Inpatient rotations on the adult medical floors consist of two blocks in the first, second, and third years—a total of 6 blocks over the 3-year program. These rotations expose residents to a variety of common and uncommon problems in adult medicine. Residents learn the rational use and interpretation of diagnostic procedures and tests.
Teaching occurs daily during morning report, noon conference (healthy lunch provided!), and during sign-out rounds. These conferences are attended by residents of all levels in family medicine, internal medicine and internal medicine-pediatrics. One morning a week, there is a joint internal medicine-family medicine grand rounds. In addition to daily teaching rounds with our family medicine faculty, there are special teaching sessions exclusively for family medicine residents led by specialists in cardiology, geriatrics, hospital medicine, and other subspecialists.
There are an additional 3 weeks of medicine while on night float - one week as a PGY-2 and two weeks as a PGY-3 (see below).
Call is typically every fourth night until 8:00 p.m. Family medicine teams are usually comprised of one first-year and one second-year resident, with a third-year supervisor. The PGY-1 is paired with a PGY-3 while on call. There is no overnight call on medicine; night floats cover 8:00 p.m. to 7:00 a.m.
The Internal Medicine department chair at Highland has a strong commitment to primary care and a special interest in geriatrics. Highland has a unit entirely dedicated to acute care for the elderly. It has become a national model for elder care.
“I found myself in great shape compared with my colleagues.” –Alumni Survey 2010
Intensive Care Unit
The Medical Intensive Care Unit at Highland Hospital is the setting for training in the management of acute cardiac and pulmonary disease and other complex medical illnesses. A pair of family medicine first-year residents covers the service with supervision by a pulmonary/critical care fellow, and intensivists working in the 14-bed unit. There is no overnight call. The nursing staff, along with attending physicians from cardiology, pulmonary, and critical care, provide excellent inpatient teaching for residents. It also offers opportunities to become proficient in many hospital procedures. The rotation is 4 weeks, done during the first year of residency.
First-year residents do not take night float responsibilities. For one week in the second year, a resident provides cross-cover for patients on non-surgical floors, receiving sign out from the day teams at 8pm and covering until 7:00 a.m. Third year residents admit patients during night float for two weeks.
During this two week rotation, residents work with the cardiology practice at Highland Hospital. Residents have an opportunity to choose whether they’d like to focus their time in cardiology on outpatient visits or with the inpatient consultation team. In addition to weekly EKG rounds at Noon Conference at Highland, there are cardiology teaching sessions on inpatient medicine rotations.
Training in geriatrics is a significant strength of the Family Medicine Residency Program and occurs in one of two designated sites with direct supervision by family medicine geriatric faculty. In addition to providing continuity care for patients in nursing homes, a full block of geriatric medicine in the third year provides training in geriatric mental health care, rehabilitation, and end-of-life care as well as a more intensive experience in day-to-day nursing home care. From clinic patient panels, residents participate in functional assessments and home visits for the elderly. In addition, Highland Hospital has a medicine floor devoted entirely to the needs of geriatric patients and residents on the inpatient medicine service work closely with geriatricians on inpatient care for the elderly.
Electives are available for residents with an interest in geriatrics and many of our graduates have gone on to the Geriatrics Fellowship available here at URMC.
Geriatrics Continuity Experience
First- and second-year residents provide continuity of care for nursing home patients at one of two participating community nursing home sites. In this experience residents learn about the structure of nursing home care, the process for nursing home admissions and follow-up. Our aim is to provide care that focuses on quality of life and dignity in the nursing home environment.
First-year residents spend three weeks with the Department of Dermatology at Strong Memorial Hospital. Residents kick off this rotation by completing interactive dermatology learning modules designed by dermatology faculty. At the conclusion of the rotation residents complete a dermatology review and self assessment quiz.