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Clinical Experiences

Our program gives you ample opportunity to become a great physician by providing you with access to a diverse patient population who present with a wide array of clinical conditions. Below are descriptions of the rotations you will experience as a categorical resident in our program.

Our 4:1 Rotation Schedule

Our innovative 4:1 rotation schedule provides you 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:

  • Better Continuity of Care: You will never be pulled from service and rushed to sign out your patients so you can make clinic. By separating inpatient and outpatient experiences in this way, the 4:1 improves your patients' safety. The primary teams will remain in the hospital to triage acute events and handle patient care instead of having a covering physician care for your patients' acute problems while you are at clinic.
  • Improved Outpatient Experience: In a conventional system, you would have clinic for one half-day once a week. Under the 4:1 schedule, you have a dedicated week in which in which to see your panel of patients. This allows you to focus on providing better outpatient care without concern for managing patients in the hospital. As an added benefit, the 4:1 schedule gives provides a “break” from daily life inside the hospital; the schedule is lighter,  but still demanding and challenging.
  • Greater Exposure to Staff and Teaching Modalities:  In a more conventional system, you would be part of a team that would be formed and expected to work cohesively until the rotation was over. With the 4:1 schedule, you and your team members will rotate. As an intern, this allows you to experience different teaching styles and, as a senior, it allows you to teach and manage a greater number of interns. This rotating structure encourages more interaction between you and your peers, making it a friendlier environment in which to learn.

Point of Care Ultrasound Training

The AHN Internal Medicine Residency Program is committed to providing longitudinal education in point-of-care ultrasound (POCUS) for the IM residents and faculty. Led by Dr. Thomas Robertson, the Director of Ultrasound Education and expert in the field, our multidisciplinary teaching team includes faculty from internal medicine, pulmonary/critical care, and emergency medicine. Our goal is to provide you with education in POCUS image acquisition, the ability to interpret those images, and appropriate clinical integration at the bedside and in the clinic.  We have a state of the art ultrasound machine for you to use on the inpatient teaching floor at AGH as well as handheld devices that you can use at AGH and West Penn hospitals and in both of our primary care clinics.

The education we provide will help you develop a framework for POCUS knowledge starting with an intensive hands-on training early in each academic year, and you will expand your knowledge through POCUS conferences and by participating in an Ultrasound Interest Group. Your performance skill is enhanced through regular hands-on scanning with POCUS faculty on the wards and in the clinic. Our training empowers you to provide the best patient care. Integrating POCUS as a piece of complex clinical assessment will empower you to use this skill safely and appropriately throughout your career.

Core Rotations

Our core rotations are designed to cover the fundamentals of internal medicine residency while giving you the opportunity to augment your education with elective rotations. Our core rotations are as follows:

Ambulatory Care

Our program offers excellent training in the outpatient setting to prepare you for a career in primary care and outpatient-based specialties. In our two ambulatory clinics, you will have the opportunity to deliver ongoing care to a panel of patients in a setting similar to one you would encounter in private practice.

Utilizing an innovative 4:1 curriculum, we place you in a variety of outpatient clinics throughout your residency. When you join us, you will be assigned to a primary care site where you will be exposed to the spectrum of primary care during your ambulatory weeks.

Your ambulatory week will consist of 5 half-days at the primary clinic and one half day of didactics. The rest of your week will be spent rotating through a wide variety of subspecialty clinics throughout the community.

The educational portion of your ambulatory rotation will consist of longitudinal lectures, online training modules, and an ambulatory academic half-day.

General Medicine

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

On the general medical floors, your team will consist 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.

You will experience attending physician rounds at least 5-days a week. Your attending physician will review the presentation and management of patients with your team. Your team will also discuss epidemiology, clinical manifestations, pathophysiologies, diagnoses and evaluations, treatments, and prognoses of the medical conditions affecting your patients, while incorporating discussions of relevant and recent literature.

Daily General Medicine Schedule. 

Night Medicine

Night medicine provides 24-hour resident coverage at Allegheny General and West Penn Hospitals. The night medicine rotation increases continuity of care for inpatients during nighttime while ensuring that you and your co-residents do not exceed work hour mandates.

On the night team, you will admit patients and provide cross coverage for the daytime teaching teams. Your shift will be from 7 p.m. to 7 a.m. and, when it is over, your team will sign out patients to the primary day teams.

Your night team will always be supervised by an overnight attending at both sites.

