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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 "overnight call."  Most shifts for all rotations are 12 hours or less in length for all PG years.

First Year

RotationDurationOvernight Shifts
General Medicine Inpatient 5 rotations 6, per rotation
Cardiology 1 rotation 6, per rotation
Pulmonary-ICU 1 rotation 6, per rotation
Continuity Clinic 2 weeks N/A
Point-of-Care Ultrasound 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 60-65.

Second Year

All PG 2 residents will have 4 medicine ward rotations, including General Medicine, Hospitalist, and Night Float.

RotationDurationOvernight Shifts
General Medicine Inpatient 1-2 rotations N/A
Hospitalist Medicine 1-2 rotations N/A
Cardiology 1 rotation 7, per rotation
Pulmonary - ICU 1 rotation 7, per rotation
Night Float 1 rotation N/A
Emergency Medicine/Urgent Care 2 rotations 2-4 (EM)
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

All PG 3 residents will have 5 medicine ward rotations, including General Medicine, Hospitalist, and Night Float.

RotationDurationOvernight Shifts
General Medicine Inpatient 1-2 rotations N/A
Hospitalist Medicine 1-2 rotations N/A
Night Float 1 rotation N/A
Cardiology 1 rotation 7
Pulmonary-ICU 1 rotation 7
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, Pulmonary-ICU, and GI. 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.

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, transitional, or family medicine 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 six 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. 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 six to seven nights of night coverage during which they will care for patients on the service, plus admit new patients.  Night coverage will be Sunday-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 six to seven nights of night coverage during which they will care for ICU patients on the service, plus admit new patients. Night coverage for the ICU will be Sunday-Thursday, as well as 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 managing their own census of patients 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 responds to codes and urgent situations with the emergency response team. They also supervise the night medicine intern and admit 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 or present one poster at a local/regional meeting 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 an option on 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 or third year, residents see patients at the University of Wisconsin-La Crosse Student Health Service, Gundersen Urgent Care, and resident continuity 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 outpatient service includes evaluation and treatment of common endocrine disorders and unusual and complex endocrine problems.  Endocrine grand rounds occur weekly. Residents are responsible for seeing any inpatient consultations during this rotation.

Gastroenterology

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

Hematology

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

Infectious Disease

The Infectious Disease (ID) services average 8-12 hospitalized patients with 12-15 new consults a week. 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 La Crosse area offers unique opportunities to manage patients with tick-borne illnesses including Lyme Disease, Anaplasmosis, and Babesiosis.

Nephrology

This is an inpatient service which averages a census of six to eight patients with three to four consultations a day. Teaching sessions are generally held daily at the end of rounds.

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 on this inpatient consultative service. 

Oncology

Residents learn to stage patients and become involved in research protocols and traditional modes of treatment for common and uncommon forms of cancer. This rotation is primarily outpatient based although some consultative inpatient experience can occur. Emotional needs of patients and families, palliative care, and symptom management are emphasized.

Palliative Care

Residents work on the inpatient palliative care team which averages eight to ten patients with three to four new consults per day. Residents learn about community resources for the end of life care, hospice enrollment, and end of life symptom management. There are several didactic lectures covering a broad range of palliative care topics. Residents also provide care to inpatient hospice patients.

Rheumatology

The emphasis is on common out-patient rheumatologic conditions. Residents average two new patients daily in rheumatology clinic, along with follow-up appointments and inpatient consults as requested. 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.

Point-of-Care Ultrasound

This rotation consists of a combination of simulation and hands-on point-of-care ultrasound as well as didactics. Residents are all issued a SonoSim simulation probe and work through a case list. Additionally, ultrasound is learned on patient models and hospitalized patients with unique pathology. After completing the rotation, residents are proficient in limited echo, lung, vascular, soft tissue, and abdominal ultrasound. Residents learn the BLUE Protocol and RUSH Protocol.

Elective Rotations

  • Allergy
  • Cardiotesting/ Treadmill Testing
  • Gynecology (office)
  • Otolaryngology
  • Pathology
  • Plastic Surgery
  • Radiation Oncology
  • Rheumatology
  • Vascular Medicine
  • Anesthesia
  • CHF Clinic
  • Neurosurgery
  • Ophthalmology
  • Pacemaker Clinic
  • Pediatrics
  • Podiatry
  • Radiology
  • Sports Medicine
  • Outside Rotation
  • Behavioral Medicine
  • Dermatology
  • General Surgery
  • 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 recently remodeled Ross Learning Center and Overholt Auditorium have a complete array of state of the art multi-media tools to enhance presentation and learning.

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 and Wednesday. 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. Additionally M&M cases are presented by staff on Wednesday mornings. All teaching is accomplished with an emphasis on evidence-based and cost-effective medicine principles.

Grand Rounds - This conference is held on Tuesday mornings from 7:30 to 8 a.m. Cases are presented by either teaching  staff or residents. An in depth discussion of disease processes or guideline updates are the emphasis of this conference.

Core Conference - This conference is held every Thursday morning from 7:30 to 8:15 a.m. These conferences are generally internal medicine subspecialty based with an emphasis on in depth review of select subspecialty topics and guidelines.

Board Review Class - On Friday mornings a small group board review class is held using MedStudy and MKSAP 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 (Gundersen Expert Lecture Series) - These conferences are held each Wednesday. Various specialty topics and outside distinguished speakers comprise this most beneficial conference curriculum.

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. Emphasis is placed on a standardized method to review journal articles and determine their quality and validity. 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 Thomas Harter, Ph.D., 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 in the resident clinic at Gundersen Health System, La Crosse. They also do a four week block of afternoon half day clinic sessions. While priority is given to autonomy, you are given the opportunity to be taught 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 referred from Emergency Services and Urgent Care. In this way you obtain an excellent patient mix of common and rare 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.

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. You have the ability to schedule patients outside of your scheduled clinic if needed as well. You do not have clinic during your month of Night Float.

Love + Medicine

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

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