Curriculum & Schedule

Rotations

There are 13 four-week rotations per year as outlined below. Rotation descriptions and electives are listed below as well.  There are no rotations that require "long or overnight call."  All shifts for all rotations are 12 hours or less in length for all PG years.

First Year

RotationDurationOvernight Shifts
General Medicine Inpatient 5 rotations 5 #
Cardiology 1 rotation # 
Pulmonary-ICU 1 rotation #
Continuity Clinic 2 weeks N/A
Research/Quality Improvement 1 rotation N/A
Subspecialties* 2-3 rotations N/A
Electives 1-2 rotations N/A
Vacation & Conference Time** 4 weeks N/A

The average hours per week worked (including conferences) for PGY-1's is 50-60.

Second Year

RotationDurationOvernight Shifts
General Medicine Inpatient 2 rotations N/A
Hospitalist Medicine 2 rotations N/A
Cardiology 1 rotation 5-6
Pulmonary - ICU 1 rotation 5-6
Night Float 1 rotation N/A
Emergency Medicine 1 rotation N/A
Geriatrics/Palliative Care 2 weeks N/A
Ambulatory Care 6 weeks N/A
Subspecialties* 2-3 rotations N/A
Electives/Non-Medicine Subspecialties 1-2 rotations N/A
Vacation & Conference Time ** 4 weeks N/A

Third Year

RotationDurationOvernight Shifts
General Medicine Inpatient 2 rotations N/A
Hospitalist Medicine 1 rotation N/A
Night Float 1 rotation N/A
Cardiology 1 rotation 5-6
Pulmonary-ICU 1 rotation 5-6
Subspecialties* 3-4 rotations N/A
Electives/Non-Medicine Subspecialties 3-4 rotations N/A
Vacation & Conference Time ** 4 weeks N/A

*Subspecialties are Endocrinology, Gastroenterology, Hematology, Oncology, Infectious Disease, Nephrology, Neurology and Rheumatology

** Vacation and conference time may be taken during any rotation except General Medicine, Cardiology, and Pulmonary-ICU. A maximum of one week of vacation or conference time per rotation is allowed. Two consecutive weeks may be taken by taking vacation the last week of one rotation and the first week of the subsequent rotation. For more information, check out Benefits.

# Night shift will not be required for all PGY2s. Only three general medicine rotations will be required if given a night float assignment.

All of our rotations stay well within the ACGME 80 hour work week guideline.

Rotation Descriptions

General Medicine Wards 

This rotation consists of four weeks of inpatient internal medicine.  Each of the teams is staffed by one attending physician. Services average a census of 10-12 patients. Each week of internal medicine service consists of six days of short call, with admissions ending at 4 p.m. on week days and 1 p.m. on weekend days and one day of long call ending at 7 p.m.  A night team (two residents and a hospitalist) cover the nights. A team can expect 2-3 admissions on a typical day. Each service team is composed of a second or third-year resident, three first-year internal medicine or transitional residents and one or two medical students. Two of the three interns on each GM teaching team will do a brief "night float" stint during the rotation. This will consist of five nights in a row (Sunday-Thursday, 7:30 p.m. to 7:00 a.m.) during which they will be responsible for up to 3-4 new admissions. All patients will be turned over in the morning to the day-time general medicine teams. Consultations are obtained as needed with other specialties. First-year residents have complete charge of the patients they evaluate. There are no "private patients." When a patient is admitted, the team has full decision-making capabilities. 

Cardiology

As a tertiary care center, the medical center has the full range of cardiology experience under the supervision of board-certified cardiologists, including state-of-the-art diagnostics, an active open heart surgery program and aggressive interventional cardiology. The cardiology service averages a census of 8-10, including many with acute myocardial infarction and its complications. Teams consist of three residents and a medical student. All three residents on this rotation will do five nights of "night float" coverage during which they will care for patients on the service, plus admit new patients.  Night float coverage will be Monday-Thursday and Saturday nights, all within the same week.  

Pulmonary/ICU 

Residents gain experience in intubation, ventilator management, central line and arterial line placement, and interpretation of pulmonary function tests. The ICU averages 8-10 patients per day. Pulmonary teaching conferences are held each weekday. Teams consist of three residents and a medical student. All three residents on this rotation will do five nights of "night float" coverage during which they will care for ICU patients on the service, plus admit new patients. Night float coverage for the ICU will be Monday-Wednesday, as well as Friday-Saturday nights all within the same week.

Hospitalist Medicine

During this rotation, senior residents have the opportunity to work outside the traditional teaching service model, alongside practicing hospitalists. Residents work on an independent daytime admitting service under the supervision of hospitalist staff. In addition, residents will work with utilization review and billing to enhance understanding of the economic side of medicine. Residents will also have responsibilities in Emergency Room/Hospital triage and didactic sessions on Quality Improvement and medical information technology.

