Rotation Goals and Objectives
During the fours year of residency training, resident will rotate through general internal medicine inpatient services, outpatient services and core internal medicine sub-specialties. Residents will be required to develop skills and show a basic understanding of the various diseases seen in internal medicine.
In the first two years, resident will be required to show an understanding of the pathophysiology of various disease processes. Residents will be required to perform a detailed history and comprehensive exam and come up with a good differential diagnosis.
In 3rd and 4th year, residents will have a supervisory role, assisting with managing patients as a whole. In addition to mastery of basic skill in the first two years, residents will be need to show a development in diagnosis and management/treatment skills.
Below are some of the objectives of rotations residents will rotate through:
General Internal Medicine Inpatient
Gain exposure to a variety of acute and chronic medical problems
Develop skills in evaluation, diagnosis, and management of common acute and chronic medical disease
Enhance communication and discussion skills within the general medicine teams
Enhance communication and counseling skills for education of patients and family members
Effective communication with ancillary staff to enhance patient care
Provide holistic and comprehensive care to the patient.
Implement primary and secondary preventative strategies for various disease processes
Effectively communicate with subspecialist to ensure best patient care
Structured teaching round to implement effective learning
Develop skills in the end of life care
General Internal Medicine Outpatient clinic
Gain exposure to various acute and chronic outpatient disease processes
Improve skills in history taking and physical exams in the outpatient setting.
Develop skills in evaluation, diagnosis and treatment of common acute and chronic medical disease
Interpretation of labs and imaging within the outpatient setting.
Enhance communication with patients and their families
Initiate appropriate subspecialty consults when needed
Ensuring appropriate follow up for patients
Cardiology
Develop skills to evaluate and manage patients with disease of the cardiovascular system.
Show a good understanding of various cardiovascular disease processes
Reliably recognize cititical illness and appropriately seek assistance
Familiarity with the mechanism, clinical manifestation and diagnosis strategies for patients with acute and chronic disease of the heart
Master technical skills for central line placement, atrial line placement, BLS and ACLS
Understanding and interpretation of electrocardiograms
Implement primary and secondary preventive strategies and to appropriately refer patients to subspecialties
Show an understanding of the various diagnosis and therapeutic options for patients with cardiovascular disease at various stages including but not limited to cardiac catherization, primary angioplasty, thrombolytics, functional stress testing, echocardiograms and tilt table testing.
Educate patients regarding ongoing treatment and possible future interventions
Gastroenterology
Develop a solid foundation in the pathophysiology, diagnostic evaluation, differential diagnosis and approach to management of gastrointestinal and liver diseases.
Learn the appropriate assessment of elevated liver enzymes and their clinical implications.
Learn the need of appropriate laboratory test in managing patients with various gastrointestinal disease
Learn the indications, appropriate use and complications of various gastrointestinal procedure.
Understand the appropriate use to other radiology studies related to gastrointestinal disease
Learn appropriate and cost-effective preventative, surveillance and screening techniques for gastrointestinal malignancies.
An understanding of the need and management of liver transplantation.
Infectious Disease
Evaluate and manage patients with suspected infectious diseases and to appropriately consult when needed.
Familiarity with the mechanisms, clinical manifestations, diagnostic strategies and treatment for patients with acute and chronic infectious diseases, including HIV.
Development of familiarity with the spectrum of activity, toxicities, and appropriate use of common antimicrobials.
Learn to interpret stained smears and culture and sensitivity results, with an emphasis on understanding the appropriate utilization of the clinical microbiology laboratory.
Introduction to principles of modern infection control and hospital specific biograms
Implement preventive strategies for immunocompetent and immunocompromised hosts and to refer patients to subspecialists at the appropriate time in their disease
Oncology/Hematology
Evaluate and manage patients with suspected oncology or hematology related disease processes.
Understand the need for urgent and appropriate consult of the services when needed in patient care.
Appreciate the role of a detailed history and the detection of abnormal physical, laboratory, and radiologic findings relating to the lymphohematopoietic system
Understand the need for a bone marrow aspirate and biopsy and lymph node biopsy
Learn the initial diagnostic evaluation and management of thrombosis and bleeding
Understand the assessment of the indications and procedure for transfusion of blood and its separate components
Management of therapeutic and prophylactic anticoagulation. Understand the role and indication of novel anticoagulation in the setting of oncology/hematology.
Learn diagnosis and management of common anemias
Learn pharmacology and use of common chemotherapies
Learn management of neutropenia/immunosuppression
Learn diagnosis and general principles of management of common solid tumors
Show an understanding of the need for End of life care/Palliative care services when appropriate.
Nephrology
Evaluate and manage patients with fluid and electrolyte disorders and learn acid base pathophysiology and management.
Familiarize them with the mechanisms, clinical manifestations, and diagnostic strategies for patients with acute and chronic diseases of the kidney.
