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Internal Medicine Residency - Services Information

Addictive Services

Division of Addiction Medicine/Chemical Dependency Unit maintains an active service responsible for treating and providing inpatient detox to different substance abuse patients.

Inpatient detox covers opioid, alcohol and benzodiazepines addiction. An extended alcohol and drug rehab unit is also under this service. Inpatient consultations are provided to patients on different services.

Allergy and Immunology

The Allergy and Immunology Division emphasizes outpatient diagnosis and the treatment of immunologic and allergic disorders. The Division conducts weekly sessions at faculty practice locations.

Medical residents and assigned students have the opportunity to evaluate patients in the faculty office setting as well as the more traditional clinic.

Residents become experienced in the recognition and management of common allergic disorders encountered in the practice of primary care general internal medicine. Assigned medical residents and students can also expect to learn the indications and techniques for performing skin testing.

All inpatient consultations are initially evaluated by the resident and then reviewed with the division's teaching staff.

The Allergy and Immunology Division conducts both formal and informal lectures, including Grand Rounds, on state-of-the-art diagnosis and treatment of allergies, asthma, and other immunologic disorders.

A student elective is available.

Ambulatory Medicine

The rotation schedule is based on a 4+1 structure where the residents spend 10 weeks per year in the outpatient setting. The resident's ambulatory experience occurs primarily in University Hospital's Medical Arts Pavilion, (MAP) and the teaching faculty's practice locations in the Staten Island Community. The MAP, a 55,000 square-foot technologically advanced facility housing a broad array of primary and subspecialty clinics with convenient on-site laboratory and radiology services, serves as an ideal site for the training of residents. Additional training sites include the private offices of many of our teaching faculty, where the intricacies of the private practice of medicine are taught. A faculty of over 50 full-time and part-time General Internists compose the primary care teaching staff and are dedicated to the ambulatory training of residents.

Patients recognize both their assigned resident and the teaching faculty as their primary care physicians. In the event of the resident's absence, the assigned faculty and another resident within the group practice will maintain continuity. A 24-hour patient answering service enables our medical residents to gain experience in telephone consultation, render total continuity of care, and reduce emergency visits and acute hospital admissions. When a patient does require hospitalization, the patient is admitted to the service of the Hospitalists. Residents are notified of the admission and are encouraged to follow that patient's progress through their acute illness. Upon discharge, the patient is given a follow-up appointment to his/her usual continuity clinic and assigned resident.

In addition to the resident's continuity experience, all medical residents, (preliminary and categorical) will rotate in the Primary Care Block Rotation. During these rotations, residents will expand their existing panel of patients by attending extra medical sessions. In addition, residents will be assigned to a variety of subspecialty clinics to provide exposure to ENT, Adolescent Medicine, Medical Gynecology, Ophthalmology, Orthopedics, Sports and Rehabilitation Medicine, Behavioral Medicine, Dermatology, Geriatrics, Allergy and Immunology, Pulmonary Medicine, Cardiology, Gastroenterology, Rheumatology, Neurology, and Nephrology. On occasion the residents are sent out into the community during their Primary Care Block Rotation to provide a wide range of educational and preventive services.

This rotation also includes a 12 noon conference covering topics in Ambulatory Medicine, as well as several projects including research and biostatistics, billing and coding, patient experience/patient relations, smoking cessation and other practice-based learning experience.

The PGY II and PGY III residents also attend a subspecialty clinic of their choice during their clinic week to prepare them for their future career path.

Medical Residents on Subspecialty Electives will also gain ambulatory experience by attending the corresponding subspecialty clinics once or twice per week. Ambulatory subspecialty clinic exposure during electives will allow residents to simultaneously experience both inpatient and outpatient aspects of the practice of an individual subspecialty, and therefore aid in the formulation of their career choices.

At the conclusion of three years, the resident will have rotated in a complementary fashion through all of these diverse experiences, and will be better prepared to serve their community regardless of their individual career paths.

A student elective is available in Primary Care Medicine.

Anticoagulation Service

The Anticoagulation Service is an outpatient program at Staten Island University Hospital, which was established for the purpose on managing and ensuring high quality care to patients receiving anticoagulation therapy. The team coordinates the ongoing treatment or prevention of many blood-clotting disorders including deep vein thrombosis, pulmonary emboli, mechanical heart valves, embolic stroke, atrial fibrillation and various hypercoaguable states.

