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Cardiology
This one-month rotation usually occurs in the first year of residency. During this time, the resident is assigned to an individual cardiologist for the entire month. The resident see patients in inpatient and outpatient settings with the cardiologist. 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. At the completion of the rotation residents should be competent in EKG interpretation, concepts of preload and afterload, proper use of pharmacologic agents in cardiology, and the use of diagnostic modalities in the cardiac patient.
Community Medicine
This is a half-time one-month rotation occurring in the second year that is designed to help the resident develop the attitudes, knowledge, and skills to practice community orientated primary care. Areas covered include occupational medicine, community health resources, and disease prevention/health promotion. The other half of the month is spent in the FMC.
Dermatology
This is a required rotation that may be taken anytime over the three years. This is primarily an outpatient rotation covering the spectrum of office dermatology, and a resident may accompany the staff dermatologist in consultation for hospital patients. Emphasis is placed on the identification of skin diseases in regards to pathogenesis, diagnosis, pathology, and treatment. Biopsy and excision techniques, use of topical agents, and repair of injuries are also emphasized.
Diagnostic Imaging
This half-time one-month rotation is taken in the first year. Radiology consists of reviewing and participating in current cases that span the entirety of radiology- Interventional, MRI/CT scanning, Nuclear Medicine, Ultrasound, General Radiology, and Mammography. The resident becomes familiar with the indications for various diagnostic tests and the interpretation of these. The other half of the month is spent in the FMC.
Emergency Medicine
Two one-month required rotations are done during residency. The goal is to allow the resident to develop the skills and techniques necessary to provide care in the emergency room setting. Residents are expected to evaluate and provide care to all levels of patients. Typical skills learned include intubation, peripheral/central intravenous access, casting/splinting, suturing, trauma management, and the importance and techniques involved in 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. The Emergency Department physicians supervise the residents.
Family Medicine
 For four months of the first and second years, residents spend half of their time in the FMC. The rotation is designed to prepare the resident for their future practice by expanding their skills in ambulatory medicine. The other half of these months is spent on Radiology, Rehab Medicine, Community Medicine, and Management of Health Systems.
Gastroenterology
This one-month rotation is accomplished with staff gastroenterologists and encompasses hospital and office topics and procedures. The resident becomes familiar with the diagnosis, pathophysiology and management, both medically and otherwise, of the broad spectrum of diseases in gastroenterology. Typical procedures include assisting/performing colonoscopy, sigmoidoscopy, upper endoscopy, placement of PEG tubes, ERCP, and various biopsy techniques.
General Surgery
This is a required rotation with a total of two months 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 are first assistant in the operating suite with their assigned surgeon. Procedures performed by residents may include chest thoracostomy, subclavian catheters, suturing, wound debridement, and other minor surgical procedures.
Geriatrics
This is a three-year longitudinal experience, which includes acute inpatient and outpatient care, nursing home rounds, and home visits. The director of geriatrics directs this curriculum. Residents during their second and third years incorporate nursing home patients into their patient population and make regular visits to provide care.
Gynecology
This rotation consists of one month with a Board Certified gynecologist and may be accomplished in the second or third years of residency. Comprehensive clinical gynecology education is emphasized in regards 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
 These are required rotations during the first and second year. The goal of the rotation is to impart sufficient instruction in Internal Medicine to enable the resident 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 (usually between 7-8 am) and consist of discussion of medical cases with emphasis on differential diagnosis, clear and concise presentation of patient cases, evidence-based medicine, and appropriate treatment regimens for a variety of disease states.
Medicine Chief
The resident’s inpatient Medicine Service has a chief medicine resident to oversee the service. This 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 that occurs twice in the first year and the second year. This is housed in our labor and delivery unit. Residents interact and receive instruction from our family practice program directors (all of whom do OB) and our OB/GYN consultants, as well as private family practice and OB/GYN staff from the community. Issues in antepartum care, labor management, and post-partum care are all covered. Resident responsibilities include evaluation of every patient presenting to the obstetrics unit for triage and eventual admission or discharge. Our residents actively participate in the management of all laboring patients and have the opportunity to be present at every delivery (including first assist 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 discussion of common ophthalmic problems. There is also an annual workshop in Ophthalmology.
Orthopedic Surgery
 Training in orthopedics is done in the offices of Board Certified orthopedic surgeons. This experience is two required months that may be taken throughout the three years of residency and includes one-half month of sports medicine (see below). The resident obtains 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 including; joint/muscle exam, 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, and includes involvement in the surgical cases at the hospital. The resident will gain experience with in-patient 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 a different aspect of pediatrics is emphasized. 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 during that month.
Management of Health Systems
Curriculum for this rotation focuses on the business aspects of Family Medicine. Most of this training is provided in a longitudinal fashion. This business side of Family Medicine is also emphasized during one of the half-months that are in the FMC. Through this rotation, the resident will understand the fundamentals of organizing and managing a medical practice.
Psychiatry
This longitudinal experience focuses attention on the inner, not exclusively medical, aspect of patient lives in order to further examine the thoughts, feelings, and attitudes that are a basis for 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 either a general hospital or mental institution.
Rehabilitation Medicine
This is a required half-time month rotation designed to teach residents the principles of rehabilitation and how to utilize 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 in which a third year resident works with a designated family physician preceptor in a rural setting. The rotation will provide exposure to and provide experience in 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 resident become proficient at pre-participation sports physical exams that are consistent with the guidelines from the ACSM, AMMSM, and AOSSM. Also residents gain experience assessing, diagnosing, and managing activity-related injuries. In addition, the resident becomes able to discuss athletic conditioning and principle of exercise physiology. Additional time in Sports Medicine can 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.
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Allergy/Clinical Immunology
This is an outpatient-elective rotation in the offices of private allergists/immunologists. The goal of this rotation is to gain clinical insight into the management of allergy and clinical immunology through observation and interaction with staff and through didactic conversation.
Anesthesia
This is a one-half to one month elective in the surgical operating suite accompanying a staff anesthesiologist. The resident gains 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 colorectal surgeon on staff provides this rotation. Experience consists of management of various colorectal problems seen by staff and special emphasis is placed 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. Opportunity to learn and perform procedures is ample. Procedures include endotracheal intubation, central line placement, arterial line placement, thoracentesis, and chest tube placement.
Endocrinology
This is an elective taken in the second or third year of residency in the private office of a board certified endocrinologist. The elective may be a half to one 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 half to one-month elective available in the second and third year of residency. It is taken in the outpatient offices of Board Certified oncologists/hematologists, the Oncology unit of St. Joseph Regional Medical Center, and at Hospice. The resident spends time learning the presenting complaints, complications, and the 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 sees patients in both the inpatient and outpatient arena. Emphasis is placed on critically ill patients.
Neurology
This is a half to one-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 half or one-month block. The goal of this rotation is to enhance the 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 is a priority at 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 for the resident to broaden his/her skills in critical review of literature, research methodology, curriculum development and general scholarly pursuits.
Rheumatology
This is an elective of a 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 resident focuses on the more common rheumatologic disorders seen in a typical Family Medicine setting.
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