Subspecialty Rotations
The General Internal Medicine Division forms the foundation for the Internal Medicine program. It is the largest division, consisting of over 70 active, board-certified general internists, many of whom hold affiliate academic professorships with Penn State College of Medicine. These physicians serve as teaching attendings for the three General Internal Medicine inpatient services and for our resident and private practice outpatient services. In addition, LVH offers three fellowships:
- Cardiology (based solely at Lehigh Valley Hospital)
- Pulmonary / Critical Care (affiliated with Penn State / Hershey Campus)
- Hematology / Oncology (affiliated with Penn State / Hershey Campus)
There is a strong and genuine commitment to resident education, as exemplified by the large number of private practice community-based physicians who volunteer their time and effort in the residents' continuity clinics and other ambulatory sites. Residents work closely with the general internists in continuity practices, ambulatory rotations, and in the hospital.
The residents are exposed to different types of "hospitalist" models of practice during their inpatient rotations. They are trained to practice cost-effective and evidenced-based medicine so that they are prepared to provide competitive, high-quality "primary care" in any health care environment, including managed care. The residents develop sustained and meaningful relationships with the practicing community internists and a number of the graduates of our program often choose to practice in the Lehigh Valley area along with their previous mentors.
Recognizing the need to better prepare our residents for outpatient primary care, the General Internal Medicine Division has expanded the ambulatory exposure to include more varied exposure to all the subspecialties. There is also a Preoperative Consultation clinic where residents learn how to provide appropriate consultations.
A divisional philosophy is also involvement of the residents in the various general internal medicine research activities that emphasize disease prevention, clinical trials, and community health. The residents are more easily able to get "hands on" experience in doing research working along with study coordinators, biostatisticians, and physician researchers. They are given opportunities to submit abstracts and papers for publication and presentation in scientific forums through the country.
The General Internal Medicine teaching services offer a balanced, high-quality experience in both outpatient primary care and inpatient secondary care settings. The residents are exposed to patients, problems, and research activities, under the guidance of committed, well qualified general internists.
SUBSPECIALTY ROTATIONS
Allergy
The focus of this rotation is one-on-one teaching in a hospital clinic and in the private physician office.
The Division of Allergy consists of board-certified allergist-immunologists who treat patients with bronchial asthma, sinusitis, allergic rhinitis, urticaria,and drug, food, and insect hypersensitivity. Special procedures which the resident may learn include: methacholine challenges, penicillin and aspirin desensitization, nasal endoscopy and laryngoscopy.
Ambulatory Care
The Ambulatory Care experience is extensive and interwoven throughout all aspects of the Internal Medicine program. It accounts for 40 percent of the overall residency training program. Throughout their residency, residents spend 30 one-week blocks in their continuity clinic, totaling approximately 180 continuity clinic sessions (session = 1/2 day). Residents develop a panel of patients that they are responsible for throughout their entire residency. During their other ambulatory time (90 sessions / 3 years) there are structured experiences in allergy, immunology, ophthalmology, sexually transmitted disease, walk-in clinic, sports medicine, GYN, rehabilitation, college health clinic, rheumatology, occupational medicine, pre-operative clinic and an extensive HIV experience. In addition, as senior residents, exposures to private Internist practice occurs in addition to any ambulatory Medicine subspecialty desired.
In addition to these ambulatory blocks, ambulatory care is emphasized in all other residency experiences. While on various subspecialty rotations, the resident spends extensive time in outpatient settings in either a clinical or private office setting. While on the outpatient services, PGY-2 and 3 residents spend one-half day in a private office setting of the attending physician with whom they are working.
Cardiology
The Cardiology Division is comprised of two groups, Lehigh Valley Heart Specialists (LVHS) and the Heart Care Group (HCG). The services provided include cardiac catheterization; electrophysiology studies; stress testing and echocardiography; ambulatory electrocardiography; and inpatient, outpatient and unmonitored cardiac rehabilitation.
The hospital operates one of the largest invasive cardiology programs in Pennsylvania, performing a great number of procedures annually. Services include: diagnostic catheterization; transluminal angioplasty; balloon valvuloplasty; endomyocardial biopsy; carotid artery stenting; and directional coronary atherectomy.
Within the electrophysiology laboratory, physicians perform modern diagnostic and therapeutic modalities including baseline electrophysiology studies; radiofrequency ablation; and cryoablative therapies.
A full range of non-invasive procedures is also performed by hospital cardiologists. These include routine exercise testing, nuclear exercise studies and exercise echocardiography; nuclear cardiac testing; ambulatory Holter monitoring; 2-D and M-Mode echocardiography, color Doppler and contrast; transesophageal echocardiography; and pacemaker follow-up services.
