Internal Medicine Residency Curriculum

This rotation schedule limits time compression and allows you to commit fully to your rotation. As a resident physician, you are assigned to a “pod” or a “firm.” For four weeks (sometimes two 2-week rotations), you are dedicated to a specific rotation. The +1 week will be spent in our ambulatory continuity clinic. During the +1 week, you will also rotate through subspecialty clinics, spend time completing research and delve into additional academic activities.

This is a dedicated block away from clinical responsibilities in which all internal medicine resident physicians gather for didactics on Friday afternoons. The dynamic curriculum includes, but is not limited to, subspecialty lectures, interactive workshops, simulation, resident-directed didactics and wellness retreats.

This program is designed to provide every resident physician the opportunity to excel in developing scholarly activity. Our research initiative starts before you begin your residency, with orientation activities that will include completing training modules for ethical research. With the additional support of the Parkview Mirro Center for Research and Innovation, the program will provide you the education, mentorship and resources to complete at least one research initiative, as well as a required quality improvement project. Parkview hosts a yearly research symposium, with plans to expand its reach. Competitive research projects will be submitted regionally and nationally.

The inpatient medicine rotation is a foundational rotation for resident physicians in their journey to become a competent, compassionate and well-rounded physician. On the medical wards, resident physicians will build their medical knowledge through exposure to different pathologies and management of hospitalized patients, develop excellent communication and interpersonal skills with patients and medical staff, and learn the complex relationship between health status and social standing. Morning report, interdisciplinary meetings and transition rounds, as well as teaching and bedside rounds, are just a few of the methods in which a resident physician will learn a team-based, patient-centered approach to care at Parkview. For resident physicians interested in a career as a hospitalist, there is an opportunity during the third year to do a more advanced hospitalist rotation.

A fundamental knowledge of critical care medicine is essential to the practice of every discipline within medicine. The successful internist must achieve competence in the essential skills of stabilizing and intervening in the care of critically ill patients for the first 24-hours until a medical intensive care specialist assumes care. This rotation will provide resident physicians with a rigorous experience in the assessment and care of critically ill medical patients. Parkview Health provides a unique environment of diverse pathophysiology as well as patients from diverse community, socioeconomic and cultural backgrounds. Resident physicians will manage patients in a tertiary care ICU setting as part of a multidisciplinary team under the direct supervision of attending physicians with expertise in critical care medicine.

Inpatient internal medicine night float rotation is a valuable experience for resident physicians to learn skills such as: assessing patients’ initial presentation through admissions, addressing acute conditions of floor patients, forming differential diagnosis, attending rapid responses/code blues and planning the patient’s work-up. Resident physicians will build their medical knowledge through exposure to different pathologies and acute management of patients and will improve upon their communication and interpersonal skills with patients, families, subspecialists and medical staff. Night rotations allow the future practicing internist to see the variations in staffing models between day and night medicine. All resident physicians on this rotation are expected to be able to provide the same level of patient care and communication to patients and families as those on day inpatient teams. Mastery of handover is an essential element of the night float rotation. Night float will be divided into two-week blocks so resident physicians will never do four consecutive weeks of night float.

Ambulatory Care is taught during the +1 block of the 4+1 rotation schedule and is the other foundational experience in Internal Medicine Residency. The 4+1 scheduling provides a structured daily office setting experience in the management of outpatients in our modern Continuity Clinic. This rotation will provide resident physicians with the tools to accurately assess and initiate appropriate diagnostic and therapeutic maneuvers. This curriculum will also develop the skills necessary for resident physicians to interact with others (e.g. attending physicians, nursing staff, therapists, family members and patients). The ambulatory curriculum will improve and build the resident physician's foundation to become a competent, compassionate well-rounded physician. Resident physicians will develop their communication skills and better understand doctor-patient relationships in areas of behavior, diversity, socioeconomic status and educational backgrounds. They will also build their medical knowledge through exposure to different pathologies and incorporation of skills and techniques which will prepare them for management of patients in an ambulatory setting. All resident physicians will develop progressive independence in the care of their patients under the supervision of outstanding ambulatory preceptors.

The general internal medicine physician is an essential part of treatment for patients who present with cardiovascular disease. Cardiovascular disease is present along a wide spectrum from undetectable to acutely life-threatening. The practicing internist must be able to stabilize and diagnose as well as treat patients who present with a variety of symptoms from underlying cardiac disease including ischemic heart disease, valvular heart disease, electrical heart rhythm disorders, muscle failure and so much more. Resident physicians will be exposed to the fast-paced world of cardiology in the inpatient services, as well as learn cardiovascular management in the office setting.