Night Float

This is a rotation in which the focus is on treating acute medical issues that arise in the hospital. Residents cover the hospitalized patients of the GM teams, under the supervision of the in-house hospitalist. In addition, the senior resident supervises the night medicine intern and admits patients as able.  

Research/Evidence-Based Medicine/Quality Improvement 

This rotation gives the resident a broad based overview of the research process and will provide a framework for the ACGME required research project. Each resident will submit at least one paper for publication prior to graduation and the rotation is set up to facilitate that goal. The resident will meet with a biostatician to review clinical epidemiological concepts, diagnostic testing and study design. This individual will assist in hypothesis development, data collection methods and general analysis techniques for the resident's research project. A librarian provides didactic education and support by teaching upper level database searching techniques. The evidence-based medicine component of the rotation covers the different levels of evidence and its usefulness in making clinical decisions, how to ask appropriate questions and some of the statistical methods used to evaluate evidence in the medical literature for use at the bedside (odds ratios, positive and negative likelihood ratios, number needed to treat, etc.). The quality improvement component includes formal instruction regarding the principles, objectives and processes of quality assessment as well as learning support systems in place to perform quality improvement work within Gundersen. Didactic and hands on experience with research work in progress at Gundersen is a second component of this rotation. It is felt that this educational experience greatly enhances internal medicine resident's experiences in that it provides a multidisciplinary approach to problem solving. 

Ambulatory 

During the second and third year, residents see patients at the University of Wisconsin-La Crosse Student Health Service and at an ambulatory women’s health clinic. Additionally during this eight-week ambulatory block, residents see indigent patients at the St. Clare Health Mission two evenings a week.

Emergency Medicine

The one month rotation in Emergency Medicine allows residents to see the acute presentation of common and uncommon diseases. Residents receive plenty of hands-on experience and are afforded the opportunity to fly on our MedLink Air helicopter on transport and rescue missions. One-on-one staff to resident teaching is the norm.

Endocrinology

This busy consultative service includes evaluation and treatment of common endocrine disorders and unusual and complex endocrine problems. The service, averaging four to six patients per day, includes endocrine grand rounds weekly, an outpatient endocrine clinic three times weekly, a weekly intensive diabetes treatment clinic and high-risk obstetric clinic for women with diabetes.

Gastroenterology

Working one-on-one with a staff gastroenterologist in the hospital and clinic, the resident is exposed to a wide variety of GI problems. This is primarily a consultation service.

Hematology

Residents are exposed to a wide variety of inpatient and outpatient hematologic problems on this consultative service. Working one-on-one with the staff hematologist, they become proficient in interpreting peripheral smears and bone marrow biopsies. This is a consultation service.

Infectious Disease

The Infectious Disease (ID) services average 8-12 hospitalized patients with 12-15 new consults a week. Patients with ID problems include those with immunosuppressive states (including a small number of patients with AIDS), complications of diabetes, orthopedic surgery, neurosurgery, other surgical infections and pediatric infections. The patients include community-acquired infections, nursing home infections and nosocomial infections. Outpatient infectious cases and travel medicine are also seen. There is a weekly infectious disease teaching conference. Residents have the opportunity to review clinical microbiology both in the lab and in didactic lectures. If interested, there is a quarterly ID journal club, a monthly infection control committee meeting and ID research projects.

Nephrology

The hospital’s hemodialysis outpatient clinic sees 50 patients a week, offering opportunities to monitor patients in chronic renal failure and manage problems occurring during hemodialysis. Clinic nephrologists also provide consultation to the hospital’s satellite unit centers in four area communities. The inpatient service averages three to four consultations a day. Teaching sessions are held several times a week at the end of rounds. The resident on rotation also sees nephrology patients twice a week in the afternoon in the clinic during their four-week rotation.

Neurology

Residents gain experience in performing and understanding the neurological examination, understanding indications for diagnostic techniques and learning to use and interpret MRI, EEG, EMG and CNS-CT scans. The daily census is six to eight patients. 

Oncology

Residents learn to stage patients and become involved in research protocols and traditional modes of treatment for common and uncommon forms of cancer through this consultative service. Emotional needs of patients and families and palliative care, including pain medication, are emphasized.

Palliative Care

During the geriatrics rotation, residents learn about community resources for the elderly. There are several didactic lectures covering a broad range of geriatric topics. Residents have daily interaction with our palliative care pain management team and provide care to hospice and home-bound palliative care patients.

Rheumatology

The emphasis is on common out-patient rheumatologic conditions. Residents see one new patient daily, along with follow-up appointments and inpatient consults. Objectives include mastery of the musculoskeletal exam and joint aspiration/injection techniques. The education program includes one-on-one teaching, and a self-study program.

