Rheumatology Fellowship

About the Program

Our 24-month program provides extensive outpatient and inpatient clinical experiences in adult rheumatology, with added experiences in outpatient pediatric rheumatology and musculoskeletal radiology. Weekly educational conferences hosted by the Division of Immunology are designed to provide a thorough grounding in immunology, to review the state-of-the-art in rheumatology, and to foster engaging discussions of our most challenging cases.

Rheumatology Fellowship Program Highlights

  • In-depth patient care experiences in outpatient adult rheumatology clinics and inpatient consultation services at University of Iowa Hospitals & Clinics and at the adjacent Iowa City Veterans Affairs Medical Center
  • Regular participation in the outpatient pediatric rheumatology clinic
  • Rotation in musculoskeletal radiology, as well as a monthly conference attended by rheumatology and musculoskeletal radiology staff and trainees
  • Fellows as Clinician Educators (FACE) Program for fellows interested in becoming clinical educators
  • Institutional Quality Improvement Curriculum, leading to certification by the Institution for Healthcare Improvement (IHI)
  • Fellowship Advancement Curriculum to foster practical skills like leadership development, billing and coding, documentation, and self-care
  • Dedicated Musculoskeletal Ultrasound Curriculum with hands-on sessions every six months
  • Annual Fellow-In-Training examination to aid in assessing progress in preparation for the rheumatology board certification examination
  • Extensive cooperation and collaboration with Allergy/Immunology who are colleagues within the division
  • A three-year dual-certification pathway for those interested in board certification in both Allergy/Immunology and Rheumatology

Specific Goals and Objectives

Our mission is to train clinically competent rheumatologists with: capacity to work in a variety of settings; skills to enable lifelong learning; and competence in performing scholarly activity/research.

The specific goals of our training program to support our mission are as follows:

1. Clinical competence is essential for all rheumatologists. We define clinical competence as:

  • Basic core knowledge of the pathophysiology, clinical manifestations, and management of rheumatologic diseases or systemic diseases with rheumatic manifestations. This knowledge base includes anatomy, genetics, biochemistry, immunology, physiology, pharmacology, epidemiology, statistics, ethics, and human behavior.
  • Clinical skills relating to data collection, such as history-taking, physical examination and the appropriate ordering of laboratory and imaging studies.
  • Interpretation of diagnostic and therapeutic procedures, including an understanding of the principles, indications, contraindications, risks, costs, and expected outcomes.
  • Logical diagnostic reasoning, based on the ability to apply medical knowledge to the clinical context and perform deductive reasoning from clinical data.
  • Formulation of treatment plans that are evidence-based and individually tailored to patient needs.
  • Performance as a consulting member of the healthcare team who recognizes her or his role in managing rheumatologic diseases in the context of systemic disorders.
  • Interpersonal communication skills with patients and other healthcare professionals that is mindful of socioeconomic circumstances and levels of health literacy.
  • Professionalism and humanistic characteristics that uphold integrity, compassion, and respect for patients, patient family members, peers, and other healthcare professionals.

2. The ability to work in a variety of settings is essential for a clinically complete rheumatologist. Fellows are expected to attain clinical competence in the following settings:

  • As a consultant in the acute inpatient setting, ambulatory clinic, emergency department, and intensive care settings.
  • As an outpatient rheumatologist in the ambulatory clinic, following patients longitudinally for management of rheumatologic diseases.
  • As a leader of a healthcare team, which may include not only other physicians, but also nurses, medical assistants, pharmacists, social workers, and physician-extenders.

3. Lifelong learning is required for the acquisition, critical analysis, synthesis, and reassessment of knowledge, skills, and professionalism. All fellows will demonstrate lifelong learning skills by:

  • Deliberate practice in the clinical setting to steadily expand core knowledge and improve clinical skills.
  • Attendance, presentation, and participation in the organization of continuing medical education conferences.
  • Attendance and presentation at regional and national professional scientific conferences.