The vision for this rotation is to provide resident physicians with skills in the acute assessment and stabilization of critically ill patients. The rotation also provides the experience needed to work up undifferentiated conditions. It is an important rotation to learn the transitions of care of patients from the emergency room to the inpatient wards.

Resident physicians will train in endocrinology predominantly in the ambulatory setting to develop a solid foundation in the pathophysiology, diagnostic evaluation, differential diagnosis and approach to management of endocrine disorders. Resident physicians will also attend on the diabetes consult service, learning about difficult-to-treat diabetes, and transitioning from the hospital to the ambulatory care setting.

This rotation provides resident physicians with valuable experience needed to complete medical training, including the opportunity to consult on hospitalized patients referred by their primary care physicians regarding specific issues related to gastrointestinal problems that often include complex cases. Resident physicians are also expected to spend time in the gastroenterology clinic, learning to treat complex gastrointestinal and hepatic conditions.

Resident physicians will train on geriatric services to learn an interdisciplinary approach to healthcare of older adults including: diagnosing and managing medical problems, providing medical care of the older surgical patient (including pre-operative evaluation and post-operative management), performing comprehensive assessments of functional status and appropriate levels of care, mastering discharge planning to optimize use of community and outpatient services available to older adults, assessing and managing ambulatory community-based older adults, caring for institutionalized long-term care patients, learning the principles of caring for chronically ill and older patients with acute and sub-acute medical issues, caring for dying patients and their families, and caring for frail patient with multiple medical, psychiatric, cognitive, socio-economic and/or functional problems.

Cancer is the second leading cause of death in the U.S., and hematologic abnormalities are frequent in medical patients. Internists must therefore be familiar with the diagnosis and care of hematologic and oncologic conditions. Through this mandatory rotation, resident physicians will become familiar with common elements of the history, physical, differential diagnosis and evaluation of hematology/oncology patients in both inpatient and outpatient settings. Internists must be comfortable with prevention, screening, initial diagnostic evaluation and management, indications for prompt referral and appropriate co-management of a plethora of hematologic and oncologic conditions. They must also be knowledgeable regarding indications for transfusion of blood components, management of neutropenia and immunosuppression, care for treatment-related side effects and palliative care.

Internal medicine resident physicians will evaluate patients with acute and chronic infectious diseases across the entire spectrum of the specialty, learn the diagnostic and therapeutic approach to these patients, and learn to communicate recommendations with other healthcare providers. Resident physicians will rotate in the clinics to learn about outpatient management of patients after hospitalization for an infectious illness, and those with chronic infections.

This rotation is designed to give resident physicians exposure to all levels of kidney disease (acute, chronic, acute on chronic) in both inpatient and outpatient settings, as well as exposure to acid base disorders, electrolyte disturbances and more. Lessons learned on this rotation will greatly aid the resident physician in their training and beyond. Resident physicians will develop progressive levels of responsibility as they care for nephrology patients in various settings such as office, inpatient services and wards.

The general internal medicine physician will be faced with numerous patients that present with neurologic complaints and conditions. This rotation will provide the resident physician with a variety of inpatient and outpatient acute and chronic neurologic conditions from which to learn and develop experience in the care of the neurologic patient.

General internal medicine physicians will encounter numerous patients with diseases of the lung. To be a fully competent physician, resident physicians must train in the specialty of pulmonary medicine to diagnose and treat lung diseases seen in the office and during consultative inpatient services.

The practice of rheumatology and musculoskeletal diseases has become quite intricate with the intention of new immune suppressant drugs. To be proficient in counseling and advising patients, the general internal medicine physician will need to see a variety of rheumatologic conditions during residency. This rotation will expose the resident physician to a vast variety of immune rheumatologic conditions as well as very common and complicated conditions.

Throughout residency, resident physicians will have the opportunity to choose from a variety of specialties and locations to gain additional training. The resident physician will gain exposure to most of these electives during the +1 week, but additional 2- or 4-week rotations may be scheduled to gain additional exposure. These rotations include:

• Allergy/Immunology
• Dermatology
• Medical Ophthalmology
• Office Gynecology
• Otolaryngology
• Palliative Medicine
• Psychiatry
• Rehabilitation Medicine
• Sleep Medicine
• Sports Medicine/Non-operative Orthopedics
• Urology

Resident physicians interested in fellowship in a specific field will have the opportunity to do a second rotation in any required rotation, with the expectation that they develop research and leadership skills within that specialty to further their goals of obtaining a fellowship in that field.