PGY-1 Rotation

Cardiology

Cardiology consists of an inpatient service at the VA. Residents work closely with the attending cardiologist in:

• Training in reading EKGs
• Performing and interpreting stress EKGs
• Reviewing ECHOs
• Conducting rounds at the VA

Focus is on the evaluation, workup and treatment of the cardiac patient.

Family Medicine Clinic

This is one of the most enjoyable months of the first year, as it is what we are all training for. You will spend the entire month at your assigned clinic seeing patients every thirty minutes. Visits include:

• Acute care for colds and allergies,
• Routine health visits
• Fractures
• School physicals

You’ll also treat newly manifested disorders such as:

• Diabetes
• Chest pain
• Other common medical conditions

Family Medicine Hospital Service

The resident will perform this rotation at Scott & White, caring for family medicine patients admitted from the "quad-clinic" area of Belton, Killeen, Santa Fe and Northside.

The service averages 12-16 patients a day, but is very busy due to a quick turnover in patients. Residents often remark that the Family Medicine service is one of the busiest months in each year.

The service spans infants to geriatrics and affords the opportunity for many procedures such as:

• Central lines
• Thorocentesis
• Lumbar punctures
• Paracentesis

Newborn Nursery

At Scott & White, you will work alongside our Neonatology staff in our bustling newborn nursery/NICU. You will see the full spectrum of newborn care from the routine to the complex patient.

The rotation consists of daily work rounds in the NICU and couplet care ward. The resident is responsible as an active participant in deliveries and will attain experience in neonatal resuscitation. Call is every fourth night.

In addition to performing the important newborn exams, the resident will perform a multitude of procedures including:

• Circumcisions
• Arterial blood gas
• Intubation
• Umbilical artery/vein catheter placement
• Ventilator management
• Tube feeds

Obstetrics

Darnall has combined with Brook Army and Wilford Hall to create a military OB/GYN residency in this area.

While the 250 to 300 deliveries a month keep things busy, the residents and staff provide good training and support in the management and delivery of babies.

During your month at Darnall, you will:

• Perform many vaginal deliveries
• Scrub in on c-sections
• Run the triage clinic
• Perform abdominal and vaginal ultrasounds
• Respond to obstetric emergencies on the floor and consults from the emergency department

A second month of Obstetrics is spent at Scott and White. During this month you will spend two weeks working the labor deck during the day with the obstetric team, and two weks working the labor deck at night with the obstetric night float.

As a tertiary medical center, the patient mix is more complex—from drop-in patients who have received no prenatal care, to multiple gestation pregnancies from fertility treatments.

The obsterical experience at Scott and White offers exposure to the most common complications of pregnancy (diabetes and pre-eclampsia) and lively discussions regarding management of patients in all stages of pregnancy.

Pediatrics

Scott & White is the location for this rotation. As a first year, you are treated as a pediatric resident. You are an equal on the team in caring for children admitted from the ER and from the pediatric clinic.

Pediatric admissions correspond to the seasons including RSV and asthma exacerbations during the winter.

With active pediatric hematology/oncology and pulmonary services, we commonly see neutropenic fever and cystic fibrosis.

Teaching comes in several forms including important issues during attending rounds, formal attending presentations and medical student presentations.

Surgery

Surgery is done at the VA. You will focus primarily on outpatient office-based surgery on a daily basis. There are typically eight to twelve cases per day.

In addition, the resident works with the plastic surgeons on to two days a week assisting and performing a wide variety of simple to complex office-based procedures. This is a very fruitful month, as you will become comfortable with office-based minor surgery.

Night Float

We employ a night float system for coverage on the Family Medicine Hospital Service.

On all weekdays, Sunday through Thursday, the PGY1 and PGY2 resident will cover all patient admissions and ward calls from checkout at 6:00 p.m. until morning report at 7:30 a.m.

A night float rotation will last for two weeks, with weekends off. We have found this system conducive to better patient continuity and the night float resident is more comfortable handling inpatient care problems than in a traditional random-type call schedule.

This environment promotes more accurate and consistent teaching from the attending physician and PGY3 resident. Also, residents who are not on the night float enjoy a less hectic call schedule during the week.

Ophthalmology

You will spend most of your time in the ophthalmology clinic seeing a wide variety of eye conditions, although you will also see consults at the hospital. You will learn to recognize and treat common ophthalmologic problems, including:

• Glaucoma
• Foreign bodies
• "Red eye"
• "Painful eye"

Urology

As a urology resident, you learn to manage many special issues common to urology including:

• Evaluation and treatment of incontinence
• Microscopic and gross hematuria
• BPH
• Elevated PSA marker
• Indications and complications of cystoscopy
• Therapeutic options for prostate cancer

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