Rheumatology Fellowship Program

Christina Chen, DO
Andrew Kelly, DO
Beatrice Kenol, MD

Jennifer Johnson, DO
Dawn Piarulli, MD
Stavros Savvas, MD

Our Division possesses several special strengths. We are comprised of distinguished scientists and prominent leaders in rheumatology and immunology. They are complemented by superb clinician- educators and scholars. We develop and present important new knowledge. We care for uniquely diverse, challenging patients at university and county medical centers in a very high quality academic environment. We do this is a collegial manner in one of the loveliest places in the world.

Clinical and scholarly excellence. We expect our graduates to be caring, competent, ethical, and intellectually curious physicians with a passion for medicine and capable of either successfully continuing academic careers or entering medical practice. We achieve this by creating a rich, congenial, collegial educational environment with appropriate role models for our fellows, by carrying out scholarly activities, and by representing and demanding clinical, scholarly, and investigative excellence.

We emphasize high standards of ethics and professionalism. We encourage questioning. We respect scholarship. We want our fellows to truly enjoy their experience; learning is easier when it is fun. Despite the size of the medical center ours is an intimate and nurturing environment.

Our division has a unique identity. We at Los Angeles General Medical Center have an unusual commitment to caring for a desperately ill underserved population. We do this in an outstanding academic setting, complemented by opportunities for caring for private patients at our University Hospital and consultative practices, with a faculty comprised of individuals recognized internationally for their superb clinical and investigative skills, in an exceptionally desirable geographic area.

We seek individuals from any background with (i) adequate liberal arts, medical, residency, and scientific educational preparation for a rheumatology/immunology fellowship, (ii) appropriate humanistic attributes– empathy, compassion, maturity, concern, responsibility, and recognition that doctors care for the sick and that the sick never inconvenience the well, and (iii) intellectual curiosity and a commitment to develop a scholarly approach to clinical medicine. (iv) Modern medicine is a “team” activity. We therefore also seek people who understand this and are committed to fit well and work well within the fellowship; individual excellence is necessary but no longer sufficient to be a good fellow or good doctor. (v) We particularly seek fellows contemplating careers in academic medicine.

We understand that the examination scores are just one of many attributes of a great applicant. Therefore, we do not have particular exam scores or quantitative data for granting interviews, we do believe that good scores on examinations reflect a strong medical knowledge base. We look for candidates who have proven records of achievement and success.

Only J1s. Regretably Los Angeles General Medical Center does not sponsor H1B visas.

Yes. We are only concerned with ability and potential. We are proud of our diversity and consider it one of our strengths. Once residents “matriculate” to our program they are all the same– young men and women who are graduate physicians anxious to learn rheumatology and continue as good, caring physicians.

Many come from the region (California, Southern California). We have had fellows who grew up in local communities such as Pasadena or Los Angeles. Others come from a variety of other regions of the U.S. They represent a variety of cultures and nationalities. We welcome diversity among our fellows.

Fellows are presented with diverse and complementary experiences, from the floors and clinics of Los Angeles General Medical Center, to the private practices of the University (Keck) Hospital and Consultation Center, to the Children’s Hospital of Los Angeles, and to the Rancho Los Amigos National Rehabilitation Center. All settings challenge fellows to learn common and uncommon problems in rheumatology and acquire the expertise to become expert consultant physicians. Fellows will complete scholarly work during their training, reflecting our expectations for intellectual curiosity, critical analysis and thinking, together with clinical excellence.

We support our fellows during and after training. This is evidenced by our success in placing our graduates into post-training opportunities. Some have stayed on our faculty; the majority have entered private practices in Southern California. Regardless of choice, all our graduates have found that their training has prepared them well for the next step in their careers.

Absolutely. See preceding.

All of us on the faculty chose academic medicine because of our passion for education– transmission of knowledge to a new generation of physicians and development of new knowledge. This is fundamental to a major medical center and its faculty. We are proud of our program, and of our clinicians who teach residents. Indeed it is noteworthy that many of our graduates who have practices in the area participate actively in our educational conferences and in teaching the fellows.

Our fellowship has been consistently and fully accredited. Our current accreditation is for10 years. Ours is a program of established excellence. All our fellows pass the certifying exam of the ABIM for medicine. Since 2007 all fellows have passed the subspecialty exam for rheumatology.