4. Fellows are expected to contribute to the body of knowledge through scholarly activity and research. Fellows are encouraged to participate in research that appeals to their interests and career aspirations.

  • For the fellow planning a career as a physician-scientist, we offer opportunities for intensive, supervised laboratory research within the Division of Immunology as well as through other divisions at the University of Iowa.
  • For the fellow planning a career in private practice, we offer opportunities for developing expertise in quality improvement, implementation science, patient-centered research, and leadership development.
  • For the fellow planning a career as a clinician educator, we offer opportunities to perform research in assessment/evaluation, curriculum design, and effectiveness of clinical teaching in collaboration with the Office for Consultation and Research in Medical Education (OCRME).

Methology for Teaching Rheumatology

In order to achieve the goals and objectives for the fellowship program, the following activities have been established for the purpose of teaching rheumatology fellows. 

1.  The Consultation Experience

Fellows participate in one-week rotations on the consultation service, which includes both outpatient and inpatient activities. Fellows lead the clinical team under direct supervision of the attending physician to evaluate and treat patients with rheumatologic diseases at University of Iowa Hospitals & Clinics and the Veterans Affairs Medical Center. These include inpatient and emergency treatment center consultations as well as management and triage of urgent outpatient consultation requests.

Fellows are expected to lead the team, which is composed of the fellow physician, the attending physician, and, depending on the schedule, an Internal Medicine resident physician, and/or medical students. Fellows are expected to develop and refine their clinical skills in evaluating and treating patients, including acquisition and analysis of clinical data, synthesis of an appropriate list of differential diagnoses, and formulation of an individualized treatment plan. Fellow physicians are strongly encouraged to develop leadership and management skills in delegating tasks among team members and fostering communication. Fellows are also integral to the educational mission of the consultation experience; they are expected to perform literature searches pertinent to the cases at hand and to teach other team members and consulting providers. Finally, consultation experiences provide ample opportunities to practice and develop procedural skills including arthrocentesis, diagnostic ultrasonography, and crystal analysis.  

In turn, attending physicians are expected to provide timely feedback on performance, including for clinical skills, procedural skills, and documentation. Face-to-face sessions prior to the rotation to better understand and prioritize the fellow’s educational goals are strongly encouraged, as well as follow-up sessions immediately thereafter to provide formative evaluation of the consultation experience. 

2. The Continuity of Care Experience

Each fellow is assigned a weekly Continuity of Care (CoC) Clinic at the University of Iowa and at the Veterans Affairs Medical Center throughout the 24 months of fellowship. Fellows are expected to assume direct responsibility for evaluation and treatment of patients that they see, under the supervision of the attending physician. Additionally, first-year fellows attend the General Rheumatology Clinic at the VA once per week.

CoC clinics provide opportunities to learn about outpatient evaluation and treatment of rheumatologic disorders. Fellow physicians work with the attending physician, as well as a dedicated specialty pharmacist, schedulers, nurses, and medical assistants to evaluate and treat patients at consultation and follow-up appointments.  This interprofessional clinical team maximizes the educational experience of fellows.

The CoC experiences at the University of Iowa and the VA allow for opportunities to learn and practice musculoskeletal ultrasonography. There are dedicated point-of-care ultrasound machines available for fellow physicians at both sites.

3. Interdisciplinary Interactions

The Division of Immunology actively fosters interactions and collaborations with providers in other specialties. This culture of cooperation has enabled us to create dedicated rotations in pediatric rheumatology and musculoskeletal radiology.

First-year fellows attend pediatric rheumatology clinics approximately every other week. These clinics provide excellent opportunities to learn about juvenile arthritides, autoinflammatory disorders, and other pediatric autoimmune diseases. Additionally, there is a monthly Pediatric/Adult Rheumatology Case Conference to discuss challenging and interesting cases of rheumatologic disorders from infancy to old age.

