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Clinical Experiences

Our program gives residents the opportunity to become great physicians by providing access to a diverse patient population presenting with a wide array of clinical conditions. Here are descriptions of the rotations for preliminary and categorical residents:

Core Rotations
Our core rotations are designed to cover the fundamentals of internal medicine residency while giving residents the opportunity to shape and augment their education with elective rotations. Core rotations are as follows:

General Medicine
During the general medicine rotation, residents gain knowledge of health promotion, disease prevention, diagnosis, and treatment.  The population includes both genders from adolescence through old age, in health through all stages of acute and chronic illness.

On the general medical floors, each team consists of an attending, a PGY-2 or PGY-3 resident, two interns, and third- and fourth-year medical students. Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage.

Attending physician rounds are conducted at least 5 days a week. The attending physicians review the presentation and management of patients with the house-staff. In addition, the team discusses epidemiology, clinical manifestations, pathophysiology, diagnosis and evaluation, treatment, and prognosis of the medical conditions that affect their patients, incorporating relevant and recent literature in these discussions.

Daily General Medicine Schedule.

Medical Intensive Care

Intensive Care Medicine
Students will gain critical care experience in the AGH Medical Intensive Care Unit (MICU) with two teams of two interns, a senior resident, a pulmonary-critical care fellow, and an attending physicians who round 7 days a week.

Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage. The pulmonary and critical care fellows provide 24-hour in-house coverage. The house staff take primary responsibility of managing critically ill patients, including performing most diagnostic procedures. All major management decisions are reviewed by the ICU medical team on daily morning rounds and evening rounds. During the ICU rotation, we teach trainees the following:

  • Techniques of resuscitation
  • Intubation
  • Central line insertion
  • Arterial line insertion
  • Respirator management
  • Bedside hemodynamics
  • Management of acutely ill medical patients

Senior residents also have the opportunity to rotate through the WPH medical ICU.

Cardiac Care
AGH's Cardiac Care Unit (CCU) cares for patients with acute heart failure, myocardial infarction, unstable angina and cardiogenic shock. Cardiac catheterization and intra-aortic balloon pumps are routinely employed.

The CCU is staffed by three senior residents, an intern, a cardiology fellow, and a cardiology attending. Overnight coverage is provided in weekly blocks by an assigned senior resident. The cardiology fellows provide 24-hour in-house coverage.

During the rotation residents learn:

  • Techniques for electrical and chemical cardioversion of arrhythmias
  • Swan-Ganz catheter insertion
  • Central line insertion
  • Arterial line insertion
  • Cardiac resuscitation
  • EKG interpretation
  • Principles of cardiac emergency therapy
  • Management of acute cardiac illness

Ambulatory Care
Our program offers training in the outpatient setting, to prepare residents pursuing careers in primary care and outpatient based specialties. In our Medical Ambulatory Clinic (MAC), residents have the opportunity to deliver ongoing care to a group of patients in a setting similar to private office practice.

Utilizing the innovative 4:1 curriculum, we place our residents in many outpatient clinics throughout their residency. Each resident is assigned to a primary care site where they are exposed to the spectrum of primary care during their ambulatory weeks.

Each ambulatory week consists of 5 half days at the primary clinic and one half day of didactics. The rest of the week is spent rotating through many subspecialty clinics throughout the community.

We provide an educational portion of the ambulatory rotation through longitudinal lectures and online modules, along with the weekly ambulatory academic half day.

Hematology/Oncology

Under the supervision of an attending physician and a hematology/oncology fellow, two senior residents rotate through the hematology/oncology service each month. Our residents care for a wide spectrum of cases ranging from new diagnosis and treatment of acute leukemias to end stage metastatic disease. Clinical sites include the AGH Medical Oncology unit and the WPH Bone Marrow Transplant unit.

Night Medicine

Night Medicine provides 24-hour resident coverage at AGH and WPH. The Night Medicine Rotation was designed to increase continuity of care for inpatients during nighttime while ensuring that residents do not exceed work hour mandates.

The night teams admit patients and provide cross coverage for the daytime teaching teams from 7 p.m. to 7 a.m. They then sign out to the primary day teams.

The night teams are supervised by an overnight attending at both sites.

Medical Consults

Third-year residents perform house general medicine consults for a 4-week block. This elective exposes senior residents to pre- and postoperative inpatient management and ensures that residents develop expertise in the clinical and interpersonal skills essential to internal medicine.