Medical residents will have the opportunity to rotate through the Anticoagulation Service during their month on the Primary Care block. During this time the residents have the opportunity to observe the one on one interaction with the patient. The protocols for outpatient monitoring of anticoagulation, including bridging patients with low molecular weight heparin will be reviewed.
Students have the ability to rotate through this clinic during their ambulatory care rotation or primary care elective.

Cardiology

During the three-year medical residency training program, scheduled didactic and clinical experience in the Cardiology Division enables the graduating resident to effectively manage patients with cardiac disease. Members of the division conduct daily teaching rounds in the Coronary Care Unit, Telemetry Unit, and the remainder of the cardiology service. Residents interact with cardiology faculty and members of the cardiology fellowship program. There is a weekly cardiology clinic for residents supervised by cardiology faculty.

Echocardiograms and electrocardiograms are read daily with the assigned cardiology resident. Consultations and procedures are performed by the resident under the direct supervision of attending cardiologists.

There is a weekly conference emphasizing EKG interpretation and cardiac catheterization. A bi-weekly conference in general clinical cardiology is patient-oriented and reviews important aspects of patient care. Regular programs are held throughout the year in coronary care, cardiopulmonary resuscitation (ACLS), and electrocardiography.

Residents and fellows become experienced in radio-isotope cardiac scanning, diagnostic cardiac catheterization, echocardiography, electrocardiography, exercise and pharmacologic stress-testing.

In the electrophysiologic studies service, residents and fellows are exposed to the diagnosis and management of complex arrhythmias including the indications for permanent pacemakers and automatic indwelling cardiac defibrillators.

In addition to participating in the selection and care of patients undergoing cardiac catheterization, the residents rotate through the invasive cardiology division, including PTCA (percutaneous transluminal coronary angioplasty) and open-heart surgery.

The division is actively involved in clinical research. Participation by medical residents is strongly encouraged.

A student elective is available. A Cardiology fellowship is available. Three positions are available each year.

Critical Care

University Hospital's commitment to provide leading edge critical care support has resulted in the Division being responsible for 60 critical care beds. The critical care team sees patients in the medical / surgical intensive care units, coronary care units, post cardiac surgery units and the burn unit.

Residents are exposed to a wide variety of critical care patients and problems. The critical care units are fully equipped with state-of-the-art ventilatory support and monitoring capabilities. A director oversees each unit and a multidisciplinary team including medical intensivists, surgical intensivists, consultants, nutrition experts, nurses, pharmacists, respiratory therapists and social workers care for all patients.

Medical residents participate in daily multidisciplinary ICU rounds with the critical care faculty. Each patient is visited at the bedside and all important aspects of pathophysiology, diagnosis and treatment are discussed.

Residents are also involved in the very complex task of conferring with families through continuous family meetings during which issues such as "do not resuscitate" orders, prognosis, end-of-life care, and pain and suffering are addressed.

There is a daily noon lecture in the ICU/CCU.

A student elective is available. A Pulmonary/Critical Care fellowship is available.

Dermatology

The Dermatology Division provides a comprehensive educational program which includes Grand Rounds, an annual core review course, and a weekly didactic discussion of patients currently under evaluation.

The clinical experience in dermatology is integrated into the residents' training throughout the three years of the program. Residents actively participate in ambulatory dermatology sessions during the primary care block rotations.

Basic and clinical research projects abound in the division and are readily available to interested residents.

Emergency Medicine

The Department of Emergency Medicine serves as a receiving unit for all categories of emergencies referred from the city-wide Emergency Medical Services network, and records tens of thousands of visits each year.

The Department is staffed with a full-time board certified teaching faculty who provide supervision of medical residents 24 hours-a-day, seven-days-a-week. Medical residents are assigned to the Emergency Department/Urgent Care for a total of four weeks over the three-year residency program. Each patient is evaluated initially by the medical resident and then reviewed with the ED faculty member.

A one-half day Academic Day is held with the ED residents on Wednesday mornings.

A student elective is available.

Endocrinology & Metabolism

The Division of Endocrinology and Metabolism provides educational opportunities for resident physicians and students in a variety of ways. Core curriculum conferences in endocrinology are held, and the Division's faculty participates in a variety of review courses held throughout the academic year. Senior residents are assigned to an endocrinology rotation that offers intensive education in both ambulatory and inpatient endocrine care. Residents also have the opportunity to participate in the activities of the Diabetic Foot Program which offers exposure to sophisticated technology and techniques.

