PGY-2 Curriculum

Cardiovascular ICU

The CCU is often one of the most intense and challenging months of the residency. The service is comprised of a cardiology staff, fellows and several residents (both Family Medicine and Internal Medicine).

The service can have up to 20 patients at a time including

• Patients who are in the unit for MI's or to rule out MI's
• Arrhythmias
• Post-op CABG
• Other cardiac-related experiences

By the end, working up an MI and risk stratification is second nature.

Dermatology

During this month, you will work at Darnall taking care of ambulatory patients as well as consults.

You will experience a very broad range of common dermatological conditions. Additionally, the resident will see and perform a spectrum of office procedures and minor surgeries. One morning a week will be spent on laser therapy.

Emergency Medicine

During this month, you will be working at Darnall's bustling emergency department. We see the gamut of conditions; therefore, you’ll find ample opportunity for laceration repair, fracture assessment and trauma.

Evaluating complex emergency medical conditions will become second nature. Darnall and Scott & White consistently rank number one and two on the emergency medicine in-service exam.

You work 15 8-hour shifts during the month.

Family Medicine Hospital Service

As a second year resident you will be responsible for a majority of the patients on the service, assisting the interns and medical students with management of patients as needed. You’ll increase your patient care skills by developing a more thorough approach, utilizing skills learned during your internship and into the second year.

Infectious Disease

During this month, your primary responsibility is hospital consultations. There are three senior staff physicians who rotate as attendings on the service. Each consult is discussed and teaching points highlighted.

Additionally, daily lectures address a broad range of topics and focus on common conditions. Resident participation is encouraged, and reading assignments often complement the discussions.

Daily and weekend rounds allow you to reevaluate hospitalized patients and the effectiveness of their therapy.

Orthopedics

The VA Medical Center houses the Ortho rotation, with an average clinic day seeing more than 30 patients. Residing on a vast, enormously busy military base, the clinic meets with multitudinous fractures and injuries.

You will commonly tend to fractures to the:

• Wrist (including the scaphoid)
• Metacarpal
• Phalange
• Metatarsal (including the 5th or Jones fx)

As a resident, you will develop skills in:

• Evaluating major joints including the knee, wrist, hand and ankle
• Evaluating long bone fractures and injuries to the lumbar and cervical spine.
• Closed reductions and joint injections
• Placing short and long leg casts
• Ulnar gutter splints
• Thumb spica splints

Pediatrics

Darnall hosts this outstanding rotation as a community-based hospital service.

As a second year, you are given primary responsibility for your patients. During this rotation, you will have the opportunity to sharpen your clinical skills and blossom in the art of managing pediatric inpatients.

The resident is responsible for consultations from the ER, nursery, pediatric admissions and all neonatal resuscitations at delivery.

After work rounds there are daily small group learning sessions. Call nights can be intense; however, the opportunity for learning is wonderful.

Night Float

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

On all weekdays, Sunday through Thursday, the PGY1 or 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 lasts for 2 weeks, with weekends off. We have found this system conducive to better patient continuity, and the night float resident is more comfortable in 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 that are not on the night float enjoy a less hectic call schedule during the week.

Behavioral Science

The Behavioral Science Rotation prepares the family physician to address a variety of psychiatric issues with patients. The rotation’s goal is to invest the Resident with a working knowledge of topics in psychiatry, psychology, sociology, ethics and the physician-patient relationship.

The physician who is skilled in understanding, diagnosing and treating common psychiatric disorders will provide holistically informed medical care, with an appreciation for the subtle interplay among the variety of biopsychosocial factors that contribute to illness and healing.

Anesthesia

During this two week block you spend your time with the anesthesia department at the VAMC. During this time you will become comfortable with

• Pre-operative assessment of the medical patient
• Various methods of intubation,
• Placement of peripheral and central venous access and arterial lines

Block Clinic

During this two week rotation you will

• Explore options for pain management through the use of adjunctive therapies
• Learn the appropriate use and technique for various local and field blocks, trigger point injections
• Caudal and epidural injections for the management of the chronic pain patient
• Learn about adjuvant therapy for the management of pain with non-opiate therapies.

Infectious Disease

During this month, your primary responsibility is hospital consultations. There are three senior staff physicians who rotate as attendings on the service. Each consult is discussed and teaching points highlighted.

Additionally, daily lectures address a broad range of topics, and focus on common conditions. Resident participation is encouraged, and reading assignments often complement the discussions.

Daily and weekend rounds allow you to reevaluate hospitalized patients and the effectiveness of their therapy.

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