Notable Electives at HUMC Internal Medicine
General Cardiology
Typical Day on the RotationOn the cardiology rotation, you rotate through different subspecialties each day of the week for the first week. This can include general cardiology, heart failure or electrophysiology, among others. During the second week, you can rotate through the service of your choice. For general cardiology consults, this typically means seeing new patients on the floors or in the ED.
Skills Learned on the Rotation
- Echocardiogram interpretation
- Swan Ganz interpretation, hypertension management
- heart failure management
- atrial fibrillation management
Common Diagnoses Seen
- Acute coronary syndrome (NSTEMI/STEMI)
- Heart failure (HFrEF/HFpEF)
- Valvular disease
- Atrial fibrillation/atrial flutter
- Cardiac syncope
- Pulmonary embolism
- Embolic cerebrovascular accident
- Symptomatic bradycardia
- Pericarditis
Structural Heart
Typical Day on the Rotation
A typical day starts with bedside rounds at 6:30 AM, so you generally come in around 6-6:15 AM to pre-round and chart review. Most days of the week, there is a multidisciplinary cardiology meeting from 7-8 AM to present upcoming cases and discuss the best approach to management. The rest of the day from 8 AM to 5 PM consists of procedures in the hybrid cath lab (TAVR, MitraClip, Watchman, ASD closure, etc). You can observe from inside the lab or the control room. This is also a good time to observe and learn about the advanced imaging techniques and intra-op TEEs that are being done. Additionally, you will get outpatient experience in their clinic two afternoons a week.
Skills Learned on the Rotation
- ECHO imaging interpretation and measurements
Common Diagnoses Seen
- Aortic stenosis
- Mitral stenosis
- Mitral regurgitation
- Tricuspid regurgitation
- Atrial septal defects and closure
- Atrial appendages and closure
Pulmonology
Typical Day on the Rotation
The inpatient pulmonary rotation typically consists of pre-rounding on the pulmonary consult census and independent rounding on assigned patients, followed by rounds with the pulmonary attending. Residents can strengthen their diagnosis and management skills of a variety of pulmonary pathologies. Residents also can perform bedside ultrasound and procedures alongside the attending such as thoracenteses or pigtail catheter placement. Additionally, residents can observe more advanced interventional pulmonary procedures in the bronchoscopy suite.
Skills Learned on the Rotation
- Supplemental oxygen management
- Pigtail catheter management
- Bronchodilator management
Common Diagnoses Seen
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Interstitial lung disease (ILD)
- Vasculitis
- Pneumonia
- Pleural effusions
- Pulmonary nodules
Ultrasound
Typical Day on the Rotation
Relative to other rotations at HUMC, the ultrasound rotation is largely self-directed. On the first day, you will meet with the attending to go over the basics of ultrasound technique and learn about a variety of views that you will work on perfecting over the course of the rotation. You will typically round with the ICU team and ultrasound the patients in the unit. You may also be asked to ultrasound patients in the step-down unit as well as patients on the pulmonary consult service. By the end of the rotation, you will review your saved images with the attending to discuss how to improve the quality of your images.
Skills Learned on the Rotation
- Identifying pleural effusion/lung consolidation
- Estimation of LVEF
- Estimation of RV function
- Pericardial effusion identification
- Valvular dysfunction
Common Diagnoses Seen
- Pleural effusion
- Pericardial effusion
- Acute hypoxic respiratory failure
- Heart failure exacerbation
- Shock
Gastroenterology
Typical Day on the Rotation
The gastroenterology rotation typically starts with rounding and follow up on patients in the morning. You will have the opportunity to see new consults and discuss them with the attending as the morning progresses. The afternoon is typically reserved for procedures. You will be exposed to a variety of procedures including colonoscopy, EGD, ERCP, EUS and capsule endoscopy.
Skills Learned on the Rotation
- Management of GI bleeding (UGIB and LGIB)
Common Diagnoses Seen
- GI bleeding (UGIB/LGIB)
- Peptic ulcer disease
- Inflammatory bowel disease
- Cholecystitis
- Choledocholithiasis
- Hepatitis
- Liver cirrhosis
- Pancreatitis
- Pancreatic masses
Lymphoma
Typical Day on the Rotation
A typical day starts at 8:30 AM with seeing your designated patients before inpatient rounds with the attending for the week. After rounds, you review imaging with the radiologist and go over histopathology slides with the pathologist to confirm diagnoses for new patients. In the afternoon, you see new patients in the outpatient lymphoma clinic. All attendings love to teach about the treatment plans and chemotherapy regimens for each type of lymphoma.
Skills Learned on the Rotation
- Histopathology review
- Chemotherapy
Common Diagnoses Seen
- Lymphoma
Multiple Myeloma
Typical Day on the Rotation
Your day will typically start at 9 AM. Time on this rotation is primarily spent in the outpatient setting. Additionally, you may see some patients in the hospital including new consults and patients undergoing treatment (chemotherapy, BMT, CAR-T, etc.). Over the course of the rotation, you will also review the most up-to-date literature with the attending to better understand the pathogenesis and current trends in treatment.
Skills Learned on the Rotation
- Bone marrow biopsy
Common Diagnoses Seen
- Multiple myeloma
- Monoclonal gammopathy of undetermined significance
- Monoclonal gammopathy of renal significance
- Smoldering multiple myeloma
- Amyloidosis
- Waldenstrom macroglobulinemia
Infectious Disease
Typical Day on the Rotation
A typical day on the infectious disease service typically starts around 8:30 AM. You will get consults throughout the day and will generally work with one to two attendings over the course of the day on your various consults. In addition to inpatient consults, you may also choose to attend the clinic once a week for a half session. The HIV clinic is especially helpful for learning about the new drugs on the market for managing this condition.