First-year fellows also have reserved time (typically 2 to 4 weeks) to learn about musculoskeletal radiology with dedicated MSK radiologists. Fellows develop fluency in reading X-rays of joints commonly involved in rheumatologic diseases, as well as familiarity with the interpretation of MRIs and CT scans. In addition, fellows coordinate with MSK radiology fellows to run the monthly Rheumatology-Radiology Conference, in which images from challenging or illustrative cases are discussed at length. 

Our curriculum is flexible enough to incorporate elective rotations with other disciplines, including clinical immunology/allergy, orthopedic medicine, rehabilitative medicine (physical and occupational therapy), dermatology, ophthalmology, endocrinology, and pulmonology, among others. The division leadership may facilitate creation of these rotations, or others, at the request of interested fellows.

4. Small Group Conferences

Wednesday afternoons are reserved for didactic activities, including Grand Rounds and Small Group Fellow Conferences. Attendance is required for both faculty and fellow physicians.  

We hold weekly Immunology Grand Rounds, in which faculty and fellows from Rheumatology and Allergy/Immunology participate to discuss basic science and clinical topics common to both subspecialties. Fellows are expected to present for Immunology Grand Rounds at least once per year on a topic of their choice, as well as prepare a Research-in-Progress talk toward the end of their first and second years. During the summer, there is a dedicated ‘Immunology Boot Camp,’ consisting of six sessions reviewing essential concepts in basic and clinical immunology.  

Small Group Sessions geared specifically toward rheumatology fellows are also held once per week, immediately after Immunology Grand Rounds. The formats of these conferences vary considerably depending on the objectives. These include formal case presentations, journal club, research presentations, and didactic conferences. The division strongly emphasizes taking advantage of these Small Group Sessions to promote interactive discussions geared specifically toward fellow physicians. During weeks in which there are interdisciplinary conferences (like Pediatric/Adult Rheumatology Case Conference or Rheumatology-Radiology Conference), Small Group Sessions are cancelled.

Additionally, rheumatology fellows attend Board Review sessions every Thursday afternoon. Board Review sessions are highly interactive and cover a variety of topics and strategies in order to pass the American Board of Internal Medicine Rheumatology Board Certification Examination. These sessions alternate between completing board-style questions and reviewing disease-specific topics.

Furthermore, there is a dedicated 10-week intensive Musculoskeletal Ultrasound Seminar Series occurring every six months. Successful completion of this seminar series fulfills one component of the pathway towards RhMSUS (Rheumatology Musculoskeletal Ultrasound) certification. Fellows are also encouraged to apply for the USSONAR (Ultrasound School of North American Rheumatologists) course for advanced training.

Rheumatology fellows also regularly share conferences with other Internal Medicine fellows. This includes the Interdisciplinary Fellowship Conference, which occurs approximately once per month.

Other didactic conferences are available to fellows if they are interested. These include Internal Medicine Grand Rounds, Immunology Group Seminar, and the Fellows as Clinical Educators (FACE) Program.

5. Continuing Medical Education and Society Memberships

In addition to participating in the organized didactic conferences established within the fellowship program, all fellows are strongly encouraged to become members of the American College of Rheumatology (ACR). The division pays for Fellows-in-Training membership in the ACR and encourages annual attendance to at least one ACR national meeting of (the Annual Conference, State-of-the-Art meeting, or the Rheumatology Research Workshop). To those presenting original research, funds are available for travel.

Fellows also play a pivotal role in organizing the Iowa Rheumatology Symposium, an annual meeting of rheumatologists in the state of Iowa. This includes preparing case presentations and didactic lectures, in conjunction with faculty, regarding a selected theme for the year.

The Division of Immunology also encourages fellows who apply to the Ultrasound School for North American Rheumatologists (USSONAR) to obtain advanced training in musculoskeletal ultrasound.

6. Scholarly Activity/Research Experience

All fellows are expected to participate in scholarly activity. Fellows are strongly encouraged to identify topics that interest them, and to develop their research plans with mentors either within the division or outside of it. All fellows are exposed to divisional research early in their fellowship to allow adequate insight into areas of active research at the institution.