Elective Rotations

  • Allergy
  • Cardiotesting/ Treadmill Testing
  • Endocrinology
  • Gynecology (office)
  • Infectious Disease
  • Neurology
  • Oncology
  • Otolaryngology
  • Pathology
  • Plastic Surgery
  • Radiation Oncology
  • Rheumatology
  • Vascular Medicine
  • Anesthesia
  • CHF Clinic
  • Gastroenterology
  • Hematology
  • Nephrology
  • Neurosurgery
  • Ophthalmology
  • Pacemaker Clinic
  • Pediatrics
  • Podiatry
  • Radiology
  • Sports Medicine
  • Outside Rotation
  • Behavioral Medicine
  • Dermatology
  • General Surgery
  • Hospitalist Rotation
  • Nephrology Outpatient
  • Occupational Health
  • Orthopedic Surgery
  • Palliative Care
  • Physical Medicine & Rehabilitation
  • Procedure Rotation
  • Research
  • Urology

Conferences

Our wide variety of Internal Medicine conferences cover inpatient and outpatient medicine, including both rare and common diseases. The Overholt Auditorium has a complete array of multi-media tools to enhance presentation and learning. These include PowerPoint, digital video projection capability (live camera, radiology projection, and VCR for ECHO), slide projectors, overhead projector and dry-erase boards.

Gundersen Medical Foundation offers complimentary meals at each morning and noon teaching conference. House staff are able to attend all conferences unless there is a patient in need of immediate care.

Morning Report - This is a cornerstone of our resident education. It runs from 7:30 to 8 a.m. on Monday, Tuesday and Friday. Attendance is expected for all internal medicine residents, other residents, students on internal medicine rotations and selected staff. The Chief resident, a senior resident or GM attending physician moderates a case in a highly interactive fashion. Cases range from "bread and butter" internal medicine where the fine points of management are reviewed, to the rare cases where complete differential diagnosis, test selection and treatment methods are discussed.

Senior residents present the case once a week and summarize the main learning points at the end. All teaching is accomplished with an emphasis on evidence-based and cost-effective medicine principles.

Board Review Class - On Wednesday mornings a small group board review class is held using MedStudy as a guide. The chief resident leads this class that emphasizes the approach to difficult questions and the "hot points" that will be seen on the ABIM exam.

Noon Conference - These conferences are held each weekday. Various specialty topics, resident presentations, and outside distinguished speakers comprise this most beneficial conference curriculum. This venue is also the setting for Medical Grand Rounds. Special attention at this conference is provided in the beginning of the academic year for our new residents. Several departments present "Emergency" clinical situations for their particular specialty, e.g. "Oncology Emergencies" or "ENT Emergencies."

Journal Club - This is a monthly resident-led, evidenced-based review of current journal articles. Residents choose journal articles relevant to the practice of internal medicine. Statistics are reviewed with one of our biostatisticians in an effort to learn statistical methodology and to judge the relative strengths and weaknesses of the selected articles.

Intern Ethics Seminar - This is a monthly discussion led by Bernard Hammes, Medical Humanities/Ethics, along with various staff. First year residents meet and discuss ethics in a case-based format. Topics are often driven by current clinical experiences in an effort to help residents handle difficult ethical issues that they will face during the remainder of their careers.

Resident Clinic

On most rotations, our residents have continuity clinic a half day per week at the resident clinic at Gundersen Health System, La Crosse. They also do a four week block of afternoon half day clinic sessions. When residents are on busy inpatient services, they do no clinic or half day every other week. While priority is given to autonomy, you are given the opportunity to be taught exceptional clinical medicine by experienced faculty. During your three-year experience you will also learn clinic operation, including billing, insurance and appropriate patient referral. Special emphasis is placed on evidence-based clinical medicine.

Your clinic consists of patients you have cared for in the hospital on general medicine and subspecialty rotations who then become your primary patients, as well as patients you have seen in the Urgent Care, personal referrals and other patients looking for an internal medicine physician. In this way you obtain an excellent patient mix of common, rare, and severe medical problems, along with patients with varying ages and socioeconomic status.

To enhance and enrich your experience, we have assembled a top-notch team of support staff, consisting of registered nurses, medical assistants and patient liaisons. They are ready and willing to help with procedures, fielding calls from your patients, handling prescription refills and addressing patient scheduling.

There is full primary care dermatology equipment available for cryotherapy, excisions, shave and punch biopsies. Joint aspiration and I&D equipment are also available.

A typical first year resident will see one new patient and two follow-up patients in an afternoon. As your training progresses, your volume will increase to accurately reflect your future practice. You have the ability to schedule patients outside of your scheduled clinic if needed as well. You do not have clinic during your months of ICU, Night Float and post-call on General Medicine inpatient service.

Love + Medicine

Every day, Gundersen Health System delivers great medicine plus a little something extra—we call it Love + Medicine.

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