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Clinic Rotations

Over one-third of our educational program is conducted in the outpatient setting. The Internal Medicine ambulatory experience consists of six months of daily services plus one-half day per week of continuity services. This equates to over one year of ambulatory experience within the three year residency training. This training provides the resident with the opportunity to learn the primary care knowledge; attitudes and skills needed to practice ambulatory medicine.

The primary care knowledge, attitudes and skills consist of:

  • Comprehensive evaluation, which emphasizes diagnosis; risk identification; preventive care; and developing a comprehensive health care plan to include all the patient’s problems.
  • Coordination of care delivered by the health care team of one’s partners, nurses, consultants, other physicians, laboratories, or other health care providers.
  • Continuing care over time for all the patient’s illnesses and other health problems, including telephone evaluation and management during both office and after hours.
  • Cost-effective care.
  • Personal humanistic care delivered with compassion, respect and integrity.
  • Providing consultation with the appropriate tests and recommendations.
  • Learning the management and treatment of either new or established patients seeking acute or urgent care.

 

The Ambulatory Clinic Team

The learning team consists of the clinic attending, medical director, senior residents, interns and non-internal medicine residents. The clinical attending is the physician who is taking responsibility for the supervision and direction of the care delivered to the patient by the resident.

  • The medical director is responsible for the day-to-day operations and the physician’s activity in the clinic. He is responsible for the monthly schedule and the assignment of residents and attendings to the general medicine, continuity, block and subspecialty clinics.
  • The senior residents have larger panels of patients and focus most of their continuity clinic time on the continuing, preventive and comprehensive care of a stable panel of patients. They have more independence in managing their patients than interns.
  • The interns will acquire a panel of patients in transfer from residents who have left the program and from new patients they discharge from the hospital or from the emergency room.
  • Non-internal medicine residents from Obstetrics and Gynecology and Psychiatry each take one to two months of ambulatory medicine. These residents will work in acute care, general internal medicine and triage situations in the clinic.

 

Evaluation

In addition to the monthly performance evaluation for each rotation, each resident has multiple mini clinical exams (CEX) to evaluate clinical skills during the ambulatory month, including history taking and physical exam skills, patient rapport and diagnostic and decision making skills. Feedback is given immediately.

 

ICU Rotations

The ICU rotation is comprised of a day team (6a-6p) and a night team (6p-6a). Interns generally cover one week of nights during the month. Teaching rounds occur daily in the morning, followed by teaching sessions and short quizzes. Interns also admit new patients to the ICU with direct supervision by senior residents and attending physicians on both the day team and while on overnight call. The ICU rotation offers intense, hands-on learning on ventilator management, sepsis treatment, intubation, and numerous other procedures. There is attending physician support 24/7.

 

Procedures

All interns complete a comprehensive procedures course during July of the internship. This includes, video instruction, reading, and a written test. Additionally all residents participate in the Fundamental Critical Care course, which includes hands on procedural training. Residents are expected to develop competency in routine internal medicine procedures including placement of central lines, LP’s, thoracentesis, paracentesis and skin biopsy.

 

Moonlighting

Moonlighting is available to second and third year residents who demonstrate academic competency. Moonlighting positions must be approved by the program director and are counted towards the 80-hour work week according to RRC rules.

 

Required Subspecialties

  • Cardiology
  • Critical Care Medicine
  • Emergency Medicine
  • Geriatrics
  • Infectious Disease
  • Nephrology
  • Neurology
  • Oncology
  • Pulmonary

 

List of Electives

  • Allergy
  • Cardiology
  • Critical Care Medicine
  • Emergency Medicine
  • Endocrinology
  • Gastroenterology
  • Geriatrics
  • Infectious Disease
  • Nephrology
  • Neurology
  • Oncology
  • Pulmonary
  • Rheumatology
  • Special Studies