Curriculum & Schedule

The average hours per week worked (including conferences) for PGY-1's is 60-65.

PG 2 residents have four medicine ward rotations, including General Medicine, Hospitalist and Night Float. Residents interested in a primary care career have the option of one less General Medicine or Hospitalist rotation in lieu of another Ambulatory rotation.

PG 3 residents have five medicine ward rotations, including General Medicine, Hospitalist and Night Float. Residents interested in a primary care career have the option of one less General Medicine or Hospitalist rotation in lieu of another Ambulatory rotation.

This rotation consists of four weeks of practicing inpatient internal medicine. Each of the teams is staffed by one attending physician. Services average a census of 12-16 patients. Each week of internal medicine service consists of six days of short call, with admissions ending at 4 p.m. weekdays and 1 p.m. weekend days. There also is 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 two to three 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 General Medicine teaching team do a brief night float stint during the rotation. This consists of five nights in a row (Sunday through Thursday, 7:30 p.m. to 7 a.m.) during which they are responsible for up to three to four new admissions. All patients are 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.

As a tertiary care center, Gundersen 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. Cardiology averages a census of eight to 10 patients, including many with acute myocardial infarction and its complications. Teams consist of three residents and a medical student. All three residents on this rotation complete six to seven nights of night coverage during which they care for patients on the service, plus admit new patients. Night coverage takes place Sunday through 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 eight to 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 complete six to seven nights of night coverage during which they care for ICU patients on the service, plus admit new patients. Night coverage for the ICU is Sunday through Thursday and Saturday nights, all within the same week.

During this rotation, senior residents have an opportunity to work outside the traditional teaching service model alongside practicing hospitalists. Residents spend time on an independent daytime admitting service, managing their own census of patients under the supervision of hospitalist staff. In addition, residents work with utilization review and billing to enhance understanding of the economic side of medicine. Residents also have responsibilities for Emergency Room/Hospital triage and didactic sessions on quality improvement and medical information technology. The Hospitalist team is issued an iPad mini and Butterfly IQ ultrasound probe to augment evaluation and care of patients and residents’ learning.

This rotation focuses on treating acute medical issues that arise in the Hospital. Residents cover the hospitalized patients of the General Medicine teams, under the supervision of the in-house hospitalist. In addition, the senior resident responds to medical emergencies with the medical response team. They also supervise the night medicine intern and admit patients.

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 simulated ultrasound and a case list. Additionally, ultrasound is learned on patient models and hospitalized patients with unique pathology. Residents will also use a high-fidelity ultrasound training simulator to allow real time ultrasound of disease in a simulated environment to augment learning of pathology.

After completing the rotation, residents are proficient in limited echo, lung/pleura, vascular, soft tissue, and abdominal ultrasound (including the eFAST, BLUE and RUSH protocols).   Further, ALL resident inpatient teams in general medicine, cardiology, ICU and hospitalist, are issued a Butterfly ultrasound probe and iPad Mini.  Therefore, residents have easy and immediate access to ultrasound on inpatient rotations.  This also allows for continued training beyond the rotation.

Our simulation course is an integrated experience in our simulation center which involves interdisciplinary training with pharmacy residents, family medicine residents, and PA students. The purpose of these simulations is to prepare our residents to lead medical emergency teams. During the intern year, our internal medicine residents navigate simulation sessions which are structured to focus on team-based treatment of high stakes, high risk encounters in medical settings encompassing ambulatory, acute care, and emergency services. Training activities are launched with a workshop that focuses on the use of team-based strategies and interventions, based on the TeamSTEPPS curriculum developed by the Agency for Healthcare Research and Quality (AHRQ).

During simulation sessions, training will involve responding as an interdisciplinary team to simulated medical emergencies (e.g. acute dyspnea, chest pain, shock, etc). The team will incorporate point of care ultrasound, Epic as the EHR, and utilization of a high-fidelity mannequin to enhance the overall fidelity of the medical simulation.

Each resident submits at least one paper for publication or presents one poster at a local/regional meeting prior to graduation.

All PGY1s will complete a research rotation. The purpose of this rotation is to introduce the resident to our robust research department, including our medical research consultants, scientific medical editor, biostatisticians, QI department, IRB personnel, Medical Media and librarians. An introduction to the fellowship track occurs during the research rotation, and several additional fellowship mentoring sessions occur throughout the academic year. Didactic and hands-on experience with research work in progress at Gundersen is an option on this rotation. Many feel that this educational experience greatly enhances Internal Medicine residents’ experiences by providing a multidisciplinary approach to problem solving.

All residents will begin to build their own patient panel as a first year. In addition to Resident Clinic, during the second or third year, residents see patients at the University of Wisconsin-La Crosse Student Health Service and Gundersen Urgent Care. During the ambulatory blocks, residents see indigent patients at the St. Clare Health Mission two evenings a week. Residents planning careers in ambulatory medicine are required one less inpatient General Medicine service in each of the PG2 and PG3 years so they may substitute more ambulatory rotations or increase Continuity Clinic experience.

PATT Clinic during the second or third year consists of 2 - 4 weeks of morning-only clinics, Monday through Friday. This experience consists of seeing patients for "pre-operative" medical evaluations in the PATT Clinic. Patients are seen in collaboration with Pharmacy, Anesthesia, Social Services and Nursing departments.

The Rural Medicine rotation consists of experience at a primary care clinic in close proximity to the La Crosse area. The unique opportunity afforded by this rotation is the emphasis on the delivery of more rural health care versus what may be experienced at the La Crosse clinic setting. Residents will learn new patient evaluations and will learn how to evaluate, manage and refer patients with isolated problems involving the broad gamut of disease, and they will have the potential opportunity for doing minor surgical procedures including lacerations and skin cryotherapy. They will also be exposed to the broad range of procedures encountered in the rural general internal medicine physician's office. 

The Addiction Medicine rotation is comprised of a 2- or 4-week block of weekdays. This rotation is well suited for IM residents who are looking at a career in outpatient medicine or as hospitalists. Residents evaluate and manage common addiction medicine-related problems of adults encountered in the inpatient or ambulatory setting.

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 GundersenAIR helicopter on transport and rescue missions. One-on-one staff to resident teaching is the norm.

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.

Working one-on-one with a staff gastroenterologist in the Hospital, residents are exposed to a wide variety of GI problems and observe numerous GI procedures. This is an inpatient and outpatient experience.

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. Weekly hematology rounds occur to provide hand-off on inpatient admissions, as well as discuss challenging cases and review smears with staff and fellows.

Infectious Disease (ID) services average 12-14 hospitalized patients with 15-20 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.

This is an inpatient service that 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.

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.

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, though some consultative inpatient experience can occur. Emotional needs of patients and families, palliative care and symptom management are emphasized. Residents are encouraged to attend weekly tumor boards.

Residents work on the inpatient Palliative Care team, which averages eight to 10 patients with three to four new consults per day. Residents learn about community resources for 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.

This rotation emphasizes common outpatient rheumatologic conditions. Residents average two new patients daily in the 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.