Once a project is selected, the division helps to facilitate regular meetings with the research mentor. Research conferences during Small Group Sessions and Research-in-Progress talks provide opportunities for other faculty members and fellows to give feedback and to disseminate preliminary results in a friendly and collegial atmosphere.

Previous fellows have performed basic science, patient-centered, translational, medical education, and outcomes-based research, and have published their findings in peer-reviewed journals as well as presented them at national meetings. Fellows have written case reports, case series, commentaries, observational studies, clinical trials, narrative reviews, and systematic reviews. 

Methods of Evaluation

The Division of Immunology is dedicated to rigorously assessing and evaluating the progress of fellows throughout the 24 months of fellowship. A strong focus is placed on providing timely and valuable formative evaluations as well as comprehensive summative evaluations adhering to ACGME standards.

Just as important, fellows evaluate the program and its faculty members regularly, which drive continuous improvements in order to cater to fellow needs and desires

Formative Evaluation of the Fellows

Feedback is at the heart of the Rheumatology Fellowship, and all the attending physicians take their responsibility to provide timely and valuable feedback to fellows seriously. During consultation weeks, the fellow and attending physician meet at the beginning of the rotation to discuss expectations, values, and priorities for the week. This is the basis for feedback throughout the rest of the week, and the formative evaluation session that occurs at the end of the week. We utilize a customized feedback form in order to promote (1) collaboration between learners and teachers, (2) objective feedback on performance, and (3) suggestions for further improvement.

During Continuity-of-Care experiences, periodic feedback between attending physicians and fellows occurs in order to improve performance of clinical and procedural skills. Fellows control the frequency and style of feedback. Standardized forms are used to document and catalogue what type of formative evaluation has been provided.

Research mentors and fellows also meet for formative evaluation, typically occurring about once every three months. A review of the effort and progress is documented, as well as opportunities for further advancement.

Summative Evaluation of the Fellows

The Clinical Competency Committee (CCC) meets at least every six months to review how fellows are meeting their ACGME Internal Medicine subspecialty milestones.  The CCC reviews formative and summative evaluations obtained from a variety of inputs, including faculty members, peers (other fellows), administrative staff, other healthcare team members, and patients in order to provide a balanced and holistic view of fellow performance. This is the basis for the semi-annual meeting with the Program Director, at which time the fellow and the program director collectively look at the evaluations and determine a plan for further improvement over the coming six months.

Evaluation of the Faculty and Program

Evaluation of the faculty and the program is considered just as important as evaluation of fellows. All fellows are required to complete an online evaluation form on the faculty and the program at least every three months. These evaluations are essential for improving the quality of the division and its educational programs. Additionally, fellows are highly encouraged to provide feedback informally to the program leadership in order to ensure that the quality of fellowship experience is maintained at a high level.

Curriculum: Year 1

Clinic Experience

First-year fellows typically attend four clinics per week:

  • Monday AM - Urgent Consultation Clinic (Only when on consults)
  • Tues/Wed AM - UI Hospitals & Clinics Continuity of Care Clinic 
  • Tuesday PM - Pediatric Rheumatology Clinic (Only when NOT on consults)
  • Thursday AM - General VA Rheumatology Clinic
  • Friday AM - VA Continuity of Care Clinic

Conferences

Wed 1-2 PM - Immunology Grand Rounds

  • Immunology “Boot Camp” - Six 60-minute sessions on essential concepts in basic and clinical immunology

Wed 2-3PM - Fellow Small-Group Sessions

  • Case Conference
  • Journal Club
  • Research Presentations
  • Core Didactic Topics

Thurs 1-2PM - Interdisciplinary Fellowship Conferences

Thurs 4-5PM - Board Review

Friday 1-2PM - Fellows Advancement Series (Once monthly)

Electives

  • Radiology – 2 to 4 weeks, depending on fellow preference
  • Fellows are not on consults during this time

Consultation Experience

  • 16-24 weeks of consult weeks

Other

  • Vacation – 3 weeks (15 working days)
  • Personal or sick leave – 1 week (5 working days)

