Program Overview

The Department of Internal Medicine at the University of Kentucky offers three residency training tracks:

Categorical - (3 years)

This track is the traditional track for most residents. Residents who complete this track are well prepared to pursue a subspecialty fellowship, work as a hospitalist or enter a general Internal Medicine practice. There are 17-19 categorical positions each year.

Primary Care - (3 years)

The Primary Care track is geared towards those who are interested in primary care medicine. More ambulatory care months as well as a yearly off-site rural rotation enable graduates of this track to practice general Internal Medicine or pursue specialty training. There are four to six primary care positions in each year of this program.

Medicine/Pediatrics - (4 years)

The Med/Peds track is a four-year program offering a unique blending of Medicine and Pediatrics. These residents alternate between Internal Medicine and Pediatrics every four months for the four years of training. By completing two years of both medicine and pediatrics, the graduates of this program are board eligible for both Internal Medicine and Pediatrics. There are 5-6 Med-Peds positions each year.

Preliminary Year - (1 year)

We offer a general preliminary internship for individuals who require this prior to their residency. This is suitable for persons entering fields such as radiology, dermatology, or the Armed Forces. This typically consists of 7 ward months (no night call), night float, electives, and vacation.

2008-2009 Anticipated Yearly Schedule: By Year and by Program

^*The average number of nights in-house over the year is approximately 30-35 depending on year and track.

Rotational Structure

Inpatient Ward Teams

• 9 General Medicine ward teams (4 at VAMC, 3 at UKMC, 2 at Good Samaritan)
• 3 unit teams (UK ICU; UK CCU; VA ICU/CCU)
• Oncology inpatient team (UKMC)
• Hematologic Malignancy team (UKMC)

Teaching Team Structure at University of Kentucky Medical Center (UKMC)

The General Medicine ward structure at UK consists of one attending, one resident, two interns, two students on the three ward teams – MT 1-3. Here in our quartenary acute care hospital we see patients with anything and everything—making this a great learning climate. Rather than a set admitting schedule, we target a team census of 8-10 patients. Every third day, one team will stay until 7 PM for evening admissions and check-out to the night team who admits patients until 7 AM. There is also a private hospitalist service that cares for about a third of the admitted patients (the majority of post-procedure, ICU transfer or protocol-driven patients).

Teaching Team Structure at UK Good Samaritan (GS)

The structure of the teaching services at UK Good Samaritan is a nice blend of community hospital and academic medical center, located just 3 blocks (a short walk) from the medical center. There are 2 teams with an attending, resident, and intern each, but they will often work together, sharing admissions as well as teaching rounds. Here residents work side-by-side with their attending in a more informal atmosphere with the flavor of a community hospital experience but with all the specialized services of an academic medical center. There is no overnight call (a private hospitalist service admits at night) and we target an average team census of 8-10 patients who are shared by the intern and resident. You will have at least one weekend day off per week.

Teaching Team Structure at Veteran's Administration Hospital (VA)

Like most VA hospitals, this provides our residents a strong experience with “bread-and-butter” Internal Medicine—heart failure, COPD exacerbations, acute coronary syndromes, renal failure and the like. The ward structure at the VA is a traditional format with one attending, one resident, two interns, and two students on the four ward teams – Orange, Purple, Green and Red. These four teams have call every fourth night until 8PM with an admitting night-float service (overnight call on Friday and Saturday only). The post call team will take no admissions. On non-call days, your team will admit 3-4 patients through morning or early afternoon making it easy to get home for dinner!

Subspecialty Services at UKMC

Oncology Ward Team: This service is composed of 2 interns, a Hematology/Oncology fellow, and attending. Interns care for patients they admit between the hours of 8:00 – 4:30 Monday through Friday. There is no call on this rotation and each intern will have one weekend day off.

Hematologic Malignancy Team: This team cares for patients with acute leukemia and high-grade lymphomas. It is composed of 1 resident, a Heme-Onc Fellow and nurse practitioner. No overnight call with at least one weekend day off per week.

Night Rotations

VA Night Float Resident: The VA float is a two week rotation for PGY-2 and PGY-3 residents. The two residents on this rotation are responsible for admitting any patient admitted to the Internal Medicine ward services or the ICU/CCU at VAMC after 7:30 p.m. Sunday through Thursday. The Ward Float Resident does not work weekends.

MT Night: This team is composed of 2 residents and 2 interns and is responsible for caring for patients admitted at night. They arrive at 7 PM to get check-out from the day team and the attending and also receive feedback about the patients they admitted the night prior. The following morning, they hand-off their patients to the day teams at our supervised sign-in rounds. The team works Sun-Thursday and has weekends off.

