Rotation Schedule

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Residents have required inpatient and outpatient rotations each year complimented by an array of elective opportunities in general internal medicine, all medical subspecialties, global health, and research. 

The rotation schedule consists of thirteen four-week blocks. The inpatient rotations are at Waterbury Hospital on the general medicine floors. Each resident has four weeks of vacation each year. There is a night float system in place for the inpatient floor rotations. Electives may be taken at Waterbury Hospital or Yale-New Haven Hospital. Ambulatory medicine rotations include general internal medicine and medical subspecialty experiences and an extensive didactic curriculum as described in the Ambulatory Medicine section of our website. 

Over the course of training, forty to fifty percent of a trainees experiences will occur in the outpatient setting depending on an individual’s choice of electives.

PGY1 Schedule

During inpatient rotations, the PGY-I resident is considered to be the patient's primary physician. He or she develops a therapeutic plan, writes orders, and makes decisions about the patient's care. In these activities, there is careful supervision by a PGY-II or PGY-III resident and by the patient's attending physician.

PGY-I Preliminary Interns

Vacation4 weeks (two, 2-week vacations)
Ambulatory Medicine4 weeks
Medical Intensive Care Unit8 weeks
Inpatient Wards24 weeks
Elective12 weeks

PGY-I Categorical Interns (3-year track)

Vacation4 weeks (two, 2-week vacations)
Ambulatory Medicine12 weeks
Emergency Medicine2 weeks
Medical Intensive Care Unit8 weeks
Inpatient Wards22 weeks
Elective4 weeks

PGY2 & PGY3 Schedule

During inpatient rotations, the PGY-II and PGY-III resident has both direct patient care and supervisory responsibilities for the interns and students on their team. The team attending physician provides supervision for patient care and team management issues. During outpatient rotations the PGY-II and PGY-III resident cares for patients in a variety of settings with direct supervision by an attending physician.

PGY-II

Vacation4 weeks (two, 2-week vacations)
Ambulatory Medicine
10 weeks
Neurology2 weeks
Medical Intensive Care Unit8 weeks
Inpatient Wards20 weeks
Elective8 weeks

PGY-III

Vacation4 weeks (two, 2-week vacations)
Ambulatory Medicine12 weeks
Emergency Medicine2 weeks
Medical Intensive Care Unit8 weeks
Inpatient Wards14 weeks
Elective8 weeks
Geriatrics4 weeks

Ambulatory Education

The residents’ weekly continuity clinic and ambulatory block rotations represent the cornerstones of their ambulatory experience. In addition, about half of the activities on elective rotations take place in outpatient venues.

Skills and Behaviors

Residents will:

  • Evaluate and manage patients with the range of problems encountered by primary care physicians
  • Address health care maintenance issues for adult patients
  • Cultivate the robust set of physical examination skills essential to the practice of outpatient internal medicine
  • Perform primary care procedures, such as joint injection, skin biopsy, and dermatologic cryotherapy
  • Demonstrate communication skills necessary for effective medical interviewing and patient counseling
  • Orchestrate the longitudinal care of primary care patients, including follow-up, telephone medicine, and collaboration with consultants and various community services
  • Develop systems to convert their emerging information needs into well-formed clinical questions and to efficiently acquire, appraise, and apply medical information
  • Exemplify the highest standards of ethics in patient, professional, and interpersonal interactions
  • Efficiently provide patient-centered care as part of an interprofessional team within a practice microsystem
  • Accurately document and code for care provided in an electronic medical record

Knowledge

Residents will:

  • Understand the presentation, evaluation, and management strategies of chronic diseases and acute illnesses encountered by primary care physicians
  • Understand the basic principles for interpreting diagnostic tests, including probability revision and cost-effectiveness
  • Understand the health care system in the United States and Connecticut (and proposed reforms) and its impact on the provision of primary care

Attitudes

Residents will:

  • Appreciate the rewards and responsibilities of assuming the primary care of a group of patients, including the importance of patient advocacy
  • Consider their role as primary care physicians in the larger contexts of medicine in general, society, and their family and social networks

Continuity Clinic

Residents provide ongoing continuity care for their own panel of patients at the Henry S. Chase Outpatient Center under the supervision of experienced faculty. Before each clinic session, residents participate in a pre-clinic conference, led by both a peer teacher and a core faculty member, which utilizes Yale’s internationally renowned Yale Office-Based Medicine Curriculum.

During the residents' continuity session, the faculty devotes their time exclusively to precepting and we maintain a <4 to 1 resident to faculty ratio. Typically, each resident will see 3-5 patients as interns, 4-6 as PGY-II's, and 5-7 as PGY-III's. The patient visits include new patients, return visits and urgent care and include a broad range of internal medicine conditions. There is an infrastructure in place to ensure that residents participate in their patients' care during unscheduled clinic time, emergency room visits, and hospital admissions.

Preceptors complete biannual summative evaluations of the residents, attending to their achievement of developmental milestones, and offer formative evaluations in the form of direct observations (mini-CEXs) and informal feedback. In turn, residents have the opportunity to evaluate their preceptor’s teaching skills and the operations of the clinics.

