The General Medicine Teaching Service
There are two general medicine teaching services. A board-certified general internist faculty member leads each team and serves as the teaching attending and the attending of record. Other team members include a senior resident who is either in the second or third year of training, three first-year residents and one to two medical students.
The majority of the patients admitted to this service are from our medical clinic. The admissions represent a broad spectrum of clinical diseases. Patients range in age from eighteen years old to geriatric. Each first-year resident manages, under the supervision of the attending and senior resident, approximately five to seven patients. Topics pertinent to patient care and/or topics of general medicine interest to the teaching team are discussed daily during teaching rounds. A series of pertinent review articles are provided and discussed during the rotation.
Areas of emphasis during this rotation include: diagnosis and management of general medical problems; doctor-patient communication; ethical issues related to primary care; indications for subspecialty consultation and appropriate discharge planning.
The faculty and resident staff takes an active role in teaching medical students from Temple University School of Medicine and the Philadelphia College of Osteopathic Medicine.
The Internal Medicine Subspecialties
On the internal medicine subspecialty rotations, the resident manages a panel of patients commensurate with his/her level of training. A typical day includes completion of consultations; admissions to the service; follow-up visits; performing procedures and discharge planning. Each case is reviewed at the bedside with didactic teaching and case-based discussions integrated into rounds. While these rotations are primarily inpatient-focused in the first year, senior residents may also attend office hours in the subspecialty attending's practice to gain additional experience.
The critical care rotation is required for first, second and third-year residents. Pulmonary critical care specialists serve as the teaching attendings. This popular rotation includes an excellent opportunity to manage critically ill patients using evidence-based medicine, to gain experience in performing invasive procedures and to function as part of a multidisciplinary team. A monthly Journal Club and weekly didactics are given.
St. Luke's Hospital is a Regional Resource (Level One) Trauma Center . Residents, under the direct supervision of a faculty of board-certified emergency medicine physicians, participate in the evaluation and treatment of more than 67,000 patients a year presenting to our active, newly renovated facility. There is a broad spectrum of clinical cases including the specialized care of trauma patients, acute and decompensated chronic illnesses and non-urgent complaints that are evaluated in the “fast track” area. Residents attend a three-hour weekly educational session to review a curriculum of topics pertinent to the field. Residents also participate in the monthly Journal Club.
General Medicine Consult Team (Team C)
In the second and third year, each resident rotates on the general medicine consult team. Consultations focus on the management and evaluation of general medical conditions as well as providing pre-operative evaluation to a number of surgical subspecialties. Senior residents on this service also admit and manage patients on this team. Readings on topics of interest as well MKSAP questions are reviewed on this rotation.
Each second year resident rotates on the hospitalist service led by board-certified internists. The rotation teaches the care and management of acute illnesses requiring hospitalization and acute decompensation of chronic illness. Appropriate use of diagnostic tests, quality cost-effective therapeutic management and effective discharge planning is emphasized.
Ambulatory Primary Care
During the ambulatory primary care block rotation, the senior resident attends his/her continuity clinic as well as a number of subspecialty clinics such as cardiology, gastroenterology, endocrinology, rheumatology, neurology and HIV clinic. Under the guidance of board-certified internists and subspecialists, the resident gains experience in evaluating and managing acute and chronic illnesses. The senior resident and faculty also lead daily case-based discussions for the first year residents which focus on the evidence-based approach to common ambulatory problems. There is also a separate review of case based discussions led by the ambulatory resident for the senior residents.
rst year resident rotates on this service. The rotation emphasizes the evaluation and treatment of clinical entities likely to be encountered in an internist's practice. Under the guidance of the program director in obstetrics and gynecology and the teaching faculty, the resident sees patients daily in the hospital-based gynecology clinic, abnormal Pap clinic, reproductive endocrine clinic, prenatal clinic and high-risk obstetrics clinic. Didactic conferences include the weekly half-day educational conference, obstetric grand rounds and gynecology grand rounds and special weekly resident lectures by the program director.
The goal of this required first year rotation is to allow the resident the opportunity to acquire and develop skills in the diagnosis and management of surgical disorders and to learn criteria for referral to the appropriate surgical discipline. The resident spends approximately 40% of the rotation caring for patients in the inpatient setting and 60% in outpatient office hours with the surgical faculty.
Each senior resident rotates for two weeks on dermatology and ENT. The resident also has the opportunity to select two week rotations in the following ambulatory selectives: behavioral health, ophthalmology, orthopedics, and physical medicine and rehabilitation. The purpose of these rotations is to provide the resident with an exposure to the discipline, including how to handle conditions commonly encountered in an internist's practice and the indications for referral.
A board-certified geriatrician serves as the faculty for this outpatient-based rotation. The resident is introduced to the medical, social, functional and financial aspects of the care of older adults. The accessing and proper use of community resources is emphasized. Sites for this rotation include nursing homes, retirement villages, home visits, rehabilitative day care centers and hospital consultations.
This one month elective is offered in the second or third year of training. The goal of this rotation is to develop the resident's competency in end-of-life care (palliative and hospice) in a variety of settings. Working as part of a multidisciplinary team, the resident sees hospice patients in their homes, in the outpatient free standing Hospice House and in consultation in the hospital.
This one-month elective rotation provides the resident with experience in interpretation of plain films and allows the resident to rotate throughout the specialty areas of neuroradiology, nuclear medicine, ultrasound, interventional radiology, mammography, MRI and CT scanning to develop an appreciation of the indications, contraindications and limitations of various diagnostic and therapeutic imaging techniques.
Second and third year residents complete a total of three months of night float during their last two years of training. On this rotation, the senior resident and night shift intern from either Team A or Team B are responsible for admissions to the three general medicine teaching teams (Team A, B or C), cover the inpatients on these services, respond to codes and rapid response calls.
The senior resident reports to the evening sign-out of patients on the general medicine services at 7:30 pm. The senior resident signs-out to the morning teams at 7:30 am the following day. He/She then attends a faculty led morning teaching session that concludes at approximately 8 am and the resident goes home. Senior residents on night float work no more than four nights in a row.