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Core Rotations – Transitional

Core Rotations – Transitional

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 Cardiology
 – 3 blocks General Medicine
 – 2 blocks
General Surgery
 – 1.5 blocks Pediatrics
 – 1 block
Emergency Medicine
 – 2.5 blocks Electives (including 0.5 block Radiology “selective”)
 – 1 block Vacation

Internal Medicine

Transitional residents spend a large part of their year in Internal Medicine. Medical rotations include an assignment to Saint Raphael’s Medical Intensive Care Unit, where you are part of a team that includes senior-level residents. 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 variety of subspecialty conferences.

During each rotation, you’ll begin your 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 free lunch takes place each weekday, followed by time for admissions and other care responsibilities.

You’ll also be on call every fourth night. Residents 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 your Internal Medicine rotation, you will also take part in several programs specifically designed to enhance your learning experience, including:

Regular conferences that include autopsy with hands-on anatomical correlation of clinical findings; 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 (transportation provided)

Peer teaching conferences: At such noon conference, a PGY 2 or 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 principles of evidence-based medicine, individual study design, strengths, weaknesses, and application of the study to the clinical setting.

“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. It’s proven to be a fun and informal way to review medicine in a competitive setting.

General Surgery

Transitional residents are assigned to general surgery teams, each under the direction of an attending physician and a chief surgical resident. You will be an active participant in pre- and post-op management, surgery and clinic. Exposure to several subspecialties is facilitated through team assignments; vascular, bariatric 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. Like General Surgery residents, you 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 board-prepared or boardcertified physicians, residents receive training and experience in acute adult medical and surgical illnesses such as chest pain, stroke, myocardial infarction, syncope, pneumonia, acute cardiopulmonary arrest and trauma patient evaluation in our Level II Trauma Center. The educational emphasis is specific for emergency medicine and includes daily instruction and teaching, plus working closely with Internal Medicine and General Surgery residents. Didactic educational materials specific to emergency medicine are provided and interesting patient scenarios are formally presented at the end of the rotation.

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 discussed during personal emergency physician supervision.

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Pediatrics

This rotation will provide you with valuable experience in managing both well and sick infants, children and adolescents, as well as in interacting with concerned parents and family members. Pediatrics is our ambulatory rotation, and the emphasis is on outpatient care.

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 will teach you the principles of pediatric diagnosis, treatment,health maintenance and health education. You will work closely with attending physicians, as well as residents from Yale-New Haven Hospital.

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Electives

Working with the program director or another faculty advisor, you’ll arrange for electives oriented toward acute or ambulatory care. In addition to a two-week “selective” in radiology, other choices include anesthesiology, dermatology, endocrinology, gastroenterology, infectious diseases, neurology, ophthalmology, podiatry and radiation oncology among others.

You are encouraged to take the electives that interest you most and best match your career objectives. Most Transitional residents perform these electives at Saint Raphael’s, although they can also be done at Yale or the VA Connecticut Healthcare System West Haven campus. Most of our residency programs rotate through these centers. Up to four weeks of electives away
from Saint Raphael’s, including opportunities away from New Haven, may be arranged.

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Additional resources

For all residents, Saint Raphael’s Health Sciences Library and computer facilities are open 24 hours a day. More than 2,000 books and 400 journals are housed here, along with seven computers available for use. One computer has a CD burner and a scanner. The photocopier also offers scanning for the purpose of e-mailing. Fax machine is operational during staffed hours. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate, MDConsult, PubMed, Cochrane and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library.

Based on your interests, research and study opportunities are also available in a variety of clinical departments. These are arranged one-on-one with the program director or other faculty members.

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 [email protected]

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Page last updated on Dec. 11, 2008