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