Transitional Year Program

• Rotations
• Internal medicine
• General surgery
• Emergency medicine
• Pediatrics
• Electives
• Recent graduates
• More information

Rotations
Integrating rotations in Internal Medicine, General Surgery, Emergency Medicine, Pediatrics and elective time, the Transitional program is sponsored by Saint Raphael’s Department of Medicine and is affiliated with Yale University School of Medicine. Assignments are broken into blocks, with residents assuming the same responsibilities as categorical residents on respective services, including rotations in critical care units and specific medical and surgical services. You may also arrange electives in many of the hospital’s available clinical teaching services, and orient them toward acute or ambulatory care. Among the choices are Anesthesiology, Dermatology, Endocrinology, Gastroenterology, Infectious Diseases, Nephrology, Neurology, Ophthalmology, Podiatry, Radiation Oncology, Radiology and more.

During every rotation, residents are integral members of the patient care team and encouraged to fully participate in departmental conferences and teaching activities. Full-time faculty and senior house officers provide individual supervision and teaching. Saint Raphael's full-time faculty is devoted solely to resident teaching - whether at a patient's bedside or as a mentor for a reading group.

Rarely do two Transitional residents follow the same work schedule, as each is individually designed to meet both resident needs and program requirements. Over the course of the academic year, however, each resident rotates through the following four-week blocks:

1 block Medical Intensive Care Unit
1 block Coronary Care Unit
3.5 blocks General Medicine
2 blocks General Surgery
1.5 blocks Pediatrics
1 block Emergency Medicine
2 blocks electives
1 block vacation

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Internal Medicine
Transitional residents spend a large part of their year in Internal Medicine — more than 20 weeks. During this time, medical rotations include separate assignments on Saint Raphael’s Medical and Coronary Intensive Care units, where teams include two senior-level residents and three PGY 1s. Full-time medical directors, subspecialty fellows and additional teaching attendings provide teaching and supervision. On general medicine inpatient rotations, the teams consist of one senior resident, two PGY 1s and one student, with full-time supervision by a hospital-based clinical educator. Residents have primary responsibility for evaluating and managing patients as they are admitted to the hospital, and throughout their hospital stay. Consultant teams consisting of a subspecialty attending, fellow and rotating resident are readily available and provide support in patient care.

Also scheduled on various days are medical grand rounds, chairman's rounds (case discussions with a focus on clinical decision-making and systems of care), professor's rounds (case discussions with a senior clinician), autopsy conference and a renal pathology conference.

During each rotation, residents begin the day with a 7 a.m. sign-in and pre-round conferences. Work rounds with the medical director take place from 8 to 9:30 a.m., followed by independent work time or teaching rounds on Mondays, Wednesdays and Fridays. A noon conference with lunch takes place each weekday, followed by radiology rounds and other care responsibilities.

Residents are on call every fourth night. Those covering intensive care units are required to sleep at Saint Raphael's. Those on general medicine units are relieved by a night float service. During call time, comfortable and convenient sleep accommodations are available. Most call rooms include a bed, telephone, TV, bathroom with shower, and computer with Internet access.

During Internal Medicine rotations, residents take part in several programs including:

• Regular conferences that include autopsy with hands-on anatomical correlation of clinical findings; weekly EKG interpretation with an attending cardiologist to learn the techniques of basic and advanced EKG reading; Hospital of Saint Raphael Medical Grand Rounds and Yale Medical Grand Rounds.
• Peer teaching conferences. At noon conference, a PGY 3 resident, working with an attending, presents a topic with text and literature review to fellow residents and faculty members.
• Journal Club. Residents work with faculty to analyze an article, discussing study design, strengths, weaknesses, and application of the study to the clinical setting.
• A "Medical Quiz Show Conference" modeled after Jeopardy, which takes place monthly. Using a computer display with scanned photos, smears and short-answer questions, residents play as part of a team.
• Radiology rounds. Ward and unit teams meet daily with an attending radiologist to review films and procedures, and to discuss differential diagnoses.

General surgery
Transitional residents are assigned to general surgery teams, each under the direction of an attending physician and a chief surgical resident. Residents actively participate in pre- and post-op management, surgery and clinic. Exposure to several subspecialties is facilitated through team assignments; orthopedics, vascular and trauma among them.

Emergency admissions, pre-op assessment, participating in surgical procedures like thoracotomy and laparotomy, and post-op care of patients are also part of the experience. Weekly clinic time allows for both patient follow-up and experience in outpatient management of common surgical problems, such as peripheral vascular disease and ostomy care. Residents will be on call an average of every fourth night, allowing for more supervised decision-making and time in the OR.

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Emergency medicine
Under the direction of full-time Department of Emergency Medicine faculty, residents receive training and experience in acute adult medical and surgical illnesses like chest pain, syncope and pneumonia; trauma in our Level 2 Trauma Center; and other aspects of urgent ambulatory care. The conference schedule is specific for Emergency Medicine and includes daily instruction and teaching, plus working closely with Internal Medicine and General Surgery residents. Conferences combine didactic education and "morning report" style presentations that deal with common ED scenarios.

Daily experiences range from triage of major emergencies to decisive management of common ambulatory problems. Communication and interaction with patients, families and other physicians are emphasized. Triage decisions, discharge instructions and follow-up plans are among the many topics tackled in morning report and daily department conferences.

During this rotation, there is a night call.

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Pediatrics
This rotation will provides residents with valuable experience in managing both well and sick infants, children and adolescents, as well as in interacting with concerned parents and family members. Night call, no more than once weekly, is based in the Emergency Department, further adding to the ambulatory care experience.

Most of the 12,000 patients seen in the Saint Raphael Pediatric Clinic each year are by appointment, but urgent and semi-urgent cases are also taken each day. This clinic experience teaches residents the principles of pediatric diagnosis, treatment, health maintenance, and health education. Residents work closely with attending physicians, as well as residents from Yale-New Haven Hospital.

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For more information
For further information or to request our brochure, Resident Education at the Hospital of Saint Raphael, please contact Stephanie Pane, Department of Medicine, at (203) 789-3989 or spane@srhs.org.

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This page was last updated on 12/13/2004