Working closely with a core group of faculty, residents learn the general principles of preoperative risk evaluation and management. They:

  • Evaluate the patient’s known medical problems
  • Assess the associated surgical risk
  • Address previously unrecognized medical problems
  • Optimize treatment of all medical problems prior to surgery

Quality Improvement and Patient Safety Course (QIPS)

We are committed to preparing residents to practice independently in the new era of healthcare, providing a comprehensive approach to education and integration of our residents in activities promoting quality improvement and patient safety (QIPS). During the PGY-2 year, all residents rotate in our two-week intensive QIPS rotation. Here, residents complete IHI modules that serve as an introduction to the fundamentals of patient safety and quality improvement. We also have incorporated a module on diagnostic errors, where residents are taught to consider the cognitive biases that contribute to error, in addition to the system factors, as they develop a fishbone diagram. During the rotation, residents participate in serious event reviews, participate in actual root cause analyses, and complete a variety of other exercises which are designed to bring residents to the forefront of quality and safety in the network. As part of the course, the resident also designs and begins to work on a project of their choosing. The projects can include work already in progress, design of an educational module for the residency program, a performance improvement project, or a research project in the QIPS domain. In turn, many of these projects are presented to the other housestaff at the monthly QIPS conference, and/or presented at in-house, regional, and national conferences.

While the course is the cornerstone of our approach, immersion into our quality and safety culture begins during intern orientation, and is built upon through a series of activities and experiences until graduation.

Geriatrics

Third-year residents do a 4-week Geriatrics rotation to gain insight into a key component of community practice. Residents on this rotation, with attending physicians, make house calls, round at nursing homes, and provide care in the geriatric clinic. Residents also spend time in the clinics focusing on:

  • Wound care
  • Low vision rehabilitation
  • Audiology
  • PT/OT/SLP therapy
  • Movement disorders
  • Palliative care (1 week)

Neurology

We offer extensive experience managing neurological disorders. Our Stroke Team, staffed by a neurology attending physician and second-year internal medicine residents, provides immediate care for all stroke patients. In addition, residents rotate through a neurology consultation service to learn to diagnose, evaluate, and treat common neurology problems in both the inpatient and outpatient setting.

Emergency Medicine

The AGH Emergency Department is staffed by residents from the Emergency Medicine, Surgery, and Internal Medicine training programs. On the Emergency Medicine rotation, first-year Internal Medicine residents have the opportunity to see patients with common ED problems as well as a variety of acute medical and surgical illnesses as the initial physician under the supervision of emergency medicine attending physicians.

The objective of the rotation is to learn how to:

  • Approach emergency patients
  • Manage multiple patients
  • Recognize and triage ill patients
  • Manage patients acutely

Elective Rotations

In addition to the core rotations, our program supports professional development by offering distinct training pathways that allow residents to tailor the residency experience to meet their individual career goals. Whether residents want to subspecialize, serve patients in a primary care setting, practice as a hospitalist, or shine as a clinician researcher, our program prepares residents to reach those milestones. Available electives (generally eight to 10 weeks per year) can be performed in an expansive array of specialties at the core clinical sites or at any of several clinical sites across the network or in the community.

4:1 Rotation Schedule

Our innovative 4:1 rotation schedule provides the resident with the best of both worlds: a robust outpatient experience by enhancing continuity in the clinic experience while minimizing the outpatient duties of residents when they are on inpatient rotations. The benefits of the 4:1 schedule include:

  • Continuity of Care – You are never pulled off-service, rushing to sign out to leave the hospital for clinic. This improves your patient safety. The primary team will be in house (i.e., in the hospital) to triage acute events rather than letting a covering physician deal with acute problems while you’re at clinic.
  • Better Outpatient Experience – In the traditional system, a resident would have clinic for half a day once a week. Now there will be a dedicated week in which the resident will go to clinic Monday through Friday. There will be a better focus on the outpatient side. In addition, it gives the resident a “break” from the daily hospital life. During this time, the schedule is lighter but still demanding and challenging.
  • Staff Exposure and Teaching Modalities – In the traditional system, teams would be formed and expected to work cohesively until the one-month rotation was over. With the 4:1 schedule, there will be rotating team members. This will allow interns to see different teaching styles of different seniors and expose seniors to more of the intern staff. By doing so, this encourages more interaction among interns and senior residents making it a friendlier environment in which to learn.