Senior Rotations (PGY-2 and PGY-3 Residents)
The inpatient medicine service consists of a team of one Senior Resident and two PGY-1 Residents caring for up to 7 patients under the supervision of a Pulmonology/Critical Care Attending. (We frequently have USF medical students rotating on our service as well). Each morning we pre-round on our assigned patients, then attend Morning Report at 8am, at which a teaching case is presented and the admissions from the previous night are discussed. Next we round as a team. At the bedside, the resident presents their patient to the Attending and while we review the electronic health record for pertinent labs or images. Then team sees the patient, and as a team we create our plan of care. This is very much a group effort; our Attendings allow us to make our own decisions as long as we first do no harm! After rounds we attend noon conference, then return to the hospital. Our afternoons are spent following up on the patients, their labs, imaging, tests and consults. The afternoons are also spent discharging patients, admitting new patients, and teaching. One afternoon per week, the Residents are excused from inpatient medicine responsibilities so that they can attend to their continuity patients in clinic.
During this week-long rotation (Monday-Sunday), we care for our Turley Family Health Center patients who have been admitted to Morton Plant hospital. This in-patient team usually consists of one senior Resident and one Family Medicine attending. Each day, the resident pre-rounds on all of the patients, and then attends the 8am Morning Report with the Medicine team, where we learn about the admissions from the night before and participate in a teaching case. The Attending and Resident then round on all of the Turley patients together. The senior Resident has only one half-day of clinic scheduled during the week so he/she is available in the hospital most afternoons to follow-up on the morning's work and admit new patients. This rotation is one of our favorites as we have the opportunity to run the service in our own way and to spend quality one-on-one teaching time with the attending.
We spend four weeks in the second year and two weeks in the third year working with Obstetricians and Gynecologists in the Turley CCOE (Community Center of Excellence in Women's Health), learning the presentation and treatment of common gynecologic problems. We have further opportunities to manage these problems in our own patients at Turley. During these rotations, we also learn to perform various gynecologic procedures such as colposcopies, endometrial biopsies, and IUD insertions.
Our cardiology rotation is spent with one of two local private groups. Our time is divided at our discretion between the clinic, the hospital, stress testing, and procedures such as cardiac catheterizations and electrophysiologic studies. The cardiologists are excellent and enjoy teaching.
During this rotation, we work with a community Pediatrician, but we take a very active role seeing patients on our own and creating our own assessments and plans.
This rotation is based at Mease Countryside Hospital ER due to their higher pediatric volume. We see pediatric patients on our own and order any appropriate labs or imaging. We staff each case with the ER Attending and determine whether the child requires admission or can be treated and discharged home. Like the adult ER experience, it tends to be a fast-paced and fun rotation.
During this four week rotation at the USF Dermatology Clinic, we work directly with Dermatology Attendings and Residents. The Dermatology Clinic at USF provides an opportunity to see a high volume of patients with a variety of problems and you have opportunities to do dermatological procedures. This is our opportunity to become very comfortable performing biopsies, cryotherapy and electrocautery and desiccation.
In both second and third year, we rotate with several different orthopedics and sports medicine groups. Most of our time is spent in clinic, becoming comfortable diagnosing and treating the more common orthopedic problems and sports injuries. The volume of patients we are exposed to is phenomenal! We are exposed to musculoskeletal ultrasound in the evaluation of sports medicine patients. The remainder of the time we are in the operating room assisting with joint replacements, arthroscopies, etc. There are also numerous opportunities to work as a team physician for many local high schools and well as mass participation events.
During this rotation, we work with a local group consisting of interventional radiologists, neuroradiologists, and nuclear medicine physicians. This is a very enjoyable rotation as the group is fun and we have the opportunity to perform procedures ourselves. We spend at least one day learning about the indications for and the interpretation of the many nuclear medicine studies. And, of course, we read films!
This rotation is spent in the Morton Plant ICU, working with the Pulmonology/Critical Care physicians who are also our Medicine attendings. It is an excellent experience with a lot of one-on-one teaching. We spend our mornings pre-rounding on a few ICU patients, then rounding as an inter-disciplinary team with a pharmacist, nutritionist, clergyman, social worker, nurse, and attending on all of the ICU patients. Our afternoons are spent following up on the morning’s treatment plan, admitting and discharging patients, and performing procedures such as central line placements. Here we become comfortable (or as comfortable as possible!) managing critically ill patients.
This one-week rotation is spent at the Turley Center. It is paired with a Turley Service week, so that you spend one week in the hospital, then one week in the clinic, or vice versa. For most of this week you are the acute doctor, which means that you see patients who are acutely ill and could not wait for an appointment with their usual doctor. This tends to be fast-paced and rewarding in that you are treating problems that are quickly and easily solved (UTIs, OM, etc.) and are common problems you will typically see in a busy family practice.
During elective time, you can create any rotation you desire. Many residents choose additional exposure to specialty rotations. Some past residents have gone on mission trips, written papers for publication, or given community presentations. It is an excellent time for further study in any area of medicine that particularly interests you. Some of the electives that past residents have done include:
This is another outpatient-based community rotation where we work with private practice neurologists and learn about the office work-up of common neurological problems such as vertigo, headaches, dizziness, and neuropathy. We also learn about the office management of chronic diseases like multiple sclerosis. Finally, we have the opportunity to see interesting hospital consults including strokes and seizures.
During this rotation we work with a community ENT physician, learning to become comfortable with the more common ENT problems and the indications for referral. We have the opportunity to observe procedures such as rhinolaryngoscopy.
Our time in ophthalmology is spent with a community physician both in the office and the OR becoming comfortable with the fundoscopic exam and the management of the more common ophthalmologic problems such as glaucoma, cataracts, and eye injuries.
During this rotation, we work with a group of community urologists in their offices. We are exposed to a wide range of urologic problems and become comfortable with the office management of the more common problems as well as indications for referral. We also view procedures such as stone extractions, retrograde pyelograms and prostatic ultrasounds.
This is a very flexible, independent rotation designed to familiarize us with the community resources available to our patients in Pinellas County. Some of our options include working with the health department, completing school screenings, and participating in the investigation of public health hazards.
This rotation is spent with community endocrinologists. We become very comfortable with the management of diabetes with both insulin and oral medications. We have the opportunity to spend time with Morton Plant Mease dietitians and nurse educators so that we are comfortable giving dietary advice on counting carbs, reducing saturated fat intake, or avoiding salt. Finally, we are exposed to the work-up of common endocrine problems such as a thyroid nodule and galactorrhea.
This is another flexible rotation designed to teach us about different types of practice settings, personal and business finance, coding and billing, contract negotiation (personal employment and managed care), personnel management, asset protection, practice valuation, office design, etc. We spend time with an experienced physician practice leader and have the opportunity to visit and observe other practice sites, as well as to complete a project that is relevant to our future practice intentions. This may involve a detailed analysis of one or more prospective practice opportunities—direct preparation for selecting and securing a post-residency position.