Rotations and Clinics

During their training, residents may rotate through the following intensive care units (ICUs): the Medical Intensive Care Unit (MICU), the Coronary Care Unit (CCU) at the University of Pittsburgh Medical Center (UPMC), and the Veterans Administration Intensive Care Unit (VICU) at the Veterans Administration Medical Center (VAMC). All ICUs are closed units and have a dedicated fellow assigned to assist the housestaff teams.

MICU

The MICU is a 32-bed unit located in UPMC Presbyterian Hospital. The MICU serves as a tertiary center accepting patients from the tri-state area (western and central Pennsylvania, West Virginia, and Ohio), from other local hospitals, and from the UPMC Presbyterian emergency room. These are some of the most severely ill patients in the region, with a varying array of critical illnesses. This rotation continues to be a favorite among housestaff, allowing the residents and interns to develop technical skills in line placement and patient management. The housestaff members truly enjoy learning from our esteemed faculty as they care for critically ill patients.

Team Structure: there are four teams, each consisting of one intern and one resident. One team staffs the night float system, and each team rotates weekly as the night float team

Supervision: two pulmonary attending physicians along with two pulmonary/critical care fellows

Teaching: there are didactic teaching sessions every weekday morning in addition to the teaching that occurs on rounds

CCU

The CCU is a 10-bed unit located in UPMC Presbyterian Hospital. The resident teams get a tremendous exposure to a broad variety of cardiac problems, including arrhythmias, ST elevation myocardial infarctions (STEMIs) with and without complications, severe left- and right-sided heart failure, cardiac transplants, cardiac arrest patients undergoing our hypothermia protocol, and valvular abnormalities. All of the attending physicians are among our best clinical teachers, many with research backgrounds in areas such as invasive technology, noninvasive care, electrophysiology, heart failure, or pulmonary hypertension.

Team Structure: there are three housestaff teams, each composed of one resident and one intern. Two teams care for patients during the day and one team cares for the patients at night, with each team rotating as the night float team weekly.

Supervision: there is one attending assigned to the CCU, and there is a dedicated cardiology fellow present in the CCU throughout the day and night.

Teaching: there are didactic teaching sessions every weekday morning in addition to the teaching that occurs on rounds

VICU

The VICU is located at the nearby VA Medical Center and functions as a combined MICU and CCU. It is a closed 14 bed unit. The VA Medical Center in Pittsburgh serves both the local veterans and is a referral center for outlying, smaller VA hospitals. The residents in the VICU get experience with a variety of critical illnesses and cardiac diseases, and the autonomy the residents get while working in the VICU is a strength of the experience.

Team Structure: there are 5 residents per block. Residents will rotate through 1 week of night float. Day time residents will take overnight call every fourth day.

Supervision: one Pulmonary/Critical Care attending and one Cardiology attending, as well as a Pulmonary/Critical Care fellow.

Teaching: there are didactic sessions on critical care and cardiology topics every weekday morning in addition to the teaching that occurs on rounds

SHY MICU

The SHY MICU offers another distinct ICU experience. Because of this hospital’s connection with the University of Pittsburgh Cancer Institute and the Hillman Cancer Center, it offers residents the opportunity to care for patients with emergent hematologic/oncologic problems and critical complications.

Team Structure: There are three teams that our residents rotate between: a resident and two intern team, a two resident team and resident-intern night float team.

Supervision: A pulmonary or critical care medicine attending physician along with a pulmonary/critical care fellow

The Cardiology Pavilion is a UPMC specialty inpatient service for patients who primarily have cardiac disorders. The service covers patients with electrophysiologic problems (arrhythmias and pacemakers), congestive heart failure, valvular abnormalities, and general cardiac problems such as coronary artery disease and unstable angina.

Team Structure: There are three teams, each with one resident and one-two interns. The three teams rotate every week to cover different aspects of the service. One team (one resident and two interns) covers the traditional inpatient cardiology service and admit daily. The team census cap is 10 patients per intern. One team (one resident and one intern) is a nightfloat team, responsible for overnight admissions and crosscover at night. The third team (one resident and one intern) is the heart failure team and manages patients on the inpatient heart failure service. The team census cap is 10 patients.

Supervision: One cardiology attending and a cardiology fellow on the traditional pavilion service, and one heart failure attending and a cardiology fellow on the heart failure service.

Teaching: There are didactic teaching sessions on cardiology-specific topics every weekday morning in addition to the teaching that occurs on rounds.