The clinical cardiology teaching service consists of a one-month rotation in the Acute Coronary Care Unit where first-year, junior and senior residents learn to evaluate and manage critically ill cardiac patients and perform invasive bedside procedures. This experience exposes the resident to invasive hemodynamic monitoring; temporary transvenous pacemakers; interpreting electrocardiograms and identifying rhythm disturbances; echocardiography; diagnostic and interventional cardiac catheterization; cardiac radiography; and the initial stages of cardiac rehabilitation in acute MI patients.
A cardiology subspecialty rotation is a tutorial program designed to provide the junior and senior resident with a general introduction to clinical cardiology. During this rotation, residents will develop skills to diagnose and treat cardiac patients in inpatient and ambulatory settings. Exposure is gained to various testing modalities including: electrocardiography; exercise treadmills; echocardiography; cardiac catheterization; and cardiac radiography. In addition, the rotation provides exposure to cardiac physiology, including indications and results of right heart catheterization. Residents in this elective receive tutorial training from teaching attendings in the Section of Cardiology. The core clinical learning opportunities come through inpatient cardiology consultations, experience in the cardiology clinic, private offices and performance of ER consultations.
Critical Care Medicine
The Lehigh Valley Hospital has extensive Critical Care facilities. These include the following critical Care Units: Coronary, CNS-Trauma, Surgical and Medical. In addition, there are several step down units that provide intermediate intensive care nursing and monitoring.
Transitional and Internal Medicince residents and interns rotate through the Medical Intensive Care Unit. Categorical Internal Medicine residents also rotate through the Acute Coronary Unit (ACU) while Transitional Residents rotate through the Surgical Unit (SICU). These comprehensive rotations provide interns and residents first hand clinical and academic experiences such as fluid resuscitation, hemodynamics, ventilator support, post operative care and the diagnosis and treatment of various shock states.
The Medical Intensive Care Unit is staffed by intensivists. Residents work closely with the intensivists, other attendings and subspecialty physicians to provide treatment for a broad array of illnesses. In addition, a strong telemedicine program compliments the experience with cameras in every critical care bed and full time intensivist support around the clock. Residents receive extensive didactic and clinical experience from daily teaching attending rounds. An extensive critical care syllabus and conference schedule complete this rotation.
The Medical Intensive Care Unit is staffed by intensivists. Residents work closely with the intensivists, other attendings and subspecialty physicians to provide treatment for a broad array of illnesses. In addition, a strong telemedicine program compliments the experience with cameras in every critical care bed and full time intensivist support around the clock. Residents receive extensive didactic and clinical experience from daily teaching attending rounds. An extensive critical care syllabus and conference schedule complete this rotation.
Dermatology
The rotation in the Dermatology Division offers the resident the opportunity for exposure to diagnosis and treatment of skin diseases as well as laser surgery techniques, dermabrasion, collagen injections, chemical peels and minor surgery. The service is staffed by board-certified dermatologists who provide one-on-one teaching experiences which are the major strengths of this rotation. In addition to experience in the office setting, residents may care for patients in the outpatient dermatology clinics at the hospital and provide inpatient consultations as well.
Endocrinology
The rotation in endocrinology includes exposure to both inpatient, consultative services and to an outpatient endocrine clinic. Inpatient consultations and patient rounds are done daily to develop the resident's skills in evaluation and management of endocrine problems in the hospital setting.In the endocrine clinic, held one half-day per week, the resident sees ambulatory patients with a broad spectrum of endocrine diseases. The resident is also exposed to an outpatient endocrine testing lab and to an outpatient Diabetes Education Center. Case discussions and didactic reviews are held with the resident on a daily basis at which time pathophysiology and management of endocrine disorders are discussed in detail. The opportunity for involvement in clinical research, if desired, is available.
Gastroenterology
The Division of Gastroenterology provides comprehensive services in the evaluation of gastrointestinal and hepatobiliary diseases, including diagnostic and therapeutic endoscopy of the upper and lower GI tract and pancreatic-biliary systems. Strong ancillary services in radiology, pathology and the clinical laboratory provide a balanced approach to the management of GI patients.The GI lab at each hospital site is well-equipped with a complete array of panendoscopy as well as the Nd:YAG laser, and esophageal and anorectal manometry instruments. Medical residents rotate through the GI service in their PGY-2 or PGY-3 year. The resident is an integral part of the consultation service under the supervision of the teaching attending. Ambulatory experience in primary GI is provided by half-day rotations in the GI Clinic and in the teaching attending's private office. Residents are encouraged to observe endoscopic procedures relevant to their patients and to acquire experience and skill in the performance of flexible sigmoidoscopy.
Geriatrics
The Division of Geriatrics offers a clinical rotation for medical residents and students which includes opportunities to observe and manage elderly patients suffering a wide range of medical problems. This experience includes inpatient and outpatient care. The hospital's geriatrics division is a multifaceted community program which consists of consultative services, clinical care, and clinical, patient and community education.Rotating residents are responsible for providing primary care and consultations for patients in acute, ambulatory, community, and long-term care settings. The goal of this experience is to understand the interaction of natural aging and disease, as well as to learn assessment techniques, therapies and patient management.
