Housestaff first observe, then assist in upper and lower gastrointestinal endoscopic and various biopsy procedures. Fiberoptic proctosigmoidoscopy is taught to each resident during their rotation through GI. The housestaff meets daily with a senior fellow and consult staff to discuss consult case follow-ups. Housestaff each give a brief seminar at the end of their rotation.
Residents gain experience while working on a VA geriatric evaluation unit and in geriatric outpatient clinics. A geriatric core curriculum, a journal club, and series of conferences round out the educational experience.
A multi-disciplinary geriatric evaluation clinic is operated at FMLH and provides an office based experience. Specialty clinics in dementia management, urinary incontinence, and geropsychiatry are also available at FMLH for residents to obtain a more in depth exposure to common geriatric syndromes.
Infectious Disease
Resident rotations through the Division of Infectious Disease are one month long. The resident's primary responsibility is to see hospitalized patients in consultation and to discuss them during the daily staff rounds. Teaching activities include formal conferences at FMLH, VAMC, Children's Hospital, and St. Joeseph Hospital. A journal club and case conferences are held regularly under faculty direction.
Clinical studies and outpatient experience with patients with AIDS and HIV infection also are available.
Neoplastic Diseases
The Division of Neoplastic Diseases is a coordinated program in the study of both hematologic and oncologic diseases. Residents participating in this elective are assigned to inpatient ward rotations and consult services at both FMLH and VAMC.
Call for these residents is rotated with other housestaff assigned to these services. Residents assigned to the respective consultation services will attend consultation rounds five days per week. Patients will be evaluated by residents prior to consultation with the attending physician; expertise will be developed in interpreting peripheral blood smears, appropriate evaluation of anemias, cytopenias, performance of bone marrow aspirations and biopsies, and the principles of chemotherapy.
Attendance is expected at hospital Tumor Boards, bone marrow rounds and division teaching conferences.
Nephrology
Residents rotating with the Division of Nephrology participate in the care of inpatients and outpatients and provide consultation for inpatients on other services. The nephrology division provides a comprehensive range of hospital and ambulatory services to patients, with all types of kidney diseases, at both FMLH and VAMC.
The nephrology division based at FMLH shares a 28-bed categorical inpatient nursing unit with the Division of Transplant Surgery of the Department of Surgery. All forms of renal replacement therapy are available in the intensive care setting. Chronic hemodialysis and peritoneal dialysis, as well as training for chronic ambulatory peritoneal dialysis, are provided for patients with end stage kidney disease in a specialized facility located on the MCW campus. Clinics for patients with kidney disease, hypertension and for the follow-up of kidney graft recipients are held daily in the Nephrology/Transplant Surveillance Clinic at FMLH. Both inpatient and consultation rounds are made daily.
Pulmonary and Critical Care Medicine
The resident functions as the primary physician for patients admitted to the medical critical care units at FMLH and VAMC under the guidance of a third-year pulmonary/critical care fellow and the attending of the critical care service. Rounds in these units are followed daily by lectures on a wide variety of critical care subjects and round-the-clock coverage is provided by the Medical Critical Care Team. Educational emphasis is placed on treatment of both acute and chronic respiratory insufficiency, ventilator therapy, and hemodynamic and ventilatory monitoring.
The subspecialty rotation of pulmonary medicine consultation is available to residents at each hospital with pulmonary fellows and attendings providing supervision. The curriculum places emphasis on performance and interpretation of pulmonary function, blood gas, bronchoprovocation, exercise, and sleep studies.
During the rotation, opportunity is provided to evaluate patients in the Pulmonary and TB Clinic with the pulmonary staff. Experience is obtained in the long-term care of patients with chronic problems including bronchial asthma, chronic obstructive lung disease, lung transplants, adult cystic fibrosis, sleep apnea, tuberculosis, pneumoconioses, sarcoid, and pulmonary fibrosis.
Rheumatology
Residents participate in rheumatology clinics and perform inpatient consultation. Four clinics are held weekly, three at FMLH and one at VAMC. In addition, there are inpatient rehabilitation units at both FMLH and VAMC, utilized primarily for physical therapy and other paramedical efforts of rehabilitation. Clinical and rotation activities also occur in sports medicine and acute orthopedics.
The teaching of housestaff is enhanced with monthly multi-disciplinary conferences in orthopedics, a rheumatology journal club, interest rounds attended by the entire rheumatology staff, a biweekly research conference, and a weekly radiology conference.