Rotations

In each of the training tracks, educational development follows a similar course. However, differences do exist between tracks. Distinguishing features of each track, plus more program highlights, are outlined below:

Internship is an exciting time in which you begin to apply things learned in medical school while simultaneously developing entirely new sets of skills. In the outpatient continuity clinic and on the wards, the intern is the patient's primary physician. This affords an opportunity for you to learn medicine in a hands-on manner through work done in a variety of settings. As the patient's primary physician, the intern has the most in-depth knowledge of the patient and is most closely involved in delivering the high quality of care for which UVA is known.

Categorical Track Rotations

• 9 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, Acute Cardiology, Neurology, 1-2 months Digestive Health, 1-2 months Hematology-Oncology, and 2 months General Medicine wards
• 3 Outpatient/Ambulatory: Emergency Department, Geriatrics, and an outpatient month at an elective of choice based on availability

Primary Care Track Rotations

• 8 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, Acute Cardiology, Digestive Health, Hematology-Oncology, Neurology, and 2 months General Medicine wards
• 4 Outpatient/Ambulatory: Rotations are typically spent at a UVA General Medicine community practice clinic, the Emergency Department, Geriatrics, and an additional month at Student Health Internal Medicine or Gynecology clinic, or the Primary Care Gynecology clinic.

Preliminary Track Rotations

• 7 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, 2 months General Medicine wards, Hematology-Oncology, Digestive Health, Neurology
• 5 Outpatient/Ambulatory: Emergency Department, General Medicine consults, and 3 elective months tailored to each intern's career interests

Upper level residents are expected to function as leaders of the care team. Second-years see all admissions to the team, participate significantly in inpatient clinical teaching for the interns and medical students, and serve as an advocate for patients' longitudinal care, helping the team to coordinate care with outpatient providers. Residents frequently assume primary care responsibility for patients who lack an identified community physician, thereby optimizing the continuity of care experience.

On inpatient and ambulatory subspecialty services, you receive training from fellows and subspecialty attendings who serve as primary attendings rather than consultants as in many hospital systems. These interactions, and experiences gained through your own teaching role aid you in clarifying direction for your future career. A Career Development series runs throughout the academic year to assist those applying to fellowship during their second year.

Categorical Track Rotations

• 6 Inpatient: generally 2 months General Medicine, 1 month Medical Intensive Care, and 3 other ward months (Digestive Health, Acute Cardiology, Hematology-Oncology, and/or Coronary Care Unit)
• 6 Elective: generally a mixture of inpatient consult and subspecialty clinics. A one-month community primary care rotation at one of our UVA affiliated clinics (Charlottesville or rural areas) is required. It is also possible to do community practice, rural health, Navajo, international health, and research rotations.

Primary Care Track Rotations

• 5 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Medical Intensive Care, Hematology-Oncology, and Coronary Care Unit
• 7 Outpatient/Elective:
  - 2 consecutive months at Orange Primary Care clinic about 30 minutes north of Charlottesville. This very popular rotation offers great exposure to acute care in a semi-rural primary care practice and lots of opportunity for bedside procedures.
  - 5 months Electives generally divided between inpatient consult services and outpatient specialty clinics. It is also possible to do community practice, rural health, Navajo, international health, and research rotations.

Third-year residents set the tempo for the educational excellence that is a defining characteristic of our program. Many take on important extracurricular activities that contribute to the constant evolution necessary to maintain a progressive academic medicine program. Some recent examples: publication of a comprehensive intern/ward medicine survival guide and pocket reference; lunch time lectures for new interns on clinical approach to common cross-cover issues; aiding in the "Clinical Teaching Workshop" symposium for rising second year residents; and helping to design and implement a longitudinal career development series to assist residents in pursuing a career after residency.

Categorical Track Rotations

• 5 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Hematology-Oncology, Medical Intensive Care Unit, and Coronary Care Unit
• 7 Electives: Ideal time to do rotations internationally or at our affiliated Indian Health Service sites in Arizona. Most residents do a research month during this time.

Primary Care Track Rotations

• 4 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Medical Intensive Care, Hematology-Oncology, and Coronary Care Unit
• 7 Electives: Ideal time to do rotations internationally or at our affiliated Indian Health Service site in Arizona. Most residents do a research month during this time.
• 1 Rural Health: at Central Virginia Community Health Center, a nationally recognized health center staffed by UVA Faculty serving the rural poor of neighboring Buckingham county.

Clinical components that are common to the Categorical, Primary Care, and Fast Track curricula include:

• A 3-year outpatient continuity experience in University Medical Associates, our nationally recognized faculty-resident practice. All residents work together in an outpatient firm system with a dedicated firm attending.
  
• Ambulatory electives in all outpatient internal medicine subspecialties, sports medicine, orthopedics, dermatology, adolescent medicine/student health, women’s health, ophthalmology, palliative care, health policy, and the Charlottesville Free Clinic.
  
• Ample opportunities for national and international rotations, with established rotations on the Eastern Shore of Virginia, the Navajo Reservation in Arizona, Latin America, and Africa.
  
• A comprehensive 3-year ambulatory curriculum, covering core primary care clinical topics, systems- and practice-based learning, advanced physical diagnosis, advanced interviewing skills, and office procedures.
  
