Our PGY1 year is very balanced, designed to expose our Med-Peds residents to the basic inpatient and ambulatory experiences that they will be building on during their residencies. It is structured into 13 four-week blocks. Our interns will rotate through the inpatient wards, emergencies rooms, and clinics on both the Internal Medicine and Pediatric sides as well as the Newborn Nursery and NICU.
1, An early and timely Categorical Switch – Our interns will switch between Internal Medicine and Pediatric specialties immediately after Period 1 so as to get early exposure in both disciplines, buffering the often stressful categorical side switch later in the year. They bond with their categorical interns, residents and attendings and also learn the clear logistical differences on each side. After this early categorical switch, residents then switch categorical sides every 3 months
2. *New* Med-Peds ambulatory month aka Community and Transitional Med-Peds (CTMP). In an effort to bolster our ambulatory training and demonstrate the vast Med-Peds career opportunities available, this rotation was created! See the summary below.
3. At least 4 Ambulatory rotations (in our 13 block schedule) – This is welcome change of pace from many other Med-Peds programs with 10 or more inpatient months during the first year. (It can vary between 4-5 ambulatory rotations due to our odd number of blocks)
4. More Adult ICU experience due to open intensive care unit in internal medicine. Our Medicine Teaching Service ward teams often care for patients in the critical care unit in addition to the general medical floor patients. The open ICU policy affords our residents more opportunities to manage more severely ill patients as well as more procedural opportunities.
*New* Med-Peds Ambulatory (2015) – The Med-Peds Ambulatory rotation also known as the Community and Transitional Med-Peds (CTMP) rotation will provide our incoming interns the opportunity to meet and work with Med-Peds practitioners in a variety of settings in the Greenville community. The goals of this rotation are to enable our residents to experience the care of adults and children together in a variety of acute, primary, and specialty care settings, to learn about effective transition of care from pediatric to adult settings, and to meet potential mentors and role models in Med-Peds. This rotation incorporates experiences with Med-Peds faculty at three different Med-Peds practices in our community, urgent care with our MD360 program, as well as subspecialty Med-Peds experiences. In addition, month long electives at any of these practices are available for our upper level residents interested in primary care Med-Peds.
Pediatric Hematology/Oncology – During this rotation, our residents work directly with our Pediatric Hem/Onc physicians to see patients in the Pediatric Hem/Onc clinic and also help with inpatient services and consults. The experience accrued during this rotation help our interns during their PGY2 Hematology/Oncology nights rotation.
Pediatric Wards – While on the Pediatric Wards, interns generally care for 10 patients with a supervising upper level resident. They will see a diverse array of inpatient pediatric pathology from the more common, bread-and-butter cases (asthma exacerbation, acute gastroenteritis) and will be exposed to more rare diseases especially considering the close proximity of the Greenwood Genetic center. Each resident-intern team takes overnight call 7 times during the rotation and has two full weekends off (“golden weekends”). Interns will also help cover the Newborn Nursery overnight. They do not attend high risk deliveries as this is the role of the NICU resident. They also will help with “Mommy call,” a phone triage service from the Pediatric ambulatory clinic, answering more difficult questions that the triage nurses cannot answer.
Ambulatory Pediatric Clinic – Interns will work at the Center for Pediatric Medicine (CPM) and Rapid Access Pediatrics (RAP) during their Pediatric Clinic month, both located directly across the street from the main Greenville Memorial Hospital. They will see children for both well-child care and for acute illnesses. An intern will see 10-14 patients each day. They will be required to see patients in our night clinic at the RAP clinic 3-4 times each rotation (6pm-approximately 8pm). Interns will be asked to help with “Mommy call,” a phone triage service from the Pediatric ambulatory clinic as well. Interns and residents will take advantage of the clinic’s amazing patient-care resources: numerous interpreters, social workers, lactation consultants, referral coordinators, triage nurses, and asthma educators.
Newborn Nursery – On the newborn nursery rotation, interns master the newborn examination and learn about the management of common newborn problems such as jaundice, maternal drug exposure and withdrawal, and lactation difficulties. Interns will learn how to give thorough anticipatory guidance counseling and to perform circumcisions prior to discharge. There are usually 2-3 residents in the NBN each month taking care of an average of 25 patients each day. There is no overnight call. Interns will be asked to help with “Mommy call,” a phone triage service from the Pediatric ambulatory clinic.
