Year Four
The fourth-year Medicine block begins with an inpatient ward month, where our residents are fully able to supervise patient management and to lead educational activities for the ward team. The next rotation is the coronary care unit, where the resident is matched with one intern in order to teach the diagnosis and management of acute cardiovascular conditions. This three-month block ends with an elective. The elective can be in either a medical subspecialty or a non-medical specialty, such as ophthalmology or orthopedics. Responsibility on non-medical electives varies with the particular elective but usually includes examining patients in the attending physician's office. The last block in the fourth year includes two more electives and a month in the emergency room (ER). In this final adult ER block, the resident accepts a higher acuity or number of patients.
Pediatric training in this year provides supervisory experience in several previous locations: two weeks of neonatal ICU, two weeks of general inpatient pediatric night team, emergency room, and inpatient unit. The senior resident is responsible for organization and teaching -- critical elements in any successful residency program. Morning report with a senior faculty member is often a highlight of the inpatient unit rotation. In the pediatric ER, fourth year residents coordinate admissions and conduct conscious sedations.
| Rotation |
Location |
| NICU/Ward Night Team (P) |
Magee-Womens Hospital |
| Subspecialty (P) |
Children's Hospital of Pittsburgh |
| Emergency Room (P) |
Children's Hospital of Pittsburgh |
| Inpatient Ward (M) |
UPMC Shadyside |
| Coronary Care Unit (M) |
UPMC Presbyterian |
| Elective (M) |
UPMC Shadyside or UPMC Presbyterian |
| Subspecialty (P) |
Children's Hospital of Pittsburgh |
| International Health (P) |
Fort Defiance, AZ or other |
| Inpatient Ward (P) |
Children's Hospital of Pittsburgh |
| Emergency Department (M) |
UPMC Presbyterian |
| Elective (M) |
UPMC Shadyside or UPMC Presbyterian |
| Elective (M) |
UPMC Shadyside or UPMC Presbyterian |
| Vacation 3 Weeks |
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Another important and popular month in the fourth year may be spent away from UPMC at the Indian Health Service Hospital at Ft. Defiance, Arizona or at another underserved or international site. At Ft. Defiance, excellent practitioners supervise residents in a different medical arena and with patients of another culture. Limited "high-tech" resources teach the trainee about appropriate use of services and referral to tertiary centers. A tour of the American Southwest is an added bonus of this rotation. The resident may also choose to design an elective in another location. Further elective subspecialty experiences complete the year.
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