Rotations

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

The resident may chose from the following:

• Cardiology
• Endocrinology
• Gastroenterology
• Geriatrics
• Hematology/oncology
• Infectious disease
• Nephrology
• Palliative Care
• Pulmonary
• Rheumatology

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. The majority of these rotations are inpatient-focused. Geriatrics, Palliative Care and Rheumatology are out-patient focused with some inpatient consultations.

Critical Care

Each resident is required to rotate for one month on the critical care rotation. 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.

Emergency Medicine

Each resident is required to rotate for one month on the Emergency medicine rotation. St. Luke’s is a Regional Resource (Level 1) 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.

Electives

The transitional year resident may chose from a wide array of electives including:

• Internal medicine subspecialties
• Neurology
• Obstetrics and gynecology
• Palliative Care
• Pediatrics
• Radiology
• Surgery and surgical subspecialties

Geriatrics

The goal of this elective rotation is to introduce the resident to the medical, social, functional and financial aspects of the care of older adults. On this outpatient based rotation, a board-certified geriatrician serves as faculty. 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.

Palliative Care

The goal of this one month elective 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.

Pediatrics

The goal of this one month elective rotation is to allow the transitional year resident, under the guidance of board certified faculty, the opportunity to acquire and develop skills in the diagnosis and management of pediatric disorders. The resident may request to rotate entirely on the inpatient service or split the time between the inpatient and outpatient setting. Clinical experiences are complemented by conferences, lectures and patient directed readings.

Radiology

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.

Surgery

The goal of this 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 may do this elective either on one of the general surgical residency services or with an individual surgical attending. On this later service, the resident spends approximately 40% on the inpatient setting and 60% in outpatient office hours.

Women’s Health

This elective rotation emphasizes the evaluation and treatment of common clinical entities in the field of women’s health. Under the guidance of the program director in obstetrics and gynecology and the teaching faculty in the obstetrics and gynecology residents’ clinic, the resident sees patients daily in the gynecology clinic and other specialty clinics such as abnormal Pap clinic, reproductive endocrine clinic and the prenatal and high-risk obstetrics clinic. Didactic conferences include the weekly half-day educational conference, obstetrics grand rounds and gynecology grand rounds.