Family Medicine Residency Rotations & Electives

Rotations

Cardiology

This is a one-month rotation in the first year of residency. Each resident is assigned to the supervision of a cardiologist, seeing patients in inpatient and outpatient settings. The goal of this rotation is to experience cardiology in various settings as it applies to the family physician. Clinical competency is stressed in five main areas: Angina, Congestive Heart Failure, Valvular Heart Disease, Acute Myocardial Infarction, and Arrhythmias. Following completion, residents should be competent in EKG interpretation, concepts of pre-load and after-load, proper use of pharmacologic agents in cardiology, and the use of diagnostic modalities. 

Community Medicine

This is a two-part one-month rotation for second year residents. It is designed to develop the attitudes and skills needed to practice community-orientated primary care. Areas covered include occupational medicine, community health resources, and disease prevention. Half of the month is spent working in the Family Medical Center.

Dermatology

Dermatology is a required rotation and may be taken anytime over the three years. This is primarily an outpatient rotation covering office dermatology. Residents also typically accompany the staff dermatologist in consultation for hospital patients. Emphasis is placed on the identification of skin diseases – pathogenesis, diagnosis, pathology, and treatment. Biopsy, excision techniques, use of topical agents, and repair of injuries are also emphasized.

Diagnostic Imaging

This first year half-time rotation lasts one month and spans the entirety of Radiology – interventional, MRI/CT scanning, nuclear medicine, ultrasound, mammography and general radiology. Residents become familiar with the indications and interpretations for various diagnostic tests. The second half of the month’s rotation is spent in the Family Medical Center.

Emergency Medicine

Emergency Medicine requires two one-month rotations during residency. Emergency Department physicians supervise the residents while teaching techniques necessary to provide care in an emergency room setting. Residents are expected to evaluate and provide care to all levels of patients. Typical skills honed include intubation, peripheral/central intravenous access, casting/splinting, suturing, trauma management, and efficient triage of patient cases. The rotation is done in the Emergency Department of Saint Joseph Regional Medical Center at either the South Bend or Mishawaka campuses.

Family Medicine

For four months during the first and second years, residents spend half of their time in the Family Medicine Center, expand skills in ambulatory medicine. Residents spend the other half of their rotation time on Radiology, Rehab Medicine, Community Medicine, and Management of Health Systems.

Gastroenterology

Gastroenterology is a one-month rotation with hospital staff gastroenterologists encompassing hospital and office procedures. The resident becomes familiar with diagnosis, pathophysiology and management of the broad spectrum of diseases in gastroenterology. Typical procedures include assisting or performing colonoscopies, sigmoidoscopies, upper endoscopies, placement of PEG tubes, ERCP, and various biopsy techniques.

General Surgery

This is a required rotation. Two months are spent with a Board Certified surgeon learning diagnosis of common and acute surgical problems, basic wound care, and pre/postoperative evaluation of surgical patients. Residents serve as the first assistant in the operating suite with their assigned surgeon. Procedures may include chest thoracostomy, subclavian catheters, suturing, wound debridement, and other minor surgical procedures.

Geriatrics

This is a three-year longitudinal experience, encompassing acute inpatient and outpatient care, nursing home rounds, and home visits. The director of geriatrics oversees this curriculum. During their second and third years, residents incorporate nursing home patients into their patient population and make regular visits to provide care.

Gynecology

The Gynecology rotation consists of one month with a Board Certified gynecologist and may be accomplished in the second or third year of residency. Comprehensive clinical gynecology education is emphasized with direct application to the skills needed for a family physician. Typical procedures include colposcopy, dilation and curettage, LEEP, cryotherapy, and the interpretation of Pap smear results.

Internal Medicine

The goal of the Internal Medicine rotations, required during the first and second year, is to enable residents to provide accurate assessment and treatment of medical patients. Each month a Board Certified family physician and a Board Certified internist staff the Medicine service. Rounds occur every morning at a designated time.  Discussion centers on medical cases with differential diagnosis, clear and concise presentation of patient cases, evidence-based medicine, and appropriate treatment regimens for a variety of disease states.