Emergency Medicine

As a first-year resident, you will spend one block rotating in Emergency Medicine at Allegheny General Hospital. Working alongside EM attendings and residents, you will have the opportunity to see patients with common ED problems. As the initial physician, you will have the unique opportunity to see and treat variety of acute medical and surgical illnesses under the supervision of emergency medicine attending physicians.

By the end of your EM rotation you will learn how to:

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

Intensive Care

Medical Intensive Care Medicine

As a resident, you will gain excellent 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 MICU team provides coverage overnight. Pulmonary and critical care fellows provide you with 24-hour in-house coverage. As part of the MICU team, you will take primary responsibility for managing critically-ill patients and will be performing most of their diagnostic procedures. All major management decisions are reviewed by your MICU team on daily morning and evening rounds. During your MICU rotation you and your team will learn the following:

  • Techniques of resuscitation
  • Intubation
  • Central line insertion
  • Arterial line insertion
  • Respirator management
  • Bedside hemodynamics
  • How to manage acutely ill medical patients
  • As a senior resident you will also have the opportunity to rotate through the WPH MICU.

Cardiac Care

Our Cardiac Care Unit (CCU) provides cares for patients with acute heart failure, myocardial infarction, unstable angina, and cardiogenic shock. The CCU routinely employs cardiac catheterization and intra-aortic balloon pumps as well.

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 this rotation you will 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

Hematology/Oncology

In your second year, you and a peer, under the supervision of a hematology/oncology fellow  and an attending physician, will spend one block rotating through our hematology and oncology services. You will care for a wide spectrum of cases ranging from new diagnosis, through the treatment of acute leukemias, to end stage metastatic disease. Our clinical sites include the Medical Oncology unit at Allegheny General Hospital and the Bone Marrow Transplant unit at West Penn Hospital.

Quality Improvement and Patient Safety Course (QIPS)

We are committed to preparing you to practice independently in the new era of healthcare, providing you with a comprehensive approach to education, and integrating you in activities that promote quality improvement and patient safety (QIPS).

During your second year, you will complete our two-week intensive QIPS rotation. Here, you will undertake IHI training, a series of modules that introduce you to the fundamentals of patient safety and quality improvement. You will also complete a module on diagnostic errors that will teach you to consider the cognitive biases that contribute to error in addition to the system factors. This will culminate in you being able to develop a fishbone diagram, to aid in root-cause analysis.

During the rotation, you will participate in serious event reviews, actual root cause analyses, and complete a variety of other exercises which are designed to bring you to the forefront of quality and safety in our network. As a significant part of the course, you will also choose, design, and work on a QIPS project of your own. The project you choose can be a work already in progress, such as designing an educational module for our program, or performing an improvement or research project in the QIPS domain. Many of these projects are presented to your peers at the monthly QIPS conference; in fact, many of these projects go on to be presented at regional and national conferences.

While this course is the cornerstone of our approach, your immersion into our quality and safety culture will begin during intern orientation and continue throughout your residency through a robust series of activities and experiences.

Neurology

In your second year, you will complete a neurology rotation designed to provide you with extensive experience managing an array of neurological disorders. Half of your rotation will be spent with our Stroke Team; along with a neurology attending physician and neurology residents, you will work to provide immediate care for all stroke patients. You will serve the second half of your rotation on the neurology consultation service. Here, you will learn to diagnose, evaluate, and treat common neurological problems in both the inpatient and outpatient setting.

Geriatrics

In your third year, you will complete a one block geriatrics rotation that will help you gain insight into a key part of community practice. On this rotation you will work directly with an attending geriatrician and will make house calls, round at nursing homes, and provide care in a geriatric clinic. The time you spend in the geriatric clinic will focus on:

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

Medical Consults

As a third-year resident, you will serve as a house general medicine consults for one block. This rotation will expose you to pre- and postoperative inpatient management and will ensure that you develop expertise in the clinical and interpersonal skills that are essential to internal medicine.

You will work closely with a core group of faculty and learn the general principles of preoperative risk evaluation and management. You will:

  • Evaluate patients’ known medical problems
  • Assess associated surgical risks
  • Address previously unrecognized medical problems
  • Optimize treatment of all medical problems prior to surgery

Elective Rotations

In addition to our core rotations, you will be given elective time which you will use to tailor your residency experience to meet your individual career goals. Whether you want to subspecialize, serve patients in a primary care setting, practice as a hospitalist, or shine as a clinician researcher, our program will prepare you to reach your milestones. Each year of your training, you are given 8-10 weeks of dedicated elective time which you can fill with rotations from an expansive array of specialties at the core clinical sites or at any of several clinical sites across our network or in the community.