Curriculum: Year 2

Clinic Experience 

  • Monday AM - Urgent Consultation Clinic (Only when on consults)
  • Tues/Wed AM - UIHC Continuity of Care Clinic
  • Friday AM - VA Continuity of Care Clinic

Second-year fellows may occasionally cover Pediatric Rheumatology Clinic

Conferences

Wed 1-2PM - Immunology Grand Rounds

  • Immunology “Boot Camp” - Six 60-minute sessions given during Immunology Grand Rounds

Wed 2-3PM - Fellow Small-Group Sessions

  • Case Conference
  • Journal Club
  • Research Presentations
  • Core Didactic Topics

Thurs 4-5PM - Board Review

Friday 1-2PM - Fellowship Advancement Series

Electives

  • May be arranged depending on fellow interest

Consultation Experience

  • Second-year fellows cover VA consultations on a monthly basis
  • Second-year fellows also have approximately 8-10 weeks of UIHC consultation

Other

  • Vacation – 3 weeks (15 working days)
  • Personal or sick leave – 1 week (5 working days)

Major Areas of Research

  • T-cell and cytokine regulation of B-cell polyclonal activation
  • Stem cell transplantation for the treatment of autoimmune diseases
  • Mechanisms of tolerance induction and maintenance; role of cytokines
  • Clinical transplantation immunology, both solid organ and bone marrow transplantation; role of HLA and non-HLA polymorphisms
  • Molecular regulation of B-lymphocyte activation and death
  • Abnormal regulation of gene transcription in autoimmunity
  • Molecular biology and immunology of persistent viral infections in rheumatic diseases
  • Immune cell stimulation by bacterial DNA
  • Role of Gamma-Delta T-cells in Immune-Mediated Disease
  • Immuno-Oncology
  • Rheumatology educational curriculum development and testing

Interdisciplinary Fellowship Conference

Below is an example of the Department of Internal Medicine Common Curriculum Schedule. It is shared between Fellows from all divisions of the Department.

PDF icon20-21 Fellows Conference Master Schedule.pdf

Fellows as Clinician Educators (FACE)

The Fellows as Clinician Educators (FACE) Program is designed to introduce future clinician-educators to a set of skills that may be of use in their careers. The program presents concepts of educational design and research, lecture development, evaluation, observation, and feedback. At the conclusion of the program, FACE participants are required to develop a teaching portfolio.

Learn more about FACE 

Immunology Dual Certification Program

We offer a rigorous three-year program that incorporates rheumatology and allergy/immunology fellowship training to highly qualified candidates. This dual-certification pathway confers eligibility for fellowship graduates to become certified in Adult Rheumatology through the American Board of Internal Medicine and Allergy/Immunology through the American Board of Allergy/Immunology. 

The division has three faculty members with training in both subspecialties, two of whom are graduates of the fellowship programs at the University of Iowa. The dual-certification pathway enables graduates to specialize in the growing number of conditions that overlap these two fields. 

Applicants for this three-year program should first review all information for both fellowships on our website, then submit the ERAS application to our rheumatology fellowship training program, indicating interest in the dual-certification pathway in the personal statement. Applicants selected for interview will meet with faculty members and fellow physicians from both the rheumatology and allergy/immunology sections of the Division of Immunology.

How to Apply

All interviews will be virtual in 2021 due to the COVID-19 pandemic

Applications are only accepted through the Electronic Residency Application System (ERAS).

Residents with questions can find out more about ERAS Fellowship through the AAMC web site: http://www.aamc.org/audienceeras.htm and can begin working on their applications now.

US residents should contact their Dean's Office or ERAS at https://students-residents.aamc.org/training-residency-fellowship/applying-fellowships-eras/.

International medical graduates should contact the Educational Commission for Foreign Medical Graduates (ECFMG) at http://www.ecfmg.org/eras/index.html

A complete ERAS application includes:

  • Curriculum vitae
  • Personal statement of the applicant's long-term career goal and fields of interest
  • Four letters of support, one of which comes from the program director of the residency program where you trained
  • Copies of applicant transcripts for USMLE Steps 1, 2, and 3 and/or COMLEX-USA Levels 1, 2, and 3
  • Medical school transcript
  • A recent photograph
  • ECFMG certificate, if applicable

All applicants must also register with the National Resident Matching Program (NRMP). Our NRMP program number is 120315FO.