The rotation emphasizes the physiology of aging, the pathophysiology associated with diseases, functional assessment, and the treatment and management of acute and chronic patients in the hospital, nursing homes, the community and at home. Finally, the resident learns the behavioral aspects of illnesses, socioeconomic factors and ethical and legal considerations that are essential to the care of the elderly.
Hematology/Medical Oncology
The Hematology/Oncology Division offers exposure in medical oncology and hematology which emphasizes consultation services in the hospital and office, interdisciplinary patient care rounds, participation in several tumor boards weekly, and includes treatment planning rounds in radiation oncology, experience in breast imaging, and a hematopathology conference twice monthly.The resident sees new patient consultations in the hospital and office under the supervision of the attending physician and prepares a written consultation report. Interdisciplinary practice rounds occur twice weekly with the rounding and attending oncologists together with members of the cancer support team. Tumor boards are scheduled several times weekly and over the month will include conferences in pulmonary, urologic, colorectal, and breast cancer, as well as a weekly general conference at which time a variety of hematologic, head and neck, endocrine, and soft tissue neoplasms are presented.
Treatment planning rounds in radiation oncology are scheduled weekly and provide the resident with a detailed exposure to both the clinical and technical approach to treatment planning for the patient receiving radiation. The resident spends a half day or more if interested with the breast imaging service reviewing both screening and diagnostic mammograms and observing image guided approaches to breast biopsy. Twice monthly interesting hematopathology cases are presented by the Department of Pathology. The resident presents at least one new patient weekly either at the interdisciplinary patient care rounds or an appropriate tumor conference.
Infectious Diseases
The Infectious Diseases rotation provides experience caring for general medical and surgical patients, as well as subspecialty and pediatric patients. The service consists of physicians, all board-certified in infectious diseases. Daily consultation teaching rounds are held in various critical care units, including Shock/Trauma, General Intensive Care, Acute Coronary Care, Central Nervous System and the Burn Center. The clinical teaching in infectious diseases is supported by a comprehensive syllabus that includes microbiology rounds at the micro lab, online modules and resources, pre/post testing and participation in an ID focused Journal club.Nephrology
A large teaching faculty in the Division of Nephrology offers residents in-depth exposure to the many presentations of renal disease. The physicians provide diagnostic consultation and treatment management of medical and surgical critical care patients requiring acute hemodialysis and continuous arteriovenous hemofiltration.In addition, the service includes a large number of end-stage renal-disease patients who have undergone kidney transplants, or who are maintained on outpatient hemodialysis or continuous ambulatory peritoneal dialysis. Residents on rotation in Nephrology receive broad experience in the care of acute renal disease patients and gain an understanding of the basics of patient management, water and electrolyte balance and acid-base disturbances. Emphasis is also placed on clinical nutrition, metabolism and the psychosocial aspects of acute and chronic illness. In cooperation with the inpatient acute hemodialysis unit, a hospital pathologist currently operates an active therapeutic aphoresis program. The Division of Nephrology also plays a vital role in the hospital's kidney transplant program which started in the spring of 1991.
Neurology
During the neurology rotation, residents care for patients with a wide variety of neurologic disorders under the supervision of the teaching attendings in primary, consultative and outpatient settings.The neurology division supports and staffs the following centers - The Headache Center, Multiple Sclerosis Center, and Sleep Disorder Center. Experience at these centers may be incorporated into the resident's rotation. The clinical experience is solidified through attendance at the bimonthly neuropathology conference and through exposure to neuroradiologic procedures such as EEG, EMG/NCV and MRI. Residents can also participate in a variety of clinical research projects within the division to include the fields of stroke , MS, epilepsy, Alzheimer disease, and movement disorders. A number of national and local trials are currently underway which include ATLANTIC and ANCROD, both for the treatment of stroke; ACAS (Acute coronary artery stenosis) and NASCET (symptoms of stroke/TIA).
Pulmonary Diseases
Rotation through the Division of Pulmonary Medicine provides residents with the opportunity to learn the diagnosis and treatment of a wide spectrum of respiratory diseases. The section's certified pulmonary intensivists provide comprehensive pulmonary and critical care consultative services to both hospitalized and ambulatory patients.The pulmonary teaching service also provides an opportunity for learning about the pulmonary laboratory and respiratory therapy including the interpretation of pulmonary function tests and arterial blood gases. The resident also develops ventilator management skills. This rotation also offers the opportunity to learn the evaluation and treatment of sleep disorders in the hospital's modern sleep laboratory. In addition to hospital-based services, the resident can assist in patient care in the pulmonologists' private offices.