Fellows are carefully supervised by voluntary and full-time faculty and given those prerogatives and responsibilities commensurate with their abilities. Mature fellows will be permitted a great deal of latitude in patient care decisions. The size of program facilitates a pleasant degree of intimacy within the division. Fellows have ready access to our faculty, as well as to voluntary staff, and our faculty knows the fellows well. In today’s medicine it would be unthinkable for fellows to provide unsupervised care. It would be equally unacceptable for fellows to provide care only as directed. We therefore carefully balance supervision and autonomy titrating this to fellows’ level of training, abilities, willingness to accept responsibilities, and confidence (of fellows and faculty). All this said, the County Medical Center enjoys a reputation for being among those training sites in the country tending to allow as much trainee initiative and autonomy as possible.

Virtually every clinical activity during fellowship is formally evaluated and all these evaluations are conveyed to fellows. Fellows’ care of inpatients, outpatients, conference attendance, conference discussions and presentation, grand rounds presentations, research and scholarship, professionalism, interactions with other health care team members, scores on exams, and results of clinical exams are but some of the evaluative tools employed. As ours is a small and intimate program, fellows are quite aware of their performance. They meet formally with the program director at least twice annually to review all performance-related issues. Thus fellows are rigorously and regularly evaluated and should be quite aware of how their performance is judged.

Well. We cultivate attitudes of collegiality and mutual respect. This is facilitated by the modest size of our program which facilitates intimacy, mentoring, and nurturing.

On the average, a fellow is responsible for the care of 5-15 consultative patients on the general medical service of the County Medical Center at any given time, fewer at University Hospital. The fellow supervises 1 or more residents/interns and several students. The patients will usually have serious manifestations or complications of systemic rheumatic disease; some will be in the ICU, others less acutely ill. A typical day this past year included patients with inflammatory myopathy, gout, viral-like acute febrile polyarthritis, undifferentiated systemic rheumatic disease, scleroderma lung disease, systemic necrotizing vasculitis, lupus gastroenteritis, rheumatoid arthritis hospitalized for general surgery (for non-rheumatologic problems), pseudo-gout, and generalized flare of lupus.

An ambulatory “block” month consists of opportunities to follow patients on the Clinical Trials/Research Unit, the Early Arthritis Clinic, the Ultrasound Clinic, and the Rancho Los Amigos Clinic. This month is designed deliberately to provide fellows some protected time. All fellows are assigned to continuity experiences at Los Angeles General Medical Center and will have additional ambulatory experiences at the private practices of the Healthcare Consultation Clinic, at Rancho Los Amigos, at Children’s Hospital, in electromyography, and in sports medicine/orthopedics/regional musculoskeletal disorders.

All fellows will follow their own (“continuity”) patients in the weekly clinics at Los Angeles General Medical Center, seeing c. 5-10 patients per session.

We consider ours an excellent and comprehensive program offering all that fellows need to experience in order to become accomplished consultant rheumatologists. We would consider a request for certain specialized training or experience elsewhere if it were not available here.

Robust. We have weekly clinical conference/rheumatology grand rounds and additional regularly scheduled morbidity and mortality/pathology, radiology/imaging, research, and “journal club” conferences.

Fellows are on call weeknights during their monthly assignments to the consultative services of County and University hospitals, at Childrens’ and Rancho Los Amigos medical centers. Weekend calls are apportioned among all fellows, averaging less than once monthly.

In several ways. Fellows encounter much of this in the context of caring for patients in the hospital and their continuity experience. We are not isolated from the exigencies of modern medicine. Our faculty and voluntary faculty practice and teach today’s medicine. We supplement practical, supervised experiences with didactic conferences addressing topical issues, such as billing and coding, quality, and patient safety, for example. All fellows spend time in faculty private practices which acquaints them with these issues.

We have presented the excellence of our faculty and academic environment. We offer exceptional opportunities for fellows to engage in substantive “bench” research, translational investigation, or clinical studies. We have experienced, committed faculty with successful records of mentoring to provide the necessary supervision. There are possibilities of adding additional time to the fellowship experience to facilitate transition of interested fellows to junior faculty positions.

We believe that capable and motivated fellows in a sound educational program will learn to be good rheumatologists and have no difficulty documenting this in a quantifiable fashion. We want our fellows to develop a consistently scholarly approach to clinical medicine and lifelong study patterns. However we know too the importance of passing and that candidates perform better on the exam when properly prepared. We have therefore incorporated into our overall educational program a core lecture series throughout the year. This conference emphasizes material of educational value in the context of fellows learning to be expert rheumatologists; it does not narrowly address test-taking skills. We believe this is a satisfactory balance of necessary and desirable educational objectives for our program. Our fellows’ performances reflect this.

