Residency Core Rotations

Core rotations for physicians in Internal Medicine Residency Training Programs at The Western Pennsylvania Hospital include ambulatory care, cardiology, critical care medicine, geriatrics, hematology/oncology, and inpatient general medicine services.

Ambulatory Care

Patients from the tri-state area (Ohio, West Virginia, and Pennsylvania) are drawn to The Western Pennsylvania Hospital because of its renowned medical staff, state-of-the-art equipment, and high-quality patient care. The large and varied patient population provides the resident with an excellent spectrum of ambulatory care experiences.

The resident/faculty practice, West Penn Medical Associates, serves as the primary site for the resident's continuity experience. Each resident takes primary responsibility for a group of patients whom the resident follows in continuity as a member of the healthcare team that includes other residents, physicians, and nurses. A comprehensive diabetes education program and other medical and surgical clinics are also available for consultation in the care of ambulatory patients.

Block rotations in ambulatory care at the PGY1, PGY2, and PGY3 levels provide the resident with experience in all aspects of the office practice of internal medicine, including otolaryngology, ophthalmology, gynecology, dermatology, behavioral sciences, orthopedics, and private practice. Interns receive instruction in psychosocial skills and patient interviewing as well as computer search skills. Senior residents participate in the healthcare team that provides home visits to patients and in community outreach programs to provide health care to homeless individuals. The skills needed to perform various office procedures are taught as part of a structured educational program.

Cardiology

Cardiovascular medicine is a key component of the core curriculum for physicians enrolled in Internal Medicine Residency Programs at The Western Pennsylvania Hospital. In the Cardiac Care Unit, residents work as members of a team that includes a cardiology fellow to acquire the basic principles of critical-care medicine as they relate to cardiology.

Daily management rounds begin at 8 a.m. Attending physician rounds are held daily from 10:30 a.m. to 12 noon and include case discussions as well as the presentation of specific didactic material. The focus of the cardiology rotation is to enable the resident to develop the cognitive, decision-making, clinical, and humanistic skills needed to evaluate, stabilize, and provide acute care for patients with critical cardiovascular disease. Emphasis is also placed on developing in-depth understanding of the clinical pharmacology and practical use of cardiac medications.

Patients admitted to the Cardiac Care Unit are seen first by the resident, who is responsible for obtaining the admission history and physical examination and after consultation with the senior resident, cardiology fellow, and attending physician for writing all orders. In addition to managing their patients in the unit, residents are encouraged to observe cardiac procedures, including transesophageal echocardiography, diagnostic catheterization, and angioplasty, performed on their patients. Residents also participate in regularly scheduled cardiology conferences held two mornings each week at 7:30 a.m.

During the cardiology elective, residents have the opportunity to develop the knowledge and skills needed to provide basic cardiology care for patients seen in consultation both in the hospital and in the outpatient setting. Under the supervision of a senior cardiologist, residents learn to elicit a thorough but focused cardiac history and to perform a pertinent physical examination of the cardiovascular system. Emphasis is placed upon the management of common cardiac conditions, the interpretation of diagnostic studies, and the indications for therapeutic procedures including coronary by-pass surgery and catheter-based revascularization procedures.

Cardiology consult patients are seen first by the resident for initial evaluation. These new consultations are then presented to the attending physician before orders are written. The senior resident is responsible for writing the consultation note, formulating a plan of care, and writing orders. The resident is responsible for progress notes and appropriate orders for consultation patients on daily rounds. Residents attend all cardiology conferences during their elective rotation and observe both noninvasive and invasive procedures.

Critical Care Medicine

The Medical-Surgical Intensive Care Unit (M-SICU) at The Western Pennsylvania Hospital is an 18-bed unit providing state-of-the-art care to patients with all forms of critical illness. An adjacent 30-bed Medical-Surgical Progressive Care Unit (M-SPCU) provides care for patients with slightly less critical illness. Both units are administered by the chief of the Division of Critical Care Medicine. House staff care for patients admitted to the M-SICU and follow many of the patients in the M-SPCU.

Care for patients in the M-SICU and M-SPCU is generally supervised by a primary care attending physician and a Critical Care Medicine staff physician (managing intensivist). Management and teaching rounds are made daily with the intensivist. Patient care teams consist of either a senior resident and three interns, or a senior resident and two junior residents. A separate team provides coverage for the M-SICU during the night.

As they rotate through the M-SICU, house staff gain proficiency in performing invasive hemodynamic monitoring, assessing and supporting cardiac and pulmonary function, airway and ventilator management, fluid management, nutritional support, and medical ethics. Procedural skills such as placement of central venous and arterial catheters are also emphasized.

Geriatrics

Geriatric medicine at The Western Pennsylvania Hospital offers the internal medicine resident a unique opportunity to care for geriatric patients in a wide variety of clinical settings. Special attention is given to learning how to manage care effectively and how to function both as a primary care provider for the elderly and as a geriatric consultant. In addition, the resident is exposed to the wide array of state and county services for the elderly, including adult protective services. In conjunction with the residency home visit program, the resident is able to provide direct care to patients who are homebound.