Inpatient consultations are initially seen by the resident and then reviewed with the attending endocrinologist during daily consultation rounds. Residents participate in the weekly Diabetes/Endocrine Clinic as well as a faculty-office practice experience in endocrinology. Residents are encouraged to develop and pursue faculty-mentored research projects in endocrinology.

A student elective is available.

Gastroenterology

The Gastroenterology Division provides medical residents with a core curriculum in gastroenterology through its bi-weekly didactic conferences and clinical rotations on the gastroenterology service. With assigned teaching staff supervision, residents perform GI consultations throughout the hospital and its ambulatory centers.

Each resident gains proficiency in flexible sigmoidoscopy and paracentesis. Residents assist in esophagoscopy, colonoscopy, small bowel biopsies, liver biopsies, manometry, pneumatic dilatation of the esophagus, ERCP, and endoscopic ultrasound (EUS).

University Hospital's endoscopy laboratory features modern equipment for video endoscopy and motility studies.

Medical residents and G.I. fellows from the Gastroenterology Fellowship Training Program interact with gastroenterology faculty during patient evaluation, while performing procedures on a busy academic clinical service. A variety of research projects are supported by the division.

A student elective is available. A Gastroenterolgoy fellowship program is also available. Two positions are available each year

Geriatrics

Throughout medical residency and in conjunction with the Division of Geriatrics, residents participate in a broad learning experience in geriatric medicine. By working along with Geriatric Division faculty members and fellows in the inpatient, long-term, and ambulatory care settings, residents gain familiarity with the unique medical, functional, and psychosocial aspects of caring for the elderly.

While assigned to the inpatient Geriatric Care Unit, the resident performs the initial evaluation and provides ongoing care to acutely ill elderly patients. The resident is an instrumental member of the interdisciplinary geriatric team that meets daily to discuss the clinical care of the patients. Team meetings and case-oriented discussions allow the resident to enhance his/her clinical knowledge base while learning the skills to transition patients to ambulatory care services.

During ambulatory outpatient sessions, the resident learns about care of the "well elderly" and implements the recommendations of healthcare maintenance guidelines. Invaluable experience is gained by exposure to private practice medical and geriatric patients.

A student elective is available.

Hematology/Oncology & Palliative

University Hospital's Hematology /Oncology Division offers a unique experience for medical residents. The hospital's state-of-the-art Nalitt Institute for Cancer and Blood-Related Diseases, opened in 1991, is New York State's first accredited free-standing ambulatory cancer center offering multidisciplinary care to patients with cancer and related blood diseases.

Residents perform inpatient hematology/oncology consultations directly supervised by the Institute's staff and participate in the interdisciplinary institution-wide tumor board. They are exposed to the hospital's transplantation program, and the radiation oncology service, including a stereotactic radiosurgery division. Medical residents perform and interpret peripheral blood smears.

Residents participate in daily bedside teaching rounds when rotating on the inpatient oncology unit. The resident assigned to the Hematology/Oncology rotation also spends several sessions in the ambulatory hematology/oncology service with the Division's teaching staff.

The Institute's hematology laboratory provides all basic studies. The lab features a clotting laboratory and a plasmapheresis unit for plasma exchange. Sophisticated studies necessary for complete hematologic evaluations are available in the general or research laboratories.

The Division carries out a number of clinical research projects and encourages medical resident participation. In addition, the hospital participates in national cancer study groups such as the Eastern Cooperative Oncology Group (ECOG).

Residents rotating through hematology/oncology are also exposed to both the Palliative Care Division and to Hospice for end-of-life care. During the year, a basic course in palliative care is offered to all house staff.

The medical management of pain encountered in patients on the oncology service, as well as in the palliative care division and the hospice service, is emphasized on both didactic sessions and the consultation service.

A program to minimize the unnecessary use of blood and blood products is a part of the learning experience.

A student elective is available. A hematology/oncology fellowship program is also available. Three positions are available each year.

Hospitalist Services

The Hospitalist division of medicine at Staten Island University Hospital, under the direction of Aaron Gottesman, M.D., F.A.C.P.,Director of Service, serves as the foundation for the inpatient experience of the residency program. Consisting of 27 exclusively board-certified physicians, the hospitalists are involved in many teaching activities including morning reports, teaching attending rounds, and bedside clinical examinations. They also serve as mentors for many of the residents as well as preceptors in resident-oriented research activities.