Medicine Chief

A Chief Medicine Resident oversees the inpatient Medicine Service. The position is assigned to a third year resident for the Fall and Winter and a second year resident in the Spring. The purpose of the chief medicine resident is to enhance the educational atmosphere of the rotation by providing educational support either with formal or informal teaching as well as providing supervision of junior residents and senior medical students.

Obstetrics

Obstetrics is a month-long required rotation in our labor and delivery unit occurring in the first and second years. Residents receive instruction from our family practice program directors (all of whom practice OB), our OB/GYN consultants, and private family practice and OB/GYN staff from the community. Antepartum care, labor management, and postpartum care are all covered. Resident responsibilities include evaluation of patients, presenting to the obstetrics unit for triage, and eventual admission or discharge. Our residents actively participate in the management of laboring patients and have the opportunity to be present at every delivery. They are also able to serve as first assistants on C-Sections. On average our unit delivers 120 babies per month.

Ophthalmology

The resident becomes familiar with the scope and practice of ophthalmology through a half-month required rotation in the private offices of Board Certified ophthalmologists. This rotation is taken in the second or third year of training and includes observation of ophthalmic surgery, routine ophthalmic exams, and didactic discussions of common ophthalmic problems. There is also an annual workshop in Ophthalmology.

Orthopedic Surgery

Training in orthopedics takes place in the offices of Board Certified orthopedic surgeons. These two required months may be taken throughout the three years of residency and include one half-month of sports medicine. Residents obtain clinical skills and knowledge in general orthopedics with special emphasis on primary care and sports medicine. Typical duties include participation in orthopedic surgeries, evaluation and treatment of common orthopedic problems. Some of the items include joint/muscle exams, fracture care, splinting and casting, indications for physical therapy, and evaluation and treatment of routine sports medicine injuries.

Otolaryngology

Training in this specialty is available in the private offices of Board Certified otolaryngologists.  Surgical cases at the hospital cover inpatient and outpatient care of ENT problems, particularly as they apply to Family Medicine.

Pediatrics

This rotation consists of four separate one-month blocks taken during the first and second years of residency. Each month focuses on a different aspect of pediatrics. Inpatient rotations focus on composing differential diagnoses, developing procedural skills and formulating treatment plans based on pediatric drug pharmacology. Outpatient rotations focus on the care for children in our community and in the office. During the pediatric rotations, a staff pediatrician supervises each resident.

Management of Health Systems

Curriculum for this rotation focuses on the business aspect of family medicine. Most of this training is provided in a longitudinal fashion and is also emphasized during one of the half-months that are spent in the Family Medical Center. Through this rotation, the resident will understand the fundamentals of organizing and managing a medical practice.

Psychiatry

This longitudinal experience focuses attention on the thoughts, feelings, and attitudes that are a basis for patient behavior. The primary goal of this segment of training is to teach the resident how to diagnose and manage most psychosomatic and emotional problems, to recognize neuroses and psychoses, and to provide the after-care which many patients require following discharge from a general hospital or mental institution.

Rehabilitation Medicine

This is a required half-time month rotation teaching the principles of rehabilitation and utilizing the community rehabilitation resources in a cost-effective manner. The resident will develop an understanding of, and participate in, the team approach to rehabilitation. This rotation will enhance both the residents' geriatric and community medicine experiences.

Rural Medicine

This rotation is a one month required rotation. Third year residents work with designated family physician preceptors in a rural setting. The rotation will provide exposure to the full scope of family medicine as practiced in a rural setting, increasing the resident's preparation to independently function as a family physician upon graduation.

Sports Medicine

This is a half-month rotation done with Dr. Steve Simons, our sports medicine fellowship director. Longitudinal exposure is accomplished through didactic lectures, performance of sports physicals, workshops, and sideline attendance at sporting events. Residents are required to assist Dr. Simons at designated sports physicals at local high schools and colleges. The residents become proficient at pre-participation sports physical exams that are consistent with the guidelines from the ACSM, AMMSM, and AOSSM. Residents also gain experience assessing, diagnosing, and managing activity-related injuries. Residents learn to discuss athletic conditioning and principles of exercise physiology. Additional time in Sports Medicine may be taken as elective time.