Skills Learned on the Rotation
- Antibiotic management
- HIV medications
Common Diagnoses Seen
- Pneumonia
- Osteomyelitis
- HIV
- Endocarditis
- Meningitis
Rheumatology
Typical Day on the Rotation
The day generally starts around 8 or 9 AM. You will see several patients with different musculoskeletal concerns and rheumatologic conditions. These cases will then be discussed with the attending. Additionally, you will have the opportunity to perform arthrocentesis and practice injection skills if there is an indication for the procedure to be performed.
Skills Learned on the Rotation
- Rheumatologic serology interpretation
- Arthrocentesis
- Intraarticular steroid injection
Common Diagnoses Seen
- Lupus
- Osteoporosis
- Vasculitis
- Osteoarthritis
Geriatrics
Typical Day on the Rotation
The day generally starts around 8 or 9 AM with a teaching activity in the outpatient geriatric clinic. This is followed by rounding on the inpatient service with the attending. In the afternoon, you have the opportunity to see patients in the outpatient setting.
Skills Learned on the Rotation
- Delirium prevention and management
- Goals of care discussions
Common Diagnoses Seen
- Dementia
- Delirium
- Hip Fractures
- Anemia
- Vitamin B12 deficiency
- Vitamin D deficiency
- Osteoporosis
Allergy and Immunology
Typical Day on the Rotation
You'll mostly be in the outpatient Allergy/Immunology clinic working with the different Allergy/Immunologists there. The day typically starts at 8 or 9 AM. The attendings see both pediatric and adult patients, so you'll get to see patients of all ages. In the 'office area' half of the clinic, you'll typically spend your time shadowing the different attendings as they see patients during their office visits- both follow up and new patient visits- and you'll see a diverse range of allergic and immunologic conditions. In the other half of the clinic, you'll get to see patients with acquired immunodeficiencies (typically acquired hypogammaglobulinemia) receiving their monthly IVIG infusions. In this side of the clinic, this is also where the oral food challenges take place, and you'll get to see a variety of different challenges taking place (peanuts, almonds, eggs, shellfish, etc.) Occasionally, if one of the attendings happens to be on call that week, then you'll get to see the new inpatient consults. Seeing consults is a great learning experience because you get to see such a diverse pathology. You'll get consults from both the inpatient Medicine and inpatient Pediatric services. Sometimes the consult will also be for a specific desensitization protocol (for Bactrim or Aspirin, etc.) or for inpatient antibiotic testing, which is very interesting to see.
Skills Learned on the Rotation
- Intradermal skin testing
- Pulmonary function testing
- Desensitization protocols
- Drug testing protocols
- Patch testing
- Food allergy challenges
Common Diagnoses Seen
- Food protein induced enterocolitis syndrome (FPIES)
- Eosinophilic asthma
- Complement deficiencies
- Systemic mastocytosis
- Acquired immunodeficiencies
- Urticaria
- Allergic and non-allergic rhinitis
- Hypersensitivity reactions
- Dermatitis
- Angioedema
- Eosinophilic esophagitis
Nephrology
Typical Day on the Rotation
The day starts around 9 AM in the hospital and you typically see two to three patients on your own and meet up with the attending to discuss treatment plans for these patients. The day usually ends around 3pm. You will have the opportunity to attend clinic half days throughout the rotation as well.
Skills Learned on the Rotation
- Hemodialysis indications
- Determining pre-renal vs intrinsic vs post-renal etiology of AKI
Common Diagnoses Seen
- Acute kidney injury
- End-stage renal disease
- Hyponatremia/hypernatremia
- Hyperkalemia
- Syndrome of inappropriate diuretic hormone (SIADH) secretion
- Tumor lysis syndrome (TLS)
Stroke Neurology
Typical Day on the Rotation
You start your day on the stroke neurology service around 8 AM. You are assigned a certain number of patients from the consultation list that you are required to go round on in the morning in order to later discuss with the attending. You also respond to any “CODE STROKE” activations where a patient is suspected of having a stroke. You will assess patients with the team and determine if they truly are having a stroke and have an indication for acute intervention. In the afternoons, you occasionally go to outpatient neurology services such as the headache, stroke and general neurology clinics. Additionally, there are days you are assigned to work with the outpatient and inpatient PT, OT, and speech pathology services.
Skills Learned on the Rotation
- National Institutes of Health Stroke Scale (NIHSS) use
Common Diagnoses Seen
- Ischemic cerebrovascular accident
- hemorrhagic cerebrovascular accident
Endocrinology
Typical Day on the Rotation
The day starts around 9 AM. If the attending has clinic in the morning, you may start rounds in the afternoon. Before rounds you would chart review and see the patients. You will usually get emailed patients to see the day before. If more consults come in during the day the attending will let you know. After rounds, you finish up notes. You see a variety of cases! Diabetes is the most common consult, but you do get consulted for adrenal insufficiency, thyroid issues or patients who are post-pituitary resection.
Skills Learned on the Rotation
- Inpatient diabetes management
Common Diagnoses Seen
- Diabetes
- Hypothyroidism/hyperthyroidism
- Adrenal insufficiency
- Post-pituitary resection