experiences have been established for the purpose of teaching Rheumatology fellows. These include: 1) inpatient rheumatology experience, 2) ambulatory rheumatology experience, 3) ambulatory rotations in other clinical subspecialties, 4) didactic conferences, 5) research experience, 6) continuing medical education and society participation, and 7) development of teaching skills.
1. Inpatient rheumatology experience. This rotation primarily entails the supervised evaluation and follow-up of inpatient consultations. Essential to this experience is the development and refinement of clinical evaluation skills of patients with rheumatic diseases such as establishing an appropriate differential diagnosis, assessing the need for hospitalization, diagnostic evaluation strategies and treatment plans. During this rotation the fellow develops the skills needed to provide upmost consultation assistance that include communicating with the referring physicians, and ensuring support for continuing care of the patients’ rheumatic condition. The Rheumatology fellow may be requested to perform literature research on topics appropriate to the case at hand. They actively participate in the teaching activities of the inpatient team. Through this experience the fellow also develop a comprehensive understanding of the indications, contraindications, techniques, and complications of arthrocentesis as well as the interpretation of results from this procedure. They also acquire the necessary skill in performing these procedures, educating patients about the procedure, and in obtaining informed consent. Faculty supervision is always provided in developing these skills.
2. Ambulatory rheumatology experience. All Rheumatology fellows are required to attend rheumatology clinics 3 half days per week during their training. The ambulatory rotation includes the adult general rheumatology, lupus, scleroderma, and community-based rheumatology clinics. This experience is supervised by dedicated attending faculty members. The goal of this experience is for the fellow to gain expertise in the outpatient evaluation and management of rheumatic problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time.
3. Interdisciplinary interactions. The Training Program provides an experience with other disciplines whose expertise is required in the care of patients with rheumatic diseases, such as: 1) orthopedic medicine, 2) rehabilitative medicine, and 3) radiology. The goal of these experiences is for the fellow to learn the approach to the specific conditions that relate to rheumatic disorders within these specialties/subspecialties.
4. Didactic conferences. The following conferences are held on a regularly scheduled basis with attendance required of all trainees and divisional faculty.
Clinical Conference (weekly): Attending physicians deliver lectures on core topics in rheumatology.
Basic Science Conference (monthly): The main objective of this activity is to learn and review knowledge in musculoskeletal anatomy and biology, basic immunology, biochemistry, and pharmacology related to rheumatology.
Journal Club (monthly): In this activity current research publications are reviewed in depth, emphasizing new tendencies.
Research Conference (monthly): The objectives of this activity are to give an update of the research in progress, to offer feedback to the rheumatology residents for their respective research projects, to design protocols for new research projects, and to discuss new ideas for future research projects.
Morbidity and Mortality Conference (monthly): The objectives of the activity are to discuss patients who are unique or very interesting and to discuss patients presenting difficulties in diagnosis and/or management in order to reach a consensus.
Musculoskeletal Ultrasound Conference/Workshop: Attending physicians deliver lectures on musculoskeletal ultrasound including basic needle guidance techniques. Hands-on scanning experience with live models is conducted after lectures.
Pathology Conference (once per semester): The pathologist in charge of the activity discusses the renal biopsies. The objectives of the activity to evaluate renal biopsies of our patients with rheumatic diseases, to correlate the results of renal biopsies with the clinical and laboratory findings, and to learn to interpret light microscopy, immunofluorescence and electron microscopy findings in renal biopsies.
Resident Lecture (monthly): Internal Medicine and Physical Medicine & Rehabilitation residents rotating at our service deliver a lecture as a requisite of their rotation. Topics are selected from their own interest/specialty.
Internal Medicine Grand Rounds/Mortality Conferences (weekly): All trainees and divisional faculty are required to attend these departmental activities. These lectures help to keep abreast with cutting-edge topics in all disciplines of Internal Medicine.
American College of Rheumatology Scientific Meeting (annual): All trainees attend this meeting in their second year of fellowship.
5. Research experience. An active research component is included within the training program. A meaningfully research experience is provided with appropriate protected time for each resident. Exposure to divisional research programs is initiated early in the training to allow the resident adequate insight into the areas of research in preparation for the ultimate selection of a faculty member to serve as a specific research mentor for the remainder of the training program. The immediate goal of the research experience is for the resident to learn sound methodology in designing and performing research studies and the correct interpretation and synthesis of research data. During this phase of training the fellow works under close guidance of the research mentor. At present the UPR Rheumatology Section is very active in clinical research funded by NIH and institutional support. The spectrum of these projects is wide, ranging from epidemiological and outcome studies of autoimmune disorders to clinical trials with biological agents.
6. Continuing medical education and society memberships. In addition to participating in the organized didactic conferences established within the fellowship program it is also strongly encouraged that all fellows become members of the American College of Rheumatology (ACR) as well as any respective local society on rheumatic diseases. Participation in the continuing medical education activities of these professional organizations helps to foster the standards of professionalism and augment the process of lifelong learning. Fellows are offered the opportunity to attend the ACR annual meeting as well as one additional meeting of their choice.