Since the hospitalists are available in-house 24/7 and attend to 60% of the patients admitted in SlUH, they develop close working relationships with the residents in all areas of clinical care. At night, they provide senior medical leadership in the hospital and general supervision and teaching to the night float residents. The hospitalists are consistently ranked very highly by the house staff and continue to inspire residents to pursue careers in the fastest growing specialty in America.

A student elective is available.

Infectious Diseases

The Infectious Diseases Division conducts daily rounds throughout the hospital interacting closely with the medical resident staff. Each resident on the I.D. rotation is assigned 3-5 consultations per day. Infectious Diseases faculty reviews each consultation at the bedside with the medical residents and follows the progress of active patients on the service.

Residents scheduled for the infectious diseases rotation are assigned to both the inpatient consultation service, as well as the ambulatory primary care HIV clinic.

The Division is involved actively in a variety of research projects including sexually- transmitted diseases, HIV infection, infection control and the clinical evaluation of newly-developed antibiotics. Residents and students actively participate in these projects generated by the Infectious Diseases Division and have published numerous articles in peer-reviewed journals.

A student elective is available.

Internal Medicine

The internal medicine faculty is comprised of full-time and part-time on site attending physicians as well as a large cadre of private practitioners. The division is responsible for the vast majority of the general medical bedside teaching for both residents and students. The attending of record for each patient reviews the daily care with the resident assigned to the case, which provides the necessary supervision required to render high quality patient care.

The teaching venues on our general medical floors include a 1-1 1/2 hour patient care rounds and a one hour attending rounds. Each of these academic settings has its own design and mission for teaching. During these meetings, residents and students present their patient cases and are encouraged to lead the discussion. A review of relevant literature is also accomplished at these times.

Residents on the general medical service learn how to effectively care for a patient from the initial acute phase of the patient's admission all the way through the discharge process. Besides gaining a wealth of clinical knowledge, the residents are also taught the proper utilization of resources, the creation of a discharge summary, the correct writing of the patient's discharge summary and how to function as a member of the treatment team.

Each morning the residents attend Board review morning questions from 7:30-8:00 AM, followed by either MKSAP given by a subspecialist twice weekly or Harrison's Review twice weekly. The three scheduled noon lecture series consists of topics from the core lecture series, critical care and primary care. Three times per week attending rounds are held from 4-5 PM. Journal club is held between 3-4 PM on Wednesdays. There is a monthly Morbity and Mortality review and a monthly multidisciplinary clinical case presentation.

Residents are assigned to Simulation Laboratory to gain expertise in a large number of procedures, including central line placement, paracentesis, arthrocentesis and thoracentesis.

Nephrology

Nephrology residents become proficient in the diagnosis and management of patients with renal disease, both acute and chronic. University Hospital 's large hemodialysis population, with hundreds of patients under treatment, offers ample opportunity to learn the principles and practice of peritoneal dialysis, hemodialysis and renal transplantation.

The Nephrology Division conducts daily rounds and three conferences per week for residents. It supervises an active consultation service and renal hypertension clinic dealing with both common and unusual renal problems such as proteinuria, hematuria, hypertension, nephrolithiasis, glomerular diseases, nephritic syndrome, renal artery stenosis, amyloid and other studies.

The 24-hour availability of acute hemodialysis support systems and the significant patient population receiving dialytic therapy provide an excellent foundation for the education of the medical resident in the principles of nephrology.

A student elective is available. A Nephrology fellowship is available. Two positions are available each year

Neurology

Medical residents become adept at performing detailed neurologic histories and physical examinations while learning the indications for neuroimaging studies and techniques for lumbar puncture and spinal fluid analysis during a four-week block elective.

The faculty conducts daily teaching rounds, a weekly ambulatory neurology session, and presents patient-oriented conferences three times a week on current clinical neurologic problems. Also, didactic lectures on various topics in clinical neurology are conducted and quarterly Grand Rounds in neurology are presented by guest lecturers.

The service performs electromyography, electroencephalography and evoked potential studies. Residents learn the indications and interpretations of these studies, as well as CT, MRI, and PET Scanning.

