Gundersen Lutheran - Internal Medicine Residency Curriculum & Schedule

Internal Medicine Residency Curriculum & Schedule

"I knew Gundersen Lutheran was the place I wanted to spend the three most important years of my training the day I interviewed here. Out of all the places I interviewed, Gundersen Lutheran offered the best combination of excellent one-on-one instruction by attendings, hands-on experience and responsibility for patients, multiple research opportunites, and superb ancillary staff, all of which I have found to be invaluable. Moreover, there is a real feeling of "family" around here, both with colleagues and with patients. I think it comes down to the fact that there is a real emphasis on making you into an excellent physician without working you to death; with the excellent staff and facilities in this institution, they do just that." -Rachel Hawker, former Internal Medicine Resident

There are 13 four-week rotations per year as outlined below along with call schedules. Rotation descriptions and electives are listed below as well.

The First Year

Rotation	Duration	Call Schedule
General Medicine Inpatient	6 rotations	q 4 from home
Cardiology	1 rotation	q 4-5 in hospital
Pulmonary-ICU	1 rotation	q 4 in hospital
Night Float	1 rotation	N/A
Research/Quality Improvement	1 rotation	No Call
Subspecialties*	1-3 rotations	q 5-6 from home
Electives	1-2 rotations	N/A
Vacation & Conference Time**	4 weeks	N/A

The average hours per week worked (including conferences) for PGY-1's is 60.

"Everyday, I know that I have worked with highly qualified, dedicated and friendly staff. There is a very organized way of teaching here, based on research and experience. Working here is enjoyable and I look forward to the next day!!"
—Abhishek Tandon, Internal Medicine Resident

The Second Year

Rotation	Duration	Call Schedule
General Medicine Inpatient #	3-4 rotations	No Overnight Call
Cardiology	1 rotation	q 4-5 in hospital
Pulmonary-ICU	1 rotation	q 4 in hospital
Night Float #	1 rotation	N/A
Emergency Medicine	1 rotation	10 hour shifts; 6 days on, 3 days off
Geriatrics/Palliative Care	1 rotation	N/A
Ambulatory Care	2 rotations	N/A
Subspecialties*	1-2 rotations	q 5-6 from home
Electives/Non-Medicine Subspecialties	1-2 rotations	N/A
Vacation & Conference Time**	4 weeks	N/A

The Third Year

Rotation	Duration	Call Schedule
General Medicine Inpatient	3 rotations of 4 weeks	No Overnight Call
Cardiology	4 weeks	q 4-5 in hospital
Pulmonary-ICU	4 weeks	q 4 in hospital
Subspecialties*	3 rotations of 4 weeks	q 5-6 from home
Electives/Non-Medicine Subspecialties	3-4 rotations of 4 weeks	No Call
Vacation & Conference Time**	4 weeks	No Call

* Subspecialties are Endocrinology, Gastroenterology, Hematology, Oncology, Infectious Disease, Nephrology, Neurology and Rheumatology

** Vacation and conference time may be taken during any rotation except General Medicine, Cardiology, and Pulmonary-ICU. A maximum of one week of vacation or conference time per rotation is allowed. Two consecutive weeks may be taken by taking vacation the last week of one rotation and the first week of the subsequent rotation. For more information, click Benefits.

# Night Float will not be required for all PGY2s. Only three general medicine rotations will be required if given a night float assignment.

All of our rotations stay well within the ACGME 80 hour work week guideline.

Rotation Descriptions

Internal Medicine — This rotation consists of four weeks of inpatient internal medicine, each of the teams is staffed by one attending physician. Services average a census of 10-15 patients. A team can expect 2-4 admissions on a typical "short call" day, and 6 to 12 patients on "long call" (2-4 of which may be admitted directly to the Medical ICU). Each service team is composed of a second or third-year resident, two first-year internal medicine or transitional residents, and a medical student. Consultations are obtained as needed with other specialties. First-year residents have complete charge of the patients they evaluate. There are no "private patients." When a patient is admitted, the team has full decision-making capabilities. On a "long call" night, both interns will be on overnight call in the hospital, and take admissions with the overnight hospitalist staff. The interns then leave by 1 PM the following day and the senior resident takes care of the post-call issues. The senior resident takes call until 9:30 PM and then goes home, handing their pagers off. There is no overnight call for the senior residents.

Cardiology — As a tertiary care center, the medical center has the full range of cardiology experience under the supervision of board-certified cardiologists, including state-of-the-art diagnostics, an active open heart surgery program, and aggressive interventional cardiology. The cardiology service averages a census of 12, including many with acute myocardial infarction and its complications. Teams consist of three residents and a medical student. Gundersen Lutheran was once again recently named in the top 100 medical centers in the nation for cardiac care.

Pulmonary — Residents gain experience in intubation, ventilator management, pulmonary artery line and arterial line placement, and interpretation of pulmonary function tests. Both the ICU and pulmonary consultation services averages 10 patients each per day, including admitting or consulting on 3 patients a day on respirators and two others in critical care not on respirators. Pulmonary teaching conferences are held each weekday. Teams consist of three residents and a medical student.

Night Float — This is a rotation in which the focus is on treating acute medical issues that arise in the hospital. Residents cover the hospitalized patients of the GM teams, under the supervision of the in-house hospitalist. In addition, the residents on night float serve as a "back up" to the GM team on call, and admit 1-2 patients when needed.