7. Experience in developing teaching skills. The program provides an environment for the fellow which fosters and highly regards the activities of teaching. This includes the education not only of medical students, physicians, and other allied health personnel but also the education of patients. Development of these skills requires the fellow to receive instruction and feedback in counseling and communication techniques. This latter training includes cultural, social, behavioral and economic issues. In addition to the academic activities offered by the Division of Rheumatology, the UPR Faculty Development Program of the School of Medicine and the Department of Internal Medicine offer several seminars and workshops to enhance the teaching effectiveness of the medical faculty. Rheumatology fellows will have the opportunity to attend as many of these as possible.
RESOURCES & ENVIRONMENT
1. Participating Hospitals
The main participation hospital of the UPR Rheumatology Program is the Adult University Hospital. This is a 350 bed general hospital which serves as teaching facility of the University of Puerto Rico School of Medicine and its training programs. It is a government hospital administered by the Department of Health of Puerto Rico and a tertiary hospital that delivers health services mainly to the medically indigent population of Puerto Rico. Major services offered include Internal Medicine, Obstetrics and Gynecology, Surgery, Physical Medicine and other subspecialties. All departments offer training programs. The appointed attending physicians are faculty members of the University of Puerto Rico School of Medicine.
Other participating institutions are the Centro Cardiovascular de Puerto Rico y del Caribe and the UPR Hospital at Carolina. The Cardiovascular Hospital is a 192 bed hospital contiguous to the University Hospital. This facility is specialized in providing medical and surgical treatment to patients with cardiovascular diseases. The UPR Hospital at Carolina is a community-based hospital that serves a 250,000 population in the northeastern coast of Puerto Rico.
2. Ambulatory Clinics
The main facilities used for ambulatory medicine are those provided by the UPR School of Medicine. These facilities are contiguous to the University Hospital. The rheumatology continuity clinics are held on Monday, Tuesday, Wednesday, and Thursday, the lupus clinic on Tuesday AM and the scleroderma clinic on Monday AM. Trainees also attend community-based ambulatory settings at the UPR Hospital at Carolina and one private rheumatology practice. While in the Physical Medicine service (one-month rotation in the second year), the rheumatology fellows attends clinics at the Olympic Villa in Salinas, Puerto Rico, where they are exposed to sports medicine related conditions. In all clinical settings, trainees are under the direct supervision of faculty members.
3. Research Facilities
Most of the UPR Rheumatology Section clinical research studies are performed in the clinical facilities of the Hispanic Alliance for Clinical and Translational Research. This facility has a 14,000 sq. ft. area and is located at the University Hospital. It includes seven examination/interview rooms, two fully-equipped dental suites, one fully-equipped procedure room, day-hospital capabilities with two outpatient beds suitable for studies requiring prolonged monitoring, serial sampling or intravenous infusions, one phebotomy room, two nurses stations, record room with controlled access, double-lock cabinets and refrigerators for study medications, sterilization room, core laboratory and a biostatistical and bioinformatics support unit. The laboratory core facility provides basic laboratory services such as initial specimen processing and handling, biohazard packing and shipping and sample storage capabilities. The available equipment include a refrigerated centrifuge, ultraflow freezers (-85ºC), -20ºC explosion proof freezers, explosion proof refrigerators, CO2 incubators, and a class II A/B3 hood, among others. The PRCTRC also provides support in research design, biostatistics, data management and research ethics.
4. Computer Facilities
Computers and printers are available for all fellows. The following biostatistical support software for research analysis is currently available: SPSS and STATA.
We have our own ultrasound machine, polarized-light microscope, and articular injection models.
6. Office Space
Office space is provided to all trainees; this is located at the Division of Rheumatology in the main building of the UPR School of Medicine.
The University of Puerto Rico Rheumatology Training Program participates in the Electronic Residency Application Service (ERAS). Paper applications are not processed. Positions are only offered through the National Residency Matching Program (NRMP). Information about residents and benefits, samples of standard contract and training manual are available for review through the Graduate Medical Education (GME) Office, at (787) 758-2525, ext. 1385.
1. Requisites for Admission
A. Completing training in Internal Medicine in an ACGME accredited residency program
B. Approval of USMLE Steps I, II and III
C. Full fluency and proficiency (written and spoken) in English and Spanish
D. Sending the following documents through ERAS:
- Complete ERAS common application form (CAF)
- Curriculum vitae (ERAS format is acceptable)
- Personal statement
- Three letters of recommendation, including one from the Internal Medicine Program Director
- Certified copy of USMLE Steps I, II and III scores
Please feel free to contact us if you have any questions.
Division of Rheumatology, Allergy and Immunology
University of Puerto Rico Medical Sciences Campus
PO Box 365067;
San Juan, PR 00936-5067
Phone: 787-758-2525, x1825
Director: Luis M. Vilá, MD
Program Administrator: María Bidot, MPHE, Ed.D