Education

Patients admitted or referred to AGH/WPH Department of Medicine give residents an opportunity to manage an interesting cross-section of medical conditions. This varied experience enhances career development during their training. Interns admit up to five patients on a overnight call and are supervised by their team resident with whom they share call. Seniors can admit up to ten patients on call.

General Medicine Rotation

On the general medical floors, each team consist of an attending, a second or third year senior resident, two interns, as well as third-and fourth-year medical students. Interns and senior residents provide day coverage while the Night Float team provides overnight coverage.  Attending rounds are conducted at least five days a week.

The attending physicians will review with the house-staff the presentation and management of patients. In addition, team discussions are led about epidemiology, clinical manifestations, pathophysiology, diagnosis and evaluation, treatment, and prognosis of the medical conditions affecting their patients, incorporating relevant and recent literature. Patients are admitted to one of the five general medicine teams.

Hospitalist Rotation

Patients admitted to this special general medicine service largely come from AGH/WPH privately owned practices in Greater Pittsburgh with hospital admitting privileges The Hospitalist Service will be divided into four teams, each with an attending physician, one second- or third- year senior resident,  two interns and medical students  Interns and senior residents provide day coverage while the Night Float team provides overnight coverage.  The hospitalist attendings provide 24 hour coverage and leads the medical emergency team.

Cardiology Rotation

This rotation will provide residents the opportunity to gain experience in the diagnosis and management of patients who have diseases of the cardiovascular system.  Residents will learn to apply keen physical diagnosis skills to assess cardiac murmurs, jugular venous distension, and other clinical markers of cardiovascular disease.  They will also learn the indications, risks, benefits and interpretation of cardiac testing modalities including EKG, stress testing, echocardiogram, cardiac MRI, and cardiac catheterization. The rotation will consist of 2-3 senior residents supervised by Cardiology Attendings. Attending rounds will occur daily.  The night float teaching service will provide overnight coverage.

Medical Intensive Care Unit

Allegheny General Hospital has a fully staffed ICU. The medical team includes 8 interns, 3-4 senior residents, a pulmonary-critical care fellow, and an attending physician who rounds seven days a week. Interns and senior residents provide day coverage while the Night Float team provides overnight coverage. The pulmonary & critical care fellows provide 24 hour in-house coverage. The housestaff take primary responsibility of managing critically ill patients, including performing most diagnostic procedures. All major management decisions are reviewed by the ICU medical team on daily morning rounds and evening rounds. During the ICU rotation, trainees are taught:
 

• Techniques of resuscitation
• Intubation
• Respirator Management
• Bedside hemodynamics
• Management of acutely ill medical patients

Cardiac Care Unit

Allegheny General Hospital has a fully staffed CCU. A wide spectrum of cardiac conditions is managed in the CCU including patients with acute heart failure, myocardial infarction, unstable angina and cardiogenic shock. Cardiac catheterization and intra-aortic balloon pumps are routinely employed.The CCU is staffed by 4-5 senior residents, 1 cardiology fellow and 1 cardiology attending.  The residents rotate between day and night shifts for overnight coverage.  The cardiology fellows provide 24 hour in-house coverage.

During the rotation residents are taught:

• Techniques for electrical and chemical cardioversion of arrhythmias
• Swan-Ganz catheter insertion
• Cardiac resuscitation
• EKG interpretation
• Principles of cardiac emergency therapy
• Management of acute cardiac illness

Ambulatory Care

Our institution offers excellent training in the outpatient setting, to prepare those pursuing careers in primary care and outpatient based specialties. In our Medical Ambulatory Clinic (MAC), residents have the opportunity to deliver ongoing care to a group of patients in a setting similar to private office practice. Faculty preceptors are readily available and lead didactic and case conferences , reviewing principles of preventive medicine and management of common ambulatory problems. PGY-1 residents also spend a one-month block in the MAC, where they are exposed to the principles of outpatient medicine and can intensively develop their outpatient panels. There is protected time for self-learning using the Hopkins Modules.The clinical site is located off the hospital campus in an adjacent office complex.  This setting provides more of a “private practice” rather than an “institutional” atmosphere.  In addition, residents will be explosed to important aspects of the non-medicine specialties such as ENT, Orthopedics, Dermatolgy, OBGYN, Opthalmology.

New Project to Start January, 2011

Project name: “In The Clinic Minute”
Project description: “In The Clinic Minute” is an innovative outpatient teaching tool that affords R3 residents the opportunity to investigate and publish educational material to their resident and faculty colleagues, as well as patients. This project succinctly reviews topics pertinent to outpatient/ambulatory Internal Medicine, and serves as outpatient “teaching rounds.” R3s will accept this graduated responsibility to teach their colleagues, with faculty “editors” as a guide to revise/valid their work. All work must be accompanied by reliable references/guidelines.
Project Editor-in-Chief: Lisa Kwisnek-LaMantia, DO

Oncology Service

Under the supervision of an attending physician and an oncology fellow three senior residents rotate through the hematology/oncology service per month. Our residents care for a wide spectrum of cases ranging from new diagnosis and treatment of acute leukemias to end stage metastatic disease.

Night Float

The night float service are covered by teams consisting of 1 senior resident and 1-2 interns.   The residents cover the hematology/oncology service, hospitalist service, color teaching services, and a consult service.

The night teams will admit from 10 p.m. to 7 a.m., (Monday through Thursday night) and then attend morning report from 7-8 a.m. Night interns will be responsible for patient care of admitted patients from 7 a.m. to 8:30 a.m.  The night team will then round with the team and attending for whom the admissions were done. This will give them teaching experience while on night float and promote better transition of care. The night float team will leave by 10 a.m.

Medical Consults

Third year residents will perform house general medicine consults for one month. This elective exposes senior residents to pre and post operative management.

Geriatrics

Third year residents will be doing a month of Geriatric rotation as part of their training. This is an off-site rotation in which residents gain valuable insight into community practice with patients and families from a wide socio-economic spectrum.

Neurology

The training program offers an intensive experience in the management of neurological disease. Stroke patients are immediately taken care of by a "Stroke Team" which is staffed by a neurology attending and medicine housestaff. In addition, interns rotate through a neurology consultation service to learn to diagnose, evaluate and treat common neurology problems in both the inpatient and outpatient setting.

Emergency Medicine

The emergency rooms at both sites are staffed by residents from Emergency Medicine, Surgery and Internal Medicine training programs. Internal Medicine residents have the opportunity to see patients with a variety of acute medical and surgical illnesses as the initial physician. On the Emergency Medicine Service, residents work under the supervision of emergency medicine attendings.The objective of the rotation is to learn how to approach emergency patients, manage multiple patients, recognize and triage ill patients, and manage these patients acutely and to be exposed to common ED problems. Each resident will have 15 shifts in a month.

Electives

Core

• Cardiology

• Nephrology

• Pulmonary & Critical Care

• Rheumatology

• Gastroenterology

• Hematology/Oncology

• Dermatology

• Endocrine

• Infectious Disease

• Neurology