Adult Medicine

Hospital Medicine

Inpatient rotations on the adult medical floors consist of two months in the first, second, and third years—a total of 6 months over the 3-year program. These rotations expose residents to a variety of both common and less common problems in adult medicine and occur in both the urban and rural settings.

In the PGY-1 year, residents do two separate months of hospital medicine. One month occurs on the family medicine continuity service, comprised only of patients from the Highland Family Medicine residency clinic. Care is led by family medicine faculty. The continuity inpatient service has recently initiated a patient census cap to help ensure a balance between work and learning and to help maintain resident wellness. The team is comprised of one first-year resident, one second-year resident, and a third-year supervising resident. First-year residents typically manage 4-8 patients.

The second month of hospital medicine is on a team of family medicine residents caring for patients from other practices in the community. This team is usually overseen by hospitalists, but some family medicine faculty also oversee this team for several months of the year. This team is comprised of one first-year resident and a third-year supervising resident; in some months there is a second-year resident as well. First-year residents typically manage 4-8 patients on this service as well.

In both the PGY-2 and PGY-3 years, rural residents will do one month of inpatient medicine at Noyes Hospital in Dansville and one month at St. James Hospital in Hornell. On both rotations, residents will work directly one-on-one with a hospitalist attending managing new hospital admissions, rounding daily on hospitalized patients, and providing cross-cover care. Each hospitalist cares for approximately 15 patients with APP support. PGY-2 and PGY-3 residents will typically manage around 8 patients. Residents will attend the daily morning interdisciplinary huddle with clinicians, pharmacy, social work, and care managers as well as the afternoon huddle except when they are in their continuity clinic. There is also the opportunity to join interventional radiology procedures scheduled in the afternoon. The new ICU at St. James Hospital now allows for the care of more severely ill patients without requiring their transfer. This is an open ICU model and there are no intensivists at St. James, so the residents and hospitalists have the opportunity to provide more intensive care. At both hospitals, residents have more independence managing less common conditions due to there being fewer specialists.

Intensive Care Unit

PGY-1 residents will rotate for 4 weeks in the Intensive Care Unit at Noyes Hospital. This is an 8-bed “closed” ICU managed by a team of pulmonary-critical care attendings with whom residents will work one-on-one. Noyes Hospital is the designated referral ICU for other rural hospitals in the southern region and manages patients with both common (e.g. COPD, CHF, DKA) and less common (e.g. alveolar hemorrhage from drug toxicity) admitting diagnoses. Residents will attend the daily morning interdisciplinary huddle with clinicians, pharmacy, social work, and care managers. On less busy afternoons, residents have the opportunity to rotate in the outpatient pulmonology clinic, including procedures such as bronchoscopy or endobronchial ultrasound.

Night Float

Residents have one-week night float rotations twice at Noyes Hospital during the PGY-2 year, one in each half of the academic year. There are no night float responsibilities in the PGY-3 year. Supervision is provided by hospital medicine attendings. There are 4-8 overnight admissions as well as patient cross-cover responsibilities. All work is divided between the attending and the resident with residents primarily managing patients with higher educational value.

Cardiology

Residents will rotate for two weeks of rural outpatient cardiology during the PGY-2 year in a busy, high-volume outpatient practice.

Geriatrics

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 one of the rural nursing homes, a 4-week block of geriatric medicine in the third year provides training in geriatric mental health care, rehabilitation, comprehensive assessment, and specialty experiences such as geriatric nephrology and oncology. From their continuity clinic patient panels, residents participate in functional assessments and home visits for their elderly patients. Highland Hospital has a medicine floor devoted entirely to acute care for the elderly that has become a national model for elder care. A new inpatient palliative care unit was also opened in 2024. In addition to these dedicated experiences, residents gain significant experience caring for older adult patients during their inpatient medicine rotations.