• Opportunities to conduct research projects under the mentorship of nationally recognized general internists and geriatricians. Areas of expertise include medical errors and patient safety, cancer screening, care of the underserved, chronic illness care, geriatrics, and palliative care.

These areas are described more fully below:

Continuity Clinic

Housestaff in the Categorical and Primary Care Tracks provide comprehensive, ongoing care to a panel of primary care patients in our university-based general medicine clinic, University Medical Associates (UMA). The clinic resides in a newly renovated and dedicated space with computers in each exam room and an electronic prescribing system. Interns have clinic one half-day per week and residents see patients one half-day per week when on inpatient rotations and twice per week when on elective rotations.

The Firm System: Housestaff are assigned at the beginning of the PGY-1 year to an outpatient "firm" at UMA. This consists of a General Internal Medicine faculty mentor/firm director, a firm nurse, and approximately six residents who follow their patients over the span of their three-year residency. This team approach yields optimal patient care while facilitating the development of a mentoring relationship with a primary care faculty role model. With a base of 8,000 patients and 25,000 annual visits, diverse opportunities are provided for long-term patient management and continuity of care. Clinics do not occur on call days or post-call days.

Primary care at UMA also involves an array of health care resources including full-time clinical pharmacists, nurse practitioners, diabetes educators, a respiratory therapist, a nutritionist and a social worker. A daily outpatient morning report and longitudinal primary care curriculum are integrated into the UMA training experience. Practice Management sessions involving such issues as quality improvement, billing, and "practice profiling" are a core component of the UMA experience.

Home Visit Program

As part of training at UMA, interns and residents participate in an innovative home visit program in which they visit their patients at their place of residence in conjunction with their firm team. This highly popular program affords an opportunity to examine patients' quality-of-life factors in a way not possible in the ward or clinic setting.

Ambulatory Curriculum

Our faculty has developed an innovative, graduated program in systems-based practice, practice-based learning, communication and professionalism competencies. Over the three years, in the fall and spring elective periods, residents participate in two dozen interactive seminars and projects to acquire and practice these new skills under the direction of selected general medicine faculty. Teaching examples come from residents' daily practice in the acute and chronic illness settings and methods include simulations, chart audits, video clips, role plays and group projects. Residents develop learning portfolios to chart their progress. This curriculum reflects the values, interests and roles of general and subspecialty internal medicine physicians whether in practice or academia.

Special Ambulatory Electives

Migrant Health Eastern Shore: This one-month rotation on the rural eastern shore of Virginia offers an opportunity to provide primary care to a rural underserved cross-cultural population of local residents and migrant farm workers – working in the clinic, on the migrant farm worker camps and on the tiny island of Tangier (reached by boat or small plane). This is a rich environment for learning about public health and cross-cultural/international health.

Indian Health Service: A one-month rotation at one of our affiliated Navajo Reservation sites offers an opportunity to provide primary care to underserved Native Americans and to learn the tenets of cross-cultural medicine and population-based health. Residents are supervised by a UVA Internal Medicine program graduate.

International: Residents have been supported in overseas rotations in Kenya, Uganda, Saipan, Brazil and India and are encouraged to develop unique experiences that help them meet their goals for future practice and enhance cross cultural training in the residency program.

Subspecialty Electives

Residents gain excellent clinical training in all Internal Medicine subspecialties during elective rotations that are mainly at our University-based specialty clinics. Supervision is by nationally respected faculty who evaluate patients presenting from a wide referral base and with common and rare illnesses. Community-based subspecialty sites are also available for those interested in exposure to nontertiary care settings. Elective rotations are also available in Dermatology, Sports Medicine, Musculoskeletal Disorders, Radiology, Toxicology and other subspecialties.

Advisory Support System

Intern Support Groups: The first year of residency training can be stressful for even the most prepared house officer. Small groups run by members of the General Medical Faculty meet beginning early in September to discuss the rigors, frustrations and fears inherent in the life of an intern. Sharing with housestaff and faculty − all of whom have had similar feelings and experiences − aids in establishing bonds between residents and makes an otherwise rigorous year a learning experience among colleagues.

Committee on Residency Education (CORE):  Department faculty have a major interest in housestaff development and education. The CORE supervisory board includes the Program Director, six to eight key Clinical Faculty, the Chief Residents, and an additional resident representative. CORE faculty members are assigned incoming housestaff and serve as their mentor and advisor. This relationship is solely advisory in nature allowing residents to openly discuss all aspects of training and career planning with their assigned CORE advisor. This 1:1 relationship continues through all years of training and fosters a smooth transition from medical school to residency and then on to a fellowship or career practice.

Core faculty members also facilitate assignment of faculty subspecialty and research mentors to assist housestaff in meeting their career and educational goals.

Annual Resident Retreat

Each year, all the department interns and residents leave the hospital for a day for an educational retreat. (Clinical services are covered by IM fellows and faculty). In the setting of local camps or lodges, housestaff and CORE members discuss the program and identify strengths and weaknesses, as well as suggestions for improvement. Team building challenges like ropes courses provide a fun way to evaluate the Department's goals.