Essentially unlimited. Indeed it is a requirement of our program that fellows complete a scholarly project in order to graduate from our program. This “scholarly project” may consist of original research but may also be a case report, literature review, chart review, or other effort. For those who wish, an experience in laboratory research can be arranged; most will carry out a clinical scholarly project. Our faculty serve as preceptors, guiding the fellows appropriately through this effort. The purpose of this, of course, is to enable our fellows to gain experience with scientific method and learn to develop critical analytical skills so that they may apply these abilities to clinical medicine. We invite applicants to examine our listings of divisional publications to appreciate the excellence of and the breadth and depth of our scholarship. We are proud of the record of our fellows of presenting at the scientific meetings of the ACR and other forums, and publishing in peer-reviewed journals in recent years.

We are very pleased with and proud of our program as it is. However we are never satisfied or complacent and are committed to make our program still better. Each year our faculty and fellows together critically review our program and identify opportunities for improvement. We surely do not intend to revamp or overhaul a successful program but rather improve each year’s program to be even better. We have elsewhere presented our perceptions of the challenges we now confront in practice and education. We will develop the necessary responses to so that ours will remain a model program.

Safe and convenient housing is available in desirable neighborhoods easily accessible to the medical center. This is one of many attractive aspects of our institution and our location.

Of course. How could we not? We are selfish in that we want to succeed; our success is defined by our fellows’ performance. We understand that. That is why we do what do. That is why we are so committed to developing and maintaining an environment where everyone has fun learning and caring for patients together, and does it as well as possible. That is why we are so committed to helping our fellows flourish. That is why we expend so much effort talking with fellows about life decisions, life after fellowship, practice situations, jobs, preparing resumes, writing applications, conducting mock interviews, and otherwise supporting fellows as they move into new phases of their careers.

We enjoy being on a lovely campus of the adjacent University and County medical centers. Both are new state-of-the-art facilities. Our divisional and individual offices are a somewhat quaint, understated mix of old and new, spread across the private University Healthcare Consultation Clinic, University campus research buildings, and a rather old (some might say “historic”) county building (which was once an intern and resident dormitory and now serves much of the department of medicine). Fellows (and several faculty members) have office space in this facility. Weekly conferences take place in the old county hospital (a building not much used now and which actually does have a designation as a historic building); other conferences and activities will be in the more modern new county and other University facilities.

• Los Angeles covers 467 square miles.
• The average commuting time in Los Angeles is 29 minutes (not the nation’s longest; the shortest average time was 15 minutes

[South Dakota, but who has the better climate?]).

• The LA county coastline, with more than 25 beaches, is 75 miles long, where the iconic series Bay Watch was filmed.
• Los Angeles has an annual rainfall of only 15 inches.
• Average sunny/partly sunny days are 325; average high temperature is 74º F and average low temperature 56º F.
• LA county has the world’s 17th ranked economy and California the 7th.
• LA’s leading industry is neither film nor tourism but international trade and manufacturing.
• People from 140 countries, speaking approximately 86 different languages, currently call Los Angeles home. 47 % are Hispanic or Latino, 29% white, 13 % Asian/Pacific Islander, and 9% African-American.
• Los Angeles is the second largest city in the nation.
• If the five-county Los Angeles area were a state, it would be the fourth largest in the United States. The county of Los Angeles alone would be the eighth most populated state.
• LA has more stage theaters and museums than any other US city.
• The Port of Los Angeles is the busiest in the US.
• There are actually lots of walk-able shopping and beach areas in Hollywood, downtown LA, Venice, Santa Monica, Pasadena, Long Beach, and the coast. There are also great hikes in and around Los Angeles.
• Visitors are often surprised by tree-lined streets, parks and green. Griffith Park is over 4,000 acres of green within the city. The Hollywood hills and Santa Monica mountains provide a green backdrop all the way to the beach.
• Most tourist areas in LA are at least as safe as other big cities.
• While LA is the center of US fashion and clothing, dress is casual.
• USC has 38,000 students, 3,400 faculty, 11,800 staff, 7,200 international students, 247 merit scholars, 14% first generation students, 240,000 alumni, and has had 3 Nobel laureates. Tuition is $43,000/year; annual financial aid is $389 million, budget $3.2 billion, endowment $3.5 billion, and research grants c. $561 million.
• USC is considered among the 3 most “nurturing” (to constituents and alums) academic institutions (with Notre Dame and Wellesley).
• USC has had more Olympic athletes than any other University. If USC competed as a country, its medal count would have placed it among the top 10 nations.
• The Marcus Welby MD TV series was filmed at the old Los Angeles General Medical Center.

We hope this information has provided some additional insights and perspectives about our program. We would enjoy hearing from you. We wish you well.