Curriculum

NOTES:

• Family Medicine Clinic – consists of 60% Clinic, 20% Research, 10% Practice Management, & 10% Community Health/Osteopathic Principles
• US – Ultrasound
• PATT – Pre-Admission Testing and Teaching (Pre-Op)
• Track Month – OB, OB share care, Hospitalist, Outpatient Clinic

Multiple inpatient and outpatient electives are available pending on preference. 

Rural Medicine Rotation

During this one month rotation, the resident will work at one of Gundersen's rural community clinics. The site will be a PCMH and will offer full spectrum family medicine including obstetrics in this community.

Residents will practice with the clinic's Family Medicine team providing care in that setting, but will also work with rural surgeons and other specialists in the community.

Housing will be provided if required. This rotation will show the resident the opportunities, strengths and challenges of practicing in a rural community. All clinical sites are within a two hour drive allowing the resident to return home for weekends if there are no call responsibilities.

Core Rotations

Wellness: This residency focuses not only on improving medical skills, but also the personal wellness of staff and residents. GHS has a long history of providing an excellent work-life balance. Our curriculum has longitudinal time carved out monthly for wellness activities. Two to four hour blocks are dedicated monthly for the residents to practice personal wellness activities and team building. These resident inspired activities have ranged from ropes courses, kayaking, hiking, snow shoeing, and curling to visiting art museums, river picnics, meditation, and yoga.

Internal Medicine: The inpatient internal medicine training comprises two months per year for all three years. The PGYI year includes two months on an academic teaching service that emphasizes a slower pace within a highly academic environment focusing on complex cases. In the PGYII and PGYIII years, residents will rotate onto a hospitalist service staffed by general internal medicine and family physician hospitalists. These years you'll be part of a fast-paced, high-volume service with problems common to a community hospital which most family physicians will encounter.

OB: There are two months of required obstetrical inpatient care during the first year, which allows the resident to care for pregnant patients in prenatal, labor and delivery and postpartum. Routine vaginal deliveries, vacuum assisted deliveries and assisting in Cesarean Sections will be mastered. There are no other residents competing for vaginal deliveries on the labor and delivery service. Two months of further obstetrical training are available during second and third year for those who plan on offering obstetrics in their practice. This additional training emphasizes advanced skills and high-risk obstetrics. 

Pediatric Inpatient: Gundersen has a pediatric hospitalist program which includes pediatric inpatient, newborn and consultative services. The resident will provide pediatric inpatient care for one month of each training year with progressive responsibility and authority. The pediatric inpatient experience has no competition from other residents. Residents will feel highly competent after these months to care for common pediatric diseases. 

Rural Surgery: This one month experience in PGYII will include experiences in the general surgery clinic evaluating common surgical problems and performing common ambulatory procedures such as anoscopy, lesion removals and preoperative evaluation of common surgical problems. 

Inpatient Cardiology: In this PGYI one month rotation, residents will care for patients with acute and chronic cardiac illnesses under the care of board certified cardiologists. This will include patients with ACS, STEMI, CHF exacerbations and rhythm disturbances.

Dermatology: This two week experience will give the resident an excellent knowledge-base in common dermatological conditions and enable the resident to learn common dermatological procedures such as lesion removal, shave biopsy, punch biopsy, cryotherapy and electrodessication.

Electives: Gundersen offers a number of high-quality electives to round out the resident experience and interests. Many of these are available on the La Crosse campus including most of the surgical, medical, neurologic and pediatric subspecialties.

ER: Residents will have two months of ER during the residency - one month in the La Crosse ER and one month in the rural Tomah ER. The ER cares for over 40,000 visits per year and is staffed full time with ER boarded physicians. The ER is the only Level 2 Trauma Center in the area, receiving complex medical and surgical emergencies. 

Family Medicine Clinic: Residents will have 6 months dedicated to care in the ambulatory setting. Longitudinal care is also provided during core rotations. This newly designed Gundersen clinic is a certified PCMH team. Focus will be on maximizing the doctor patient relationship in motivational interviewing and providing high-quality longitudinal care across all ages. There will be an integration of wellness, disease management, pharmacy and behavioral health in the clinic. During these months, residents will have dedicated time to explore scholarly projects, quality improvement and practice management skills.

Geriatrics: Residents will spend one month caring for geriatric patients with a board certified geriatrician, performing geriatric assessments on frail, elderly patients. This will include caring for patients with gait dysfunction, multiple chronic problems, polypharmacy and dementia-related illness in an integrated team.

Gynecology: Residents will have a one month experience providing care to patients with board certified gynecologists. Common gynecologic procedures will be mastered. Residents will also experience with consults in the ER for issues such as evaluation of heavy vaginal bleeding, ectopic pregnancies and miscarriages.

ICU: In this PGYI inpatient month, residents will care for critically ill adult patients in a new state-of-the-art ICU staffed by pulmonary/ICU intensivists.

Orthopedics: This one month musculoskeletal rotation involves providing care with orthopedic physicians in the ambulatory setting. Common joint examinations will be mastered by the resident with management of common problems of the hip, shoulder, hand and hip. Fracture care, splinting and casting will be integrated into this experience.

Pediatric Outpatient: Residents will spend one month in PGYI and PGYII in the Patient-Centered Medical Home certified pediatric clinic caring for pediatric patients with common ambulatory problems. This will include the full spectrum of pediatric practice, emphasizing well care, anticipatory guidance, common infectious diseases, asthma, GI disorders and other common neurobehavioral issues such as ADHD.

Research: For graduation from the program, residents will be required to participate in two scholarly projects, at least one of which involves quality improvement. Our faculty have extensive experience in quality improvement, efficiency and safety. Gundersen Medical Foundation has staff including biostatisticians with expertise in designing, performing, presenting and publishing scholarly work.

Sports Medicine: Residents will participate in a Sports Medicine Clinic for one month supervised by a family physician with an added qualification in sports medicine and twenty years of clinical practice. Residents will learn pre-participation sports evaluation, treatment of common sports related injuries, with an added focus on concussion care. Residents will also attend sporting events and participate as a team physician during this rotation.