The Henry S. Chase Outpatient Center (HSCOC) is located across the street from Waterbury Hospital at 160 Robbins Street. This practice is efficiently managed by the Alliance Medical Group, which manages many other hospital-affiliated practices in the community. An electronic medical record allows for seamless documentation and sharing of patient information among providers. Physical plant resources include built in audio-video equipment in two examination rooms, proxy server connection to the Yale Medical Library, and facilities for minor procedures. Weekly educational opportunities for trainees include a number of on-site subspecialty clinics: a multidisciplinary diabetes disease management clinic, a dermatology clinic staffed by an academic dermatologist, a joint injection clinic staffed by a rheumatologist, a warfarin anticoagulation clinic managed by pharmacists, a behavioral change clinic staffed by a behavioral psychologist, a primary care psychiatry clinic staffed by a psychiatrist, informal buprenorphine training, and much more. The practice sees greater than 20,000 visits per year, providing care for a large portion of the medically underserved citizens of Waterbury. The payer mix is 62% Medicaid, 14% Medicare, 12% uninsured (self-pay), and 12% commercial insurers.

Inpatient Education

Most of the inpatient education will occur at Waterbury Hospital Health Center. The inpatient floor teams care for patients who are not in need of intensive care monitoring. Management of the inpatient stay is by the primary team with consultants as needed. As there are no fellows at the hospital, the housestaff interact directly with consultant attendings and are the primary managers of all inpatient medical illnesses. This inpatient training with general medicine patients provides trainees with a broad exposure to the breadth and depth of internal medicine.

Podell and Renda Firms

Located at Waterbury Hospital, these general medicine Firms consist attending physicians from the Section of General Medicine who are members of the core faculty of the Primary Care Residency, PGY-II and III residents, interns and students. These Firms are named after Drs. David Podell and Joseph Renda, master clinicians who embody the very best of medicine from clinical excellence to the highest standards of professionalism and devotion to patients. Areas of particular emphasis of the general medicine Firms at Waterbury Hospital include bedside rounding, the role of the physical examination in clinical care and transitions of care.

Medical Intensive Care Unit

The Medical Intensive Care Unit team is comprised of Pulmonary/Critical Care attendings, interns, PGY II and PGY III residents. Clinical care is complimented with daily case discussions and a core intensive care unit curriculum. The goal of medical training in the intensive care units is to educate residents in the diagnosis, evaluation and management of patients with a wide range of critical illnesses, most commonly sepsis, chronic disease related multi-organ failure, and respiratory failure. The resident is expected to become knowledgeable about the indications, contraindications, risks and benefits of common ICU level procedures. Residents have the opportunity to be trained in a variety of procedures such as arterial puncture and arterial blood gas interpretation, arterial line and central venous line placement, paracentesis, lumbar puncture, and naso-gastric tube placement. Inherent in the care of critically ill patients is the management of psychiatric, social and family concerns which are heightened in these intensive care settings and are addressed by residents as part of a multidisciplinary team. Patients are transferred to the medical ward teams when discharged from the intensive care units.

Night Float

A night float system is in place to provide care for patients on the teaching service when members of the primary team are not in-house. The roles of the night residents are to both provide coverage of patients on the medical service and to admit new patients to the hospital who they will sign out to the day team in the morning.

Research and Scholarship

All residents in the three-year categorical program are required to complete a scholarly activity project during residency. These projects can consist of case reports, literature reviews, curriculum development, or hypothesis driven research.

Aims of the Resident Scholarship Requirement

The primary goals of the resident scholarship requirement are to enhance the critical thinking skills of the residents as bedside clinicians, to facilitate scholarly thinking, creativity, and appreciation of the excitement in creating new knowledge in medicine, and to broaden the scholarly sophistication of all elements of the residency program (i.e., morning report, peer teaching, work rounds, attending rounds, etc.). Didactic and experiential components of the Residency Scholarship Curriculum occur during each year of training. The didactic components include a three-part clinical biostatistics course, a seven-part evidence-based medicine seminar series, and a structured journal club. In addition, a yearly research in residency retreat introduces residents to potential faculty mentors who are willing to mentor residents in a more in-depth project during their training. Interns will be taught how to write a clinical vignette abstract that they will then submit to the Connecticut Chapter of the American College of Physicians (ACP) annual meeting or to the yearly New England Regional Society of General Internal Medicine (SGIM) meeting. Residents with the highest quality work will also submit their work to the National ACP or the National SGIM meeting. Residents whose abstracts are accepted will be financially supported to attend the national meeting. Residents are also encouraged to develop a more in-depth scholarly project during their PGY 2 and PGY 3 years. Projects can be in hypothesis-driven research, curriculum development, or community service. Residents pursuing hypothesis driven research or those developing an educational curriculum can spend one half-day per week during their PGY 2 and PGY 3 ambulatory block rotations to work on their projects. In addition, residents can also designate up to two months per year of elective time for research.

Presentation of Results

All PGY 3 residents present their work either as oral presentations or as posters at our annual Primary Care and Medicine/Pediatrics Residency Research Day each May. Those who have completed hypothesis driven research projects also present their work at the Department’s “Annual Research in Residency Day Symposium” also held each May. Residents are encouraged to submit their research to regional and national scientific meetings (e.g., Society of General Internal Medicine, American College of Physicians, etc.) and funding is available to support residents to attend these meetings in order to present their work.