Unit Team Structure

UK CCU: The UK CCU is divided into two teams with an attending, fellow and two residents on each team. Call is every fourth night. Our division of cardiology is quickly becoming one of the pre-eminent cardiac care centers in the country so you will have the opportunity to practice cutting-edge medicine.

UK ICU: The UK ICU is divided into two teams with an attending, fellow and three residents on each team. There are two residents in the hospital each night; an ICU float resident plus a resident from one of the two teams. During the month, each of the six residents will be the ICU float resident for five consecutive nights and will have five nights of in-house call. This remains one of our most-popular and highly rated rotations as it is an excellent learning experience.

VA ICU/CCU: The VA ICU/CCU is a two week rotation for one intern and resident in a combined unit. The resident and intern are supervised by both a Cardiology fellow and attending and a Pulmonary fellow and attending. The intern and resident work six 12-hour shifts each week and have one weekend day off.

Off-Site Rotations

Morehead St. Claire Regional Medical Center: Each intern is assigned one month at the St Claire Medical Center, Morehead, KY. The interns are supervised by an excellent group of general internists who are interested in teaching. Interns do 14-16 12 hour shifts per month and round on their patients with the supervising attending. Morehead is located approximately one hour east of Lexington on I-64. This very popular rotation offers interns a true feel for the practice of medicine in a rural setting.

Other Off-site Rotations: The second and third-year primary care residents spend one month at one of the other affiliated practices with one or more general internists. Practices where our residents have rotated recently are located in Morehead, Berea (35 minutes south of Lexington on I-75), Mt. Sterling (40 minutes east on I-64) and London (1 hour south of Lexington on I-75).

Subspecialty Consult Rotations

The following consult rotations are available for our residents to choose: Allergy-Immunology, Cardiology, Gastroenterology, Nephrology, Infectious Diseases, Rheumatology, Endocrinology, Hematology/Oncology, General Internal Medicine, Pulmonary and Dermatology. Each resident will have weekend days off.

Ambulatory Care

Ambulatory care training has become an increasingly important aspect of Internal Medicine training. The shift in Internal Medicine from the hospital to the ambulatory setting (and now for those interested in being hospitalists, back to the hospital) requires a balance in training between the hospital and the clinic.

In addition, the program has a dedicated one to three month Ambulatory Care Block rotation, all of which is spent in the outpatient setting. During this time you may select a variety of outpatient medicine experiences including: Pre-op Clinic, Call-in Clinic, Endocrinology, Allergy/Immunology, Geriatrics, Pulmonary, Cardiology, Nephrology, Rheumatology, Hematology/Oncology, Dermatology, Gastroenterology and Infectious Diseases. A number of non-medicine clinical experiences are also utilized, such as ENT, Rehabilitation Medicine, Orthopedics, Sports Medicine, Ophthalmology, Neurology, Psychiatry, Adolescent Medicine, Radiology and other clinical skills training. Each day consists of two half-day clinics with one half-day off each week for self study. You have weekends off and no scheduled call.

Continuity Clinic

Each intern is assigned a primary care continuity clinic at UK Internal Medicine. Primary care practices are staffed by faculty from the Division of General Medicine. In the second and third years of training, residents have two sessions of continuity clinic each week. This provides a wonderful opportunity to develop long standing relationships with their patients and attending.  Residents work with the same attending through all years of training.

The total outpatient experience for residents over the three years is:

Emergency Department

Each second-year resident will complete one month of ED training in our Level 1 Trauma Center under the direction of the attendings from the Department of Emergency Medicine. During this month you will act as the primary physician caring for patients with gynecologic, surgical, pediatric, psychiatric and medical emergencies. You will work approximately 15-17 shifts per month.

Neurology

First-year residents will spend one month on a Neurology team under the direction of attendings from the Department of Neurology. During this month you will learn about many common neurological problems which are often seen by Internal Medicine physicians. You also spend one half-day per week on the ambulatory care rotation in Neurology clinic to gain more experience in the care of patients with neurological problems.

Electives

During an elective month a resident may arrange for a special experience or to enhance particular clinical skills. Examples in the past have included reading ECGs and echocardiogram interpretation, performing exercise stress tests, endoscopy and reading abdominal and chests films in Radiology.

One may spend up to three elective months performing research. All rotations must be approved in advance by the Program Director. For those wishing to conduct research, consult months can be substituted for research months. This is arranged on an individual basis.