Neonatal Intensive Care Unit (NICU) – On their NICU rotation, the interns will learn about the stark differences and similarities of neonatal critical care as compared to the Pediatric and Medical Intensive Care. They will see approximately 8-10 infants with wide range of pathology such as extreme prematurity, respiratory distress syndrome, hypoglycemia, sepsis, potentially genetic abnormalities, hypoxic-ischemic encephalopathy, possibly gastroschisis or omphalocele. They will learn evidence-based guidelines of preventative care in prematurity (cranial ultrasounds, eye exams, fortified formula, etc), review the nutritional differences and requirements for premature infants from certified nutritionists that round with the team and attend high risk deliveries and participate in neonatal resuscitation.
Pediatric Emergency Room – While working in a busy pediatric ER rotation, they will care for a wide range of pediatric acute care illnesses such as acute asthma exacerbations, concussions, and acute gastroenteritis and participate in the acute stabilization of pediatric patients who are brought to our trauma bay. During 15 twelve hour shifts, they are also able to perform a wide variety of procedures including lumbar punctures, intubations, incision and drainages and laceration repair.
Medical Teaching Service (MTS) – There are three Medical Teaching Service ward teams, one staffed by Infectious Disease attendings and two that are staffed by the GHS Hospitalists. Each team consists of two senior residents and two interns. Alternating every four days, one of the senior residents completes a 6pm overnight admitting shift with a separate nightshift intern (not on your team). Each intern is generally responsible for 5-10 general medicine patients including both floor and non-ventilated ICU patients. We are responsible for admitting and caring for all our Internal Medicine clinic patients. Since we have an “open” ICU, interns will accrue plenty of experience caring for the critically ill patients in the ICU during their two Internal Medicine wards months and Pulmonary Teaching Service months. The intern is also responsible for returning triage phone calls from the Internal Medicine clinic overnight.
Pulmonary Teaching Service (PTS) – PTS is an admitting and consult service for all hospitalized patients attended by GHS Pulmonary Disease Associates (PDA) Pulmonary/Critical Care attendings. The teams consist of 1-2 senior residents and 4 PTS interns and the senior resident(s) will coordinate rounds and help triage admissions (of PDA patients exclusively) and consults between 2-3 daytime interns. The nightshift intern will rotate every week. Interns will focus on the management of mainly specific pulmonary problems such as acute respiratory failure, COPD exacerbation, community acquired pneumonia, lung nodules, lung cancer, pleural effusions, and, in the process, learn about basic ventilator management. They will also be consulted for specific interventions such a thoracentesis for a large pleural effusion and a bronchoscopy for mucus plugging. They will have the opportunity to complete procedures such as thoracenteses, intubations, and central line placements. Interns will also work closely with the Critical Care upper levels overnight to help triage overnight admissions and consults.
Adult Emergency – During our emergency medicine rotation, interns primarily work in the adult Critical Care Emergency Room (CCER) where they triage, stabilize and treat a wide variety of patients. They will also spend some time in the Intermediate Care Unit and Chest Pain center unit. They will also have the ability to perform an array of procedures such has intubations, central line and peripheral line placements, and arterial blood gases.
Ambulatory Internal Medicine Clinic – Interns on our ambulatory medicine rotation will work primarily at the Medicine Center Clinics seeing patients at longitudinal continuity appointments and episodic triage visits. They will also gain amazing experience by rotating through a myriad of specialty clinics supervised by subspecialists such as the Congestive Heart Failure clinic, Cardiology Teaching Service clinic, Nephrology clinic, GI clinic, Hepatitis C clinic, Pulmonary/Sleep clinic, Ophthalmology clinic, Psychiatry clinic, Neurology clinic and Pain Management clinic. There will also be a regular clinic didactic series in the morning or at lunch. Residents are encouraged to perform one scholar project whether it be completing specific clinic online modules or a quality improvement project.
Geriatrics – On the Geriatric rotation, interns will spend most of their time at a Geriatric outpatient healthcare center (The Cascades, The Cottages or Laurel Baye) and participate in the care for a wide array of Geriatric patients in acute rehabilitation and long-term care settings. They will perform the initial comprehensive assessment of many new patients.