Research/Evidence-Based Medicine/Quality Improvement — In July, 1998 the residency program added this cutting-edge 4 week rotation to the educational curriculum. This rotation gives the resident a broad based overview of the research process and will provide a framework for the ACGME required research project. Each resident will submit at least one paper for publication prior to graduation, and the rotation is set up to facilitate that goal. The resident will meet with a biostatician to review clinical epidemiological concepts, diagnostic testing, and study design. This individual will assist in hypothesis development, data collection methods, and general analysis techniques for the resident's research project. A librarian provides didactic education and support by teaching upper level database searching techniques. The evidence-based medicine component of the rotation covers the different levels of evidence and its usefulness in making clinical decisions, how to ask appropriate questions, and some of the statistical methods used to evaluate evidence in the medical literature for use at the bedside, (odds ratios, positive & negative likelihood ratios, number needed to treat, etc.). The quality improvement component includes formal instruction regarding the principles, objectives, and processes of quality assessment as well as learning support systems in place to perform quality improvement work within Gundersen Lutheran. Didactic and hands on experience with research work in progress at Gundersen Lutheran is a second component of this rotation. It is felt that this educational experience greatly enhances internal medicine resident's experiences in that it provides a multidisciplinary approach to problem solving.

Endocrinology — This busy consultative service includes evaluation and treatment of common endocrine disorders and unusual and complex endocrine problems. The service, averaging 4 to 6 patients per day, includes endocrine grand rounds weekly, an outpatient endocrine clinic three times weekly, a weekly intensive diabetes treatment clinic, and high-risk obstetric clinic for women with diabetes.

Gastroenterology — Working one-on-one with a staff gastroenterologist in the hospital and clinic, the resident is exposed to a wide variety of GI problems. This is primarily a consultation service.

Hematology — Residents are exposed to a wide variety of inpatient and outpatient hematologic problems on this consultative service. Working one-on-one with the staff hematologist, they become proficient in interpreting peripheral smears and bone marrow biopsies. This is a consultation service.

Oncology — Residents learn to stage patients and become involved in research protocols and traditional modes of treatment for common and uncommon forms of cancer through this consultative service. Emotional needs of patients and families and palliative care, including pain medication, are emphasized.

Infectious Disease — The Infectious Disease (ID) services average 8-12 hospitalized patients with 12-15 new consults a week. Patients with ID problems include those with immunosuppressive states (including a small number of patients with AIDS), complications of diabetes, orthopedic surgery, neurosurgery, other surgical infectious, and pediatric infections. The patients include community-acquired infections, nursing home infections and nosocomial infections. Outpatient infectious cases and travel medicine are also seen. There is a weekly infectious disease teaching conference. Residents have the opportunity to review clinical microbiology both in the lab and in didactic lectures. If interested, there is a quarterly ID journal club, a monthly infection control committee meeting and ID research projects.

Nephrology — The hospital’s hemodialysis outpatient clinic sees 50 patients a week, offering opportunities to monitor patients in chronic renal failure and manage problems occurring during hemodialysis. Clinic nephrologists also provide consultation to the hospital’s satellite unit centers in four area communities. The inpatient service averages 3 to 4 consultations a day. Teaching sessions are held several times a week at the end of rounds. The resident on rotation also sees Nephrology patients twice a week in the afternoon in the clinic during their four-week rotation.

Neurology — Residents gain experience in performing and understanding the neurological examination, understanding indications for diagnostic techniques, and learning to use and interpret MRI, EEG, EMG, and CNS-CT scans. The daily census is six to eight patients.

Rheumatology — The emphasis is on common out-patient rheumatologic conditions. Residents see one new patient daily, along with follow-up appointments and inpatient consults. Objectives include mastery of the musculoskeletal exam and joint aspiration/injection techniques. The education program includes one-on-one teaching, and a self-study program.

Emergency Medicine — The 4-week rotation in Emergency Medicine allows residents to see the acute presentation of common and uncommon diseases. Residents receive plenty of hands-on experience and are afforded the opportunity to fly on our MedLink Air helicopter on transport and rescue missions. One-on-one staff to resident teaching is the norm.

Palliative Care — During the geriatrics rotation, residents learn about community resources for the elderly. There are several didactic lectures covering a broad range of geriatric topics. Residents have daily interaction with our palliative care pain management team and provide care to hospice and home-bound palliative care patients.

Ambulatory — During the second and third year, residents see patients at Gundersen’s regional clinic in La Crescent, MN, at the University of Wisconsin-La Crosse Student Health Service, and at a free ambulatory women’s health clinic. Additionally during this 8-week ambulatory block, residents see indigent patients at the St. Clare Health Mission two evenings a week.

Hospitalist Rotation — During this elective month, senior residents have the opportunity to work outside the traditional teaching service model, alongside practicing hospitalists. Residents will have the option to work on an independent daytime admitting service and a night shift service, both under the supervision of hospitalist staff. In addition, residents will work with utilization review and billing to enhance understanding of the economic side of medicine. Residents will also have responsibilities in Emergency Room/Hospital triage, and didactic sessions on Quality Improvement and medical information technology.

Elective Rotations

Allergy	Anesthesia	Behavioral Medicine
Treadmill Testing	Dermatology	Endocrinology
Gastroenterology	Palliative Care	General Surgery
Research	Infectious Disease	Vascular Medicine
Neurology	Neurosurgery	Office Gynecology
Ophthalmology	Orthopaedic Surgery	Otolaryngology
Pathology	Plastic Surgery	Pediatrics
Procedure Rotation	Radiation Oncology	Radiology
Rheumatology	Sports Medicine	Urology
Hematology	Nephrology	Pacemaker Clinic
Oncology	Podiatry	Nephrology Outpatient
Physical Medicine & Rehabilitation	Metabolic Support	Occupational Health
CHF Clinic	Outside Rotation	Hospitalist Rotation