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, two first-year residents and 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, seven to ten patients. Topics pertinent to patient care and/or otherwise of 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 Subspecialty Rotations
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 frequently also will attend office hours in the subspecialty attending's practice to gain additional experience.
Critical Care Rotation
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. Call is every fourth night.
Emergency Medicine
St. Luke's is a Regional Resource (Level One) Trauma Center. Residents, under the direct supervision of a faculty of ten 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. Structured readings on topics related to the medical management of the surgical patient are reviewed.
Hospitalist 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 Block Rotation
In the second year of training, each resident rotates for one month at St. Luke's Union Station clinic. During this rotation, the resident attends his/her continuity clinic as well as a number of subspeciality 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. Daily case-based discussions focus on the evidence-based approach to common ambulatory problems.
During this month, the resident under faculty guidance begins to develop a quality improvement project. The resident identifies an area for clinical improvement, implements steps to affect clinical changes, and monitors changes in clinical practice and patient outcomes. These projects have formed the basis of several poster presentations presented at regional and national meetings.
Ambulatory Selectives
Each resident rotates for two weeks each on the ambulatory selectives, which include behavioral health, dermatology, ENT, ophthalmology, orthopedics, physical medicine and rehabilitation and women's health. 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.
Geriatrics
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.
Palliative Care Rotation
This one month elective is offered in the second and 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.
Radiology
This one-month required 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.