Medical College of Wisconsin Medicine Residency Program Subspecialties

Clinical experience in allergic and immunologic disease is provided in clinics at the Children's Wisconsin Office Building or the VA Medical Center where more than 11,000 patient visits occur each year. Along with the outpatient service, an inpatient consultation service is available at all affiliated hospitals. Housestaff and fellows are provided an educational experience with adult and pediatric patients with immunologic respiratory disease, including asthma, occupational asthma, hypersensitivity pneumonitis, allergic aspergillosis and rhinitis, as well as other diseases of immune mechanisms, such as urticaria, serum sickness and food and drug reactions.

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Medical residents assigned to the various cardiology services—including outpatient clinics, inpatient general cardiovascular wards and the cardiovascular intensive care unit--play an integral role in these services at both Froedtert Hospital and the VA Medical Center. Housestaff develop advanced skills in the evaluation and management of patients with acute coronary syndrome, decompensated heart failure, arrhythmias, pericardial disease and congenital heart defects. All residents have the opportunity to work with patients with mechanical assist devices, temporary and permanent pacemakers and those requiring electrical cardioversion. Experiences in electrophysiology, advanced heart failure, and cardiac imaging can be orchestrated for senior residents interested in pursuing a cardiovascular fellowship.

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The principal objective of the endocrinology rotation is to provide residents with the opportunities necessary to develop knowledge regarding a wide variety of endocrine abnormalities in both the inpatient and outpatient settings. Housestaff generally spend their mornings in the outpatient clinic and afternoons are primarily spent rounding on the inpatient consult service at either Froedtert Hospital or the VA Medical Center. An option to spend a week with the inpatient Diabetes Management Service is available to all. In addition, residents attend three popular weekly endocrine conferences, including a case conference, a journal club and a board review session.

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Residents may elect to rotate on the GI and Hepatology consult service during any of their three years of training. In addition to seeing hospitalized patients in consultation, all residents participate in two half-day outpatient clinics per week and are encouraged to observe procedures in the advanced endoscopy suites. The overall goal of the experience is to prepare each resident to be able to handle the most common gastrointestinal problems likely to be encountered by general internists, and to expose them to a sample of the diversity and breadth of gastrointestinal and hepatology problems for which a gastroenterologist or hepatologist may be consulted. Experiences in IBD and hepatology can be orchestrated for senior residents interested in pursuing a gastroenterology fellowship.

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The Division of General Internal Medicine is the largest and most clinically diverse program in the Department of Medicine, with hospital-based clinics and community outreach clinics. The majority of the staffing on the general medicine wards at Froedtert Hospital and the VA Medical Center is done by GIM staff. There are also affiliated general medical services at St. Joseph Hospital, a private community hospital nearby. The principal objective of GIM rotations is to provide residents with the comprehensive preparation in general internal necessary to function effectively as a strong primary care physician or medical subspecialist.

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The Division of Geriatrics-Gerontology provides clinical service and instruction at Froedtert Hospital, the VA Medical Center, and off campus affiliates. Through combined programs of closely supervised clinical care and formal didactic teaching, housestaff learn the important principles involved in caring for the elderly. All residents gain value experience while working on the Geriatrics Evaluation and Management team at the VA Medical center during either the PGY-2 or PGY-3 years and many elect to spend time in geriatric outpatient clinics. A geriatric core curriculum, including journal clubs and multiple conferences, round out the educational experience

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Residents at MCW have a broad range of Hematology/Oncology rotations to select from, including ambulatory clinics, inpatient consult services, inpatient wards and the bone marrow transplant unit. These opportunities are available at both Froedtert Hospital and the VA Medical Center. Under the supervision of hematology and oncology attendings and fellows, residents develop expertise in interpreting peripheral blood smears, participate in the evaluation, diagnosis and management of blood disorders and a wide array of malignancies, and provide direct patient care to individuals with oncologic emergencies. All residents are invited to partake in the multiple educational conferences offered by the Division of Hematology/Oncology, including case conferences, journal clubs, and tumor board.

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Most housestaff elect to spend at least a month during their residency on the Infectious Disease service, where the overall goal is to prepare residents to be able to handle the most common infectious problems encountered by general interests, but also to expose them to a sample of the breadth of infectious diseases problems for which an infectious diseases specialist may be consulted. Residents may take the infectious disease consult rotation at either Froedtert Hospital or the VA Medical Center, and they spend at least one half day per week in outpatient ID clinics, including the very busy HIV/AIDs clinics affiliated with the Medical College of Wisconsin. Additional teaching activities include weekly journal clubs and case conferences, as well as other formal conferences at Froedtert Hospital, the VA Medical Center, Children's Wisconsin, and Froedtert West Bend Hospital. Experiences in Transplant ID can be orchestrated for senior residents interested in pursuing a ID fellowship.

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Residents rotating with the Division of Nephrology participate in the primary care of kidney transplant recipients, as well as consultative services provided to clinical and hospitalized patients with a wide variety of renal disorders at both Froedtert Hospital and the VA Medical Center. Residents develop great skill in caring for patients receiving all forms of renal replacement, including continuous veno-venous hemofiltration in intensive care units, chronic hemodialysis and peritoneal dialysis, as well as patients with both acute and chronic kidney disease not requiring dialysis. Residents on the Nephrology consult service are expected to attend weekly case conferences, grand rounds and research conferences, as well as the monthly biopsy conference.

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Residents at MCW typically spend at least three months rotating through the intensive care units at Froedtert Hospital and the VA Medical Center. These opportunities allow the housestaff to acquire knowledge and skills necessary to care for critically ill patients as part of a multidisciplinary team. Residents develop the ability to understand, initiate and provide essential organ support therapy including respiratory and circulatory support within our tertiary care facility. In addition, they become proficient with most common ICU procedures, such as central venous catheter insertion, arterial line placement, endotracheal intubation, paracentesis and thoracentesis.

The subspecialty consult rotation of pulmonary medicine 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 tests, blood gas analyses, and sleep studies. In addition, 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, sarcoidosis, and pulmonary fibrosis.

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The principal objective of the Rheumatology elective is to facilitate a resident’s ability to recognize and understand the pathogenesis and treatment strategies for common rheumatologic disorders including degenerative joint disease, soft tissue disorders, inflammatory arthridities, and systemic rheumatologic diseases such as vasculitis and sarcoidosis. Residents on the Rheumatology service have two primary settings for clinical encounters, including the outpatient clinic arena and inpatient consultations. Time is divided equally between the inpatient and outpatient experiences. Housestaff are presented with ample opportunities to perform joint injections and aspirations. Clinical experiences are supplemented with a wide array of valuable educational conferences, including the weekly Radiology Imaging of Rheumatologic Diseases conference, journal clubs, and clinical case conference, as well as a monthly research conference.

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