Urology

This is a half-month rotation taken in the second or third year of training. Experience consists of both inpatient and outpatient urology. Particular focus is placed on common urologic problems encountered in family medicine.

Electives

Allergy/Clinical Immunology

This is an outpatient-elective rotation in the offices of private allergists/immunologists. The goal is to gain clinical insight into the management of allergy and clinical immunology through observation and interaction with staff and didactic conversation.

Anesthesia

This is a one-half to one month elective in the surgical operating suite accompanying a staff anesthesiologist. Residents gain experience in all areas of anesthesia and obtain clinical competence in procedure skills related to the field.

Colorectal Surgery

This elective is taken either in the second or third year for a half to one month. A Board Certified on-staff colorectal surgeon provides this rotation. Experience consists of management of various colorectal problems seen by staff with special emphasis on the skills necessary for the family physician.

Critical Care

Critical Care, an elective month-long rotation, occurs in our Intensive Care Unit under the direct supervision of pulmonologists/intensivists. Instruction is given in all aspects of care for the critical patient including ventilator management, cardiovascular stabilization, renal and electrolyte management, and infectious disease. Extensive instruction is also given in pulmonary function testing. Resident responsibilities include initial history and physicals, daily rounds, and problem management on all patients under the care of our pulmonologists. Home Call, on average, occurs every third night. Procedures include endotracheal intubation, central line placement, arterial line placement, thoracentesis, and chest tube placement.

Endocrinology

Endocrinology, if elected, is taken in the second or third year of residency in the private office of a board certified endocrinologist. The elective may be one-half to one full month in duration and is primarily a didactic experience with exposure to a wide range of endocrine problems as they present in the preceptor's office.

Hematology-Oncology

This is a one-half to one full month elective available in the second and third year of residency taken in the outpatient offices of Board Certified oncologists/hematologists, the Oncology unit of St. Joseph Regional Medical Center, and at Hospice. Time is spent learning the presenting complaints, complications, and diagnosis of cancer through hands-on experience and observation of various patients with malignancy.

Infectious Disease

This is a half to one-month elective taken in the second or third year of residency in the private office of a Board-Certified infectious disease specialist, as well as in the hospital setting. The resident gains attitudes, skills, and knowledge in patients with infectious diseases.

Nephrology

This is a one-month elective rotation available in the second or third year. Residents see patients in both the inpatient and outpatient arena. Emphasis is placed on critically ill patients.

Neurology

This is a one-half to one full month elective rotation during the second or third year of residency. It is a combined inpatient and outpatient rotation working with Board Certified neurologists.

Plastic Surgery

This elective is available to second and third-year residents. It involves inpatient and outpatient training with Board Certified Plastic Surgeons. This may be a half or one-month rotation, and emphasis is placed on wound healing, suturing, and common problems in plastic surgery.

Podiatry

This elective is available to second and third year residents and may be taken in a one-half or one-month block. The goal of this rotation is to enhance residents' awareness of common foot problems, as well as to communicate, understand, and effectively interact with podiatrists in the community.

Scholarly Activity

This elective rotation can be taken either in the second or third year of residency. Research and scholarly pursuit are the priorities of the residency. While all residents are required to complete a family practice project, residents may also use this elective to more fully develop a specific research initiative. The goal is to broaden skills in the critical review of literature, research methodology, curriculum development and general scholarly pursuits.

Rheumatology

This is an elective of a one-half to one-month duration under the supervision of a Board Certified rheumatologist. Through observation and didactic interaction, the resident gains an understanding of topics in rheumatology with regard to their clinical presentation, diagnosis, and treatment. The focus is on the more common rheumatologic disorders seen in a typical Family Medicine setting.