Internal Medicine - Education

Program Overview

The Department of Internal Medicine at the University of Kentucky offers four 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. We have sixteen categorical positions each year.

Primary Care - 3 years

The Primary Care track is geared towards those who are interested in primary care medicine. Our track is focused on ambulatory care, with three months each year dedicated to outpatient general internal medicine and internal medicine subspecialty clinics.  In addition, residents have a yearly off-site rural rotation, which provides experiences in community primary care.  Last, residents in this track spend time helping in our student-run Salvation Army Clinic [https://sites.google.com/site/uksastudentclinic/home], working with vulnerable underserved populations.  There are six primary care positions in each year of this program.

For more details about our primary track and for a description of some of the track specific rotations, please go to our Primary Care Residency program website [http://www.mc.uky.edu/primarycareresidency/].

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 six 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 four ward months (no night call), night float, ICU, subspecialty consults, electives, and vacation. There are two preliminary positions each year.

Rotational Structure

UK- Chandler Inpatient Ward Team

The general medicine ward structure at UK-Chandler consists of three resident teams and one hospitalist teams.  The resident teams each consist of one attending, two upper-level residents, two interns and two to three 3rd year medical students.  Within each team, one upper-level resident and one intern forms a dyad which work together on most days.  Teams cycle through a schedule, working a night shift every sixth night.  Our schedule was designed to maintain the physician-patient relationship and maintain the educational value of admitting and following the same patients.  Our teams have a maximum census of 14 patients to ensure an ideal balance of resident education and patient care experience.  At night, an intern working a night float block helps provide cross-coverage to admitted internal medicine patients.

UK- Good Samaritan Inpatient Ward Team

The general medicine ward structure has two resident teams and three hospitalist only teams.  The 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. This seems the perfect environment for our residents to truly function as hospitalists during residency.  We have two resident teams each consisting of an attending, two upper-level residents and two to three 3^rd year medical students.  The residents work side-by-side with their attending in a more informal atmosphere and direct patient care responsibility.  Residents rotate a series of late shifts, working until 8pm, but hospitalists admit patients throughout the night.

VAMC Inpatient Ward Team

The general medicine ward structure consists of three resident teams and two hospitalist only teams.  Like most VA hospitals, this rotation provides a strong experience with “bread-and-butter” Internal Medicine—heart failure, COPD exacerbations, acute coronary syndromes, renal failure and the like. The ward structure has one attending, one resident, two interns, and two students on each team.   An additional upper-level resident works night shifts, supervising interns on admissions and cross-cover overnight.

UK-Chandler Hematology/BMT Ward Team

This team cares for patients with a wide variety of hematologic problems, including acute leukemia and high-grade lymphomas. All of our interns rotate on this team, working with a Hematology attending physician, a Hem-Onc Fellow and several nurse practitioners. Interns do not have overnight call responsibilities.

UK-Chandler Coronary Care Unit

The UK CCU has a single team consisting of an attending, fellow and four residents.  Residents rotate blocks of night shifts to admit and cross-cover patients overnight.   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-Chandler Medical Intensive Care Unit

The MICU is divided into two teams with an attending, fellow and three residents on each team during the first six months of the year.  During the last six months of the year, each team consists of an attending, a fellow, two upper-level residents and two interns.  This provides an excellent intensive care unit experience to our interns when they are prepared for the severity and intensity of care.  There are two residents in the hospital each night, with a resident from each team working a block of night shifts. This remains one of our most-popular and highly rated rotations as it is an excellent learning experience.

Subspecialty Services

Residents rotating on our subspecialty services have their time divided between inpatient consults and ambulatory clinics.  Each resident spends at least half of their rotation in the ambulatory clinics to ensure exposure to the broad subspecialty patient population.  Every categorical resident rotates on the following core subspecialty services:

• Cardiology
• Endocrinology
• Gastroenterology
• Infectious Disease
• Nephrology
• Oncology
• Pulmonology
• Rheumatology

Electives

For the elective months, residents have several options.

·       Additional rotations in the core subspecialties listed above

·         Non-core subspecialty rotation

o   Allergy-Immunology

o   Dermatology

o   Hematology & VAMC Consults

o   Hospice & Palliative Medicine

·         Other specialty rotations

o   Ophthalmology

o   Orthopedics/Sports Medicine

o   Otolaryngology

o   Physical Medicine & Rehabilitation

o   Psychiatry

·         Research rotation

·         Focused Procedure rotation

·         Hospitalist rotation

·         Resident-designed month consisting of any combination of didactic, research and clinical experiences.

Off-Site Rotations

St. Claire Regional Medical Center: Each intern is assigned one month at the St Claire Medical Center in Morehead, KY. The interns are supervised by an excellent group of general internists who are interested in teaching. Interns do 14-16 twelve 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.

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 to ensure great mentorship from our core faculty members.

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. The month is divided between the general neurology service and our nationally recognized stroke service.

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 16-20 shifts per month.