During the geriatric rotation block, the resident will also have the opportunity to learn how to manage and care for elderly patients in a long-term care setting. Residents work with experienced board-certified geriatric faculty at extended care facilities both on and off site. Particular attention is paid to rehabilitation needs as well as careful follow-up and healthcare coordination at the time of discharge. During the rotation, the resident spends a minimum of two days a week in a nursing home. The resident also learns to manage geriatric patients admitted to the Hospital for acute medical conditions both on the geriatric service directly and via consultation.  By the end of the rotation, and through exposure to the geriatric curriculum throughout the residency years, the resident develops skill in evaluating and managing the full spectrum of syndromes, acute medical problems, and chronic conditions that are prevalent in the geriatric population.

A one-month geriatric rotation at The Western Pennsylvania Hospital is also available as a senior elective for interested medical students.

Hematology/Oncology

The Division of Hematology/Oncology at The Western Pennsylvania Hospital is an integral part of The Western Pennsylvania Cancer Institute. This program provides primary as well as tertiary care for patients with a variety of hematologic and oncologic disorders. All members of the division are board-certified in internal medicine and hematology or medical oncology.

Fellows, residents, and students evaluate and treat patients on the 20-bed Hematology/Oncology/Bone Marrow Transplant Unit, and they participate in the care of patients with a variety of benign and neoplastic disorders, including those undergoing bone marrow transplantation. There are ongoing hematology, oncology, and bone marrow transplant conferences that stress the team approach to the care of such patients. Opportunities are available to participate in the management of outpatients.

The Division has an active program in quality patient care, teaching, and clinical and basic research. There are a number of active clinical protocols, including those with the Cancer and Leukemia Group B Cooperative Oncology Group, the Radiation Therapy Oncology Group, and the Gynecology Oncology Group, that are enrolling patients in clinical studies. There are also a number of ongoing studies investigating the use of hematopoietic growth factors and other newer agents. The Division maintains a Protocol Office that helps physicians to enter patients in these studies.

Inpatient General Medicine Services

A strength of The Western Pennsylvania Hospital Internal Medicine Residency is the ability to offer the residents an opportunity to evaluate and manage patients with an exceptionally broad spectrum of medical disorders. The patient population includes patients of both sexes, all socioeconomic classes, and varied ethnic and racial origins and religions. The attending physicians admitting these patients include general internists and subspecialists, full-time faculty attending physicians, and private practitioners from both small and large group practices who admit both primary/secondary care patients and tertiary care patients with illnesses from every subspecialty.

The internal medicine patient population ranges in age from adolescent to elderly. Approximately 35% of the patients come from the resident/faculty practice, full-time general internal medicine faculty practices, or emergency room patients without an assigned attending physician. The remaining 65% are referred by physicians selected to participate in The Western Pennsylvania Hospital's teaching program.

Each patient admitted to the medical teaching service has a managing attending physician who serves as the attending physician of record. The house officer performs the initial evaluation, then reviews diagnosis and management plans with the patient's private attending physician or the assigned full-time faculty member acting as managing attending. House staff write all orders for the care of patients under their service, whether the managing physician is a private practitioner or a full-time faculty member.

The inpatient general medicine service is divided into six teams. Admissions to each team are from a limited group of attending physicians. Team 1 admits patients from the hospitalist team of physicians. Team 2 admits patients of selected private practitioners. Team 3 admits patients of other primary care physicians. Team 4 admits primarily patients of subspecialty faculty in infectious disease, rheumatology, pulmonary medicine, neurology, and gastroenterology. Team 5 admits patients from the general medicine resident/faculty practice. Team 6 is a student team, an acting intern and a senior resident.

A team typically cares for 18 to 20 patients per day, is staffed by two PGY1 residents, and is supervised by a PGY2. A senior resident is assigned to supervise two teams and covers for the second-year resident during ambulatory continuity clinic assignments. Third- and fourth-year medical students from Temple University School of Medicine, Lake Erie College of Osteopathic Medicine, and the University of Pittsburgh School of Medicine are assigned to teams.

A teaching attending physician is assigned to each team. That attending physician makes rounds solely for the purpose of resident education three days per week from 10:30 a.m. to 12 noon. On the fifth day, Director's Rounds are held with the chairman or vice chairman of the Department of Medicine. Additional didactic teaching occurs during the daily noon conferences and during Morning Report, a conference attended by PGY2 residents, and the on-call teams and is held daily from 7:30 to 8:30 a.m. Teaching also occurs when the house staff team makes its work rounds and during daily discussions with the attending physicians who are responsible for overseeing the management of their patients.

A radiology conference is held two Tuesdays a month to discuss films of patients on the team. Teaching rounds include discussions of basic science and pathophysiology and aspects of patient care, including medical problems, psychosocial problems, ethical issues involved in patient management, and quality assurance, including cost effectiveness. Evidenced-based medicine is emphasized and residents are expected to read the current literature regarding conditions presented during teaching rounds.

Workload is limited to a maximum of 24 patients per resident team. The PGY1 resident admission workload is limited to five per day and not more than eight new patients in 48 hours. A PGY1 resident follows a maximum of 12 patients. When supervising more than one first-year resident, the supervising resident is not responsible for the care of more than 24 patients.