The University of Pittsburgh Cancer Institute and the Division of Hematology/Oncology provide opportunities for clinical and research activities in the field of cancer at the University of Pittsburgh. UPCI is the only National Cancer Institute–designated Comprehensive Cancer Center in western Pennsylvania. UPCI works in tandem with the UPMC Cancer Centers to offer patients the latest advances in cancer prevention, detection, diagnosis, and treatment. Residents and interns rotate through the inpatient oncology floors at Shadyside Hospital. The housestaff are exposed to a wide array of hematologic/oncologic illnesses, including immune thrombocytopenia, thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, aplastic anemia, hemophilia, and cancers requiring inpatient chemotherapy. Each team also cares for patients with complications from malignancy and treatments for malignancies, patients who may benefit from palliative or hospice care, and patients with neutropenic fever and transfusion-related problems.

Team Structure: There is one team consisting of one resident and two interns. There is a hospitalist service that covers the teams’ patients and admits new patients over night.

Admission Structure:The team admits 3-4 patients every day except Sunday, with one of those admissions being a holdover from the prior night. The total census cap is 20 patients, although the census for each intern is usually 5-7 patients.

Supervision: There is one hematology/oncology attending and one hematology/oncology fellow for the team.

Teaching: There are didactic lectures specific to
hematology/oncology at noon every week day in addition to the teaching that occurs on rounds.

The Acute Leukemia Service and Stem Cell Transplant Program provide separate inpatient services that are covered by nurse practitioners and a fellow. These programs offer elective opportunities for residents interested in hematologic malignancies or stem cell transplant.

Each resident has several months available each year for electives. Our program offers numerous elective opportunities from which residents may choose. Elective months may be spent performing research, working in a particular outpatient subspecialty clinic of interest, or rounding with subspecialty consult teams. The consult teams allow housestaff to explore other fields in internal medicine and to experience the role of a medical consultant. There is no call during a consult month, and all weekends are free. Outpatient clinics in the medical subspecialties are also included as part of several consult rotations. In addition, interns have the opportunity to explore medical subspecialties through exposure electives (see below). The electives offered in 2-week blocks are designed to provide interns with a broad experience in a subspecialty, with the focus on outpatient aspects of care. The electives in 4-week blocks are designed to provide more in-depth training in an area of medicine for both interns and residents.

Exposure Electives

Residents have multiple venues in which to experience patient care in the ambulatory setting. In addition to their continuity clinics, residents rotate through the emergency department at UPMC and the VA and four ambulatory blocks during their 3 years of training. The goal of each ambulatory experience is to obtain a broader and deeper knowledge of the diagnosis and management of common problems seen in outpatient general medicine, to become familiar with “real world” office experiences as practiced in community-based general internal medicine (including aspects of billing, scheduling, and personnel management), and to apply evidence-based medicine principles as learned in the academic setting to the management of patients in a community practice.

During the ambulatory rotations, residents have experiences with community internists as well as practitioners in all medical subspecialties. There is an ambulatory care conference each week, during which various ambulatory medicine topics and evidence-based medicine concepts are reviewed. Residents rotating through the ambulatory block have opportunities to master their skills of clinical interviewing, communication, and motivational interviewing during focused communication skills training workshops.

The goal of the continuity clinic is to help residents develop the skill sets involved in providing excellent longitudinal patient care, including differential diagnosis skills, management skills, methods to prioritize management decisions, and methods to coordinate care across time and among subspecialists. In continuity clinic, residents each have a panel of patients for whom they provide care over the 3-year residency period and serve as the patients’ primary physician. Each attending physician in the continuity clinic is a general medicine clinician-educator who precepts the same residents throughout their training. This allows for continuity in patient care, mentoring, feedback, and skill development. We recognize that the skills of longitudinal care are as important for residents going into subspecialties as they are for those going into primary care.

All residents enrolled in one of the 3-year programs participate in a continuity clinic at either UPMC Montefiore, Shadyside, South Hills Clinic, or VA, with 1 full day of clinic per week every other month during elective and ambulatory months. Each resident serves as the sole primary care physician for his or her own panel of patients under the supervision of a teaching attending. A well-trained ancillary staff helps the resident manage complex medical problems, make referrals, follow up on laboratory and other studies, and respond to patient phone calls. A housestaff call system is in place for after-hours phone coverage to closely simulate “real world” patient care. Clinics with an emphasis on women’s health and geriatrics are available as part of the individual training tracks. A half-hour pre-clinic conference is held each week to review important topics encountered in outpatient medicine.