Learn to implement reno-preventive strategies and to refer patients to subspecialists at the appropriate time in their disease.
To develop familiarity with principles, clinical indications, complications and performance of nephrologic procedures including acute and chronic hemo- and peritoneal dialysis, renal biopsy, vascular access placement, slow dialysis, and plasmapheresis.
Educate them regarding the ongoing management of a patient s/p kidney transplantation
Pulmonary/ICU
Learn to recognize and to treat the major clinical syndromes and diseases encountered in pulmonary medicine.
To learn the appropriate use, interpretation, and troubleshooting of invasive monitoring equipment used in the ICU.
To learn the appropriate indication for intubation and use of mechanical and non-mechanical ventilatory support.
Develop effective consulting skills, and learn when to appropriately refer to pulmonary.
Learn to interpret pulmonary function testing, chest x-rays, and CT examinations of the thorax.
Learn the appropriate indications for bronchoscopy and other invasive procedures.
Develop skills in common diagnostic and therapeutic procedures such as thoracentesis and chest tube placement.
Rheumatology
Review and improve musculoskeletal history and exam skills and differentiate joint complaints as either articular, periarticular, or radiating pain.
Distinguish inflammatory from mechanical joint pain.
Recognize patterns of common forms of arthritis.
Have a working knowledge of rheumatology laboratory tests.
Acquire an approach to the diagnosis and treatment of common rheumatologic conditions, in particular regional conditions such as rotator cuff tendonitis and plantar fasciitis.
Recognize potential serious rheumatologic illness and the appropriate triaging/treatment
Review and improve arthrocentesis and injection skills
Endocrinology
Learn inpatient consultation management and efficient outpatient management of patients with endocrine disorders.
Learn inpatient and outpatient management of patients with diabetes mellitus, including ketoacidosis, non-ketotic hyperosmolar coma, simple glycemic control, management and prevention of diabetic complications, and adjusting insulin and/or oral hypoglycemic therapy for procedures or surgery.
Recognize and treat life threatening endocrine disorders such as thyroid storm, myxedema coma, hypertensive crises from pheochromocytoma, and adrenal crisis.
Learn how acute and chronic illnesses affect a variety of endocrinologic organ systems
Efficiently evaluate the endocrine systems of acutely and chronically ill patients, including the role of stimulation and suppression testing and imaging studies.
Assess the nutritional status in the acutely and chronically ill patient.
Learn the appropriate indications and timing of referral to endocrinologists
Palliative Care
Understand the concept of palliative care medicine
Differentiate between palliative care and hospice care
Understand the trajectory of chronic illness and how palliative care plays a role
Learn the symptoms patient face with chronic illness and treatment of such symptoms
Learn the symptoms patients suffer at the end of life and treatment of such symptoms
Understand the team concept of palliative care and the various resources the team members can provided including spiritual and psych-social counselling.
Understand the concept of sharing importance news with patients and their families. Familiarity with the concept of breaking bad news to patients
Learn the concept of family meetings and how to organize and conduct them
Understand the role of respite care, inpatient palliative as well as outpatient palliative care
Learn basic knowledge of opioid use and conversion.
Neurology
Train physicians to become comfortable managing clinical neurologic conditions through exposure to both inpatient and outpatient care.
Refine skills in performing a detailed and comprehensive neurologic history and neurologic examination.
Learn to appropriately order neuroimaging studies, the initial interpretation of such studies, and the influence of these results on initial management plans.
Learn the diagnosis, management and treatment of acute strokes. Understand the most recent stroke guidelines.
Enhance knowledge through didactics about the most common and important neurologic diseases.
Dermatology
Appreciate and learn the diagnostic evaluation, differential diagnosis and approach to management of dermatologic diseases
Learn to distinguish benign skin lesions and malignant skin lesions.
Learn principles and techniques for procedures of related to Dermatology such as, but not limited to skin biopsies.
Learn use of the microscope to interpret wet mounts and smears
Develop an understanding of skin signs of systemic diseases
Recognize rare conditions and learn appropriate referrals to dermatology specialty
Psychiatry
Appreciate the acute evaluation of a patient with suspected mental health disorders
Understand the value of a detailed psychiatry history in evaluation of a patients
Appreciate the spectrum of mental health disorders, their relationship and how to differentiate between them.
Understand the role of non-pharmacotherapy, such as but not limited to cognitive behavioral therapy, in treating patients with mental health disorders
Understand the vast pharmacotherapy is treating specific conditions
Appreciate the need for neurocognitive testing in appropriate settings
Appreciate the role of depression and its effects on other comorbidities. Appreciate and understand the role of screen for depression and other mental health disorders
Understand the role of other health providers, such as nurses, social workers and pscychologist, in addressing needs of patients with mental health disorders.
Recognize conditions that require appropriate referrals to the mental health specialist.
