Core Rotations at HUMC Internal Medicine

Medical Teaching Service / Floors

While rotating on the inpatient medical teaching service, residents will have the opportunity to learn the essentials of inpatient medicine while working on one of three teaching teams. Working in conjunction with a supervising attending physician, residents will lead a team of interns and medical students to manage patients with complex medical needs and coordinate interdisciplinary care in a hospital setting. Floor teams exist in two configurations: (a) one senior and two interns caring for 18 patients or (b) one senior and one intern caring for 14 patients. Daily teaching rounds ensure that day to day medical management is driven by evidence-based practice.

Night Float

The night float rotation is a demanding and essential aspect of training. Working in a team of one senior and one intern, residents work overnight shifts to admit new patients from the emergency room and provide care to patients who require medical attention during the night. Additionally, residents provide cross-coverage for the three teaching teams. This structure allows for the management of acute illnesses while teaching the skills needed to quickly and effectively respond to emergencies.

Intermediate Care Medicine / Step Down

The Step Down rotation provides hands-on experience working with a multidisciplinary team and managing patients with complex medical needs who require intermediate care between the ICU and the general medical floors. Common medical conditions encountered include congestive heart failure, ARDS, acute and chronic respiratory failure, diabetic ketoacidosis, gastrointestinal bleeding, etc. Residents will learn management of invasive and non-invasive ventilation and also participate in procedures such as line placements.

Intensive Care Unit (ICU)

During this rotation, residents gain crucial experience in managing critically ill patients and are challenged to develop critical thinking skills and make rapid decisions in complex and dynamic situations with the support of our critical care fellows and intensivists. Daily teaching rounds will educate residents to interpret and integrate clinical data when formulating appropriate treatment plans. They will learn to manage potential complications, handle emergencies, and participate in or lead codes. They will also provide end-of-life care for critically ill patients while developing the interpersonal and communication skills needed to hold difficult conversations with patients’ families. Additionally, there are opportunities to develop procedural skills in central venous catheter placement, arterial line placement, lumbar punctures, thoracentesis and paracentesis.

Ambulatory

With the 6 + 2 schedule, every six weeks of inpatient rotations is followed by two weeks of dedicated ambulatory medicine. This dedicated time allows residents to fully immerse themselves in the ambulatory setting while also enabling continuity of care. Residents learn to formulate and implement evidence-based treatment plans, manage chronic medical conditions, and provide preventive care, such as immunizations and health screenings.