The hospital's Parkinson's Disease, Epilepsy and Multiple Sclerosis Centers maintain staff involvement on the cutting-edge of research and clinical developments. The neurology teaching staff spends four to five hours each day reviewing clinical problems with the residents and assigned medical students on the medical floors, neurosciences unit, and Ambulatory Care Center. A four-bed monitored Epilepsy Unit and new Stroke Unit offer high quality patient care and an excellent learning opportunity.

A student elective is available.

Nutrition

Medical residents perform nutritional assessments on assigned consultations from all services in the hospital. Findings are reviewed on daily rounds and patient management plans are then formulated, including disease-specific diets, enteral feedings and parenteral nutritional support.

House staff is exposed to a wide array of nutritional and metabolic disorders and is taught to determine the appropriate route of therapy in each situation, including the intricacies of TPN formulation.

The management of home enteral and home parenteral therapies is learned through the clinical nutrition service. In the ambulatory setting, the increasing importance of dietary counseling for disease prevention, particularly regarding heart disease, obesity and cancer, is emphasized.

Pulmonary/Sleep Medicine

University Hospital's innovative brachytherapy program for lung carcinoma and its Sleep Apnea Center underscore the educational and research opportunities that exist for medical residents rotating through the Pulmonary Division during their training.

The Division interacts with residents in an ongoing fashion during all three years of residency training through daily teaching rounds on the medical floors, intensive care units and Ambulatory Care Department. The senior medical resident on the pulmonary rotation spends one month performing consultations under faculty supervision and participates actively in the pulmonary function lab and special care units.

The pulmonary service provides 24-hour-a-day availability of respiratory therapists for arterial blood gas determinations and ventilator maintenance. Full pulmonary function testing, including spirometry, lung volumes and diffusion studies, are available on a daily basis. Cardiopulmonary exercise testing, a fully equipped sleep laboratory, pulmonary angiography, fiberoptic bronchoscopy, thoracentesis, and iridium brachytherapy are available on a continual basis. Residents participate in these procedures under the supervision of the pulmonary teaching staff.

A student elective is available. A Pulmonary/Critical Care fellowship is available. Two positions are available each year.

Rhematology

In the Rheumatology Division, residents are exposed to a wide variety of rheumatologic disorders, in the hospital, office and clinic settings. Residents are expected to become familiar with signs, symptoms and findings of rheumatologic diseases. They are expected to perform histories and physicals, joint fluid examinations, interpretation of pertinent laboratory studies and imaging procedures during their rotation on this service.

Consultations are seen on a daily basis by rheumatology staff and are often initially evaluated by the medical resident on service. Residents are expected to participate in office and clinic evaluation of patients in three-hour sessions, several days a week, ensuring a diversified ambulatory exposure in rheumatology.

Specific rheumatologic topics are discussed in detail by attendings through several educational forums, including noon conferences, Harrison's reviews, MKSAP reviews and Rheumatology Grand Rounds. Rotations through orthopedics, sports medicine and rehabilitation medicine are an important aspect of this rotation.

A curriculum in basic rheumatology is presented each year to the medical house staff and new developments are stressed at Rheumatology Grand Rounds.

A student elective is available.

Women's Health

The Medical Women's Health Division enhances the education and training of residents and fellows in the comprehensive care of women. Physicians are taught to approach women through a biosocial model and promote wellness by preventing disease, treating medical disorders and providing ambulatory gynecologic care. The Division's educational objectives are met by providing residents with a core curriculum and rotations through subspecialty clinics.

During the primary care rotations, residents participate in multiple specialty clinics which provide the clinical knowledge and experience to focus on psychosocial issues, breast health, cancer screening, cardiovascular disease prevention, osteoporosis treatment and prevention, gender differences of chronic medical problems, medical disorders during pregnancy, and ambulatory gynecology.

The medical gynecology clinic is dedicated to the comprehensive care of women. During these sessions, residents are directly supervised by attending physicians with an expertise in women's health. Attending preceptors evaluate the residents' competency in performing a complete well-woman assessment, including gynecologic care and necessary procedural skills. Group discussions are held after each clinic, and pertinent topics and journal articles are reviewed.

The didactic component of the women's health curriculum is extensive. During the ambulatory block rotation, morning conferences emphasize important common problems. Women's health symposiums and Grand Rounds are presented by hospital faculty and national experts.

The Division is actively involved in various research studies pertaining to women's health including clinical studies and basic research. Resident projects have been published in peer review journals and presented at national and local meetings.

A student elective is available.

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