If you have any questions, please contact Patty Bruffey-Thoene.

Application Deadline

The deadline for applications is October 15.
Selected candidates will be invited to interview.

Board Certification

Medical specialty certification in the United States is a voluntary process that serves multiple purposes for the trainee and the public.

Certification by the American Board of Internal Medicine (ABIM) 

  • distinguishes a physician as someone with a distinct level of expertise
  • provides more opportunities when applying for employment
  • presents resources and tools by the American Board of Medical Specialties (ABMS)
  • demonstrates a commitment to lifelong improvement for providing the best patient care
  • elevates physicians into the ranks of doctors committed to the highest standards of healthcare

For more information, please visit the American Board of Internal Medicine website.

Eligibility Criteria

Qualifications for candidates include (1) an MD degree (or equivalent), (2) completion or expected completion of three years of residency training in Internal Medicine, with Board Eligibility or Certification by the American Board of Internal Medicine, by the initiation of Rheumatology Fellowship training. We welcome applicants from combined residency programs such as Internal Medicine/Pediatrics and Internal Medicine/Psychiatry.

Interview Information

At the interview, prospective candidates will receive an overview of the program and tour of the facilities. 

Applicants for the dual-certification pathway will meet faculty and fellow physicians from both Allergy/Immunology and Rheumatology sections of the Division of Immunology over the course of one or two days.

Our People

Program Leadership

Rebecca Tuetken, MD, PhD
Director, Rheumatology Fellowship Program
Clinical Associate Professor of Internal Medicine

Phone: 319-353-7089
Email: rebecca-tuetken@uiowa.edu 


Bharat Kumar, MD
Associate Director, Rheumatology Fellowship Program
Clinical Assistant Professor of Internal Medicine

Phone: 319-356-2863
Email: bharat-kumar@uiowa.edu


Scott A. Vogelgesang, MD
Director, Division of Immunology
Clinical Professor of Internal Medicine

Phone: 319-356-7725
Email: scott-vogelgesang@uiowa.edu


Contact Us

Patty Bruffey Thoene
​Rheumatology Fellowship Coordinator
Department of Internal Medicine - C42-B GH
The University of Iowa Carver College of Medicine 
200 Hawkins Drive 
Iowa City, IA; 52242-1009 

Phone: 319.356.1311
Email: patricia-bruffeythoene@uiowa.edu

Denise Floerchinger
​Internal Medicine Fellowship Program Administrator

Phone: 319.356.2732
Email: denise-floerchinger@uiowa.edu

Current Faculty

The Department of Internal Medicine has a faculty of nearly 300 professionals whose clinical, teaching, and research expertise spans the entire discipline of medicine.

Immunology Division Faculty (Allergy/Immunology and Rheumatology)

Department Faculty (alphabetical listing)

Current Fellows

Alick Feng

Alick Feng, MD (F1)
Medical School: University of Iowa
Residency: University of Iowa


Gatra Gheriani

Gatra Gheriani, MBChB (F1)
Medical School: University of Benghazi
Residency: St. Agnes Hospital


Matthew Mandell

 

Matthew Mandell, DO (F2)
Medical School: Des Moines University College of Osteopathic Medicine
Residency: University of Illinois College of Medicine-Chicago


Jennifer Strouse

Jenny Strouse, MD (F2)
Medical School: Medical College of Wisconsin
Residency: University of Iowa


Chair, Department of Internal Medicine

E. Dale Abel, MD, PhD
Chair & Department Executive Officer
Department of Internal Medicine
Francois M. Abboud Chair in Internal Medicine
John B. Stokes III Chair in Diabetes Research 
Professor of Medicine, Biochemistry, and Biomedical Engineering