Internal Medicine Residency

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, LVHN offers three fellowships:

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. Internal Medicine residents spend 10 weeks (6 half day sessions per week) in their continuity clinic at the Lehigh Valley Physician Practice. Residents develop a panel of patients that they are responsible for throughout their entire residency. The additional sessions during the ambulatory weeks provide the residents with a varied experience in the areas of: allergy, immunology, ophthalmology, sports medicine, gynecology, rehabilitation, occupational medicine, pre-operative clinic, internal medicine subspecialties along with a dedicated HIV experience within a focused practice. Transitional Year residents will spend a four week block rotating through various ambulatory settings, including internal medicine and family medicine.

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.

Cardiology

The Cardiology Division comprises 64 board-certified cardiologists, 39 of whom serve as faculty members. 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 5,400 procedures annually. Services include: diagnostic catheterization; transluminal angioplasty; balloon valvuloplasty; endomyocardial biopsy; and directional coronary atherectomy.

The clinical cardiology teaching service consists of a one-month rotation in the Coronary Intensive Care Unit where first-year, junior, senior residents and fellows learn to evaluate and manage critically ill cardiac patients and perform invasive bedside procedures. Dedicate attending teaching rounds occur daily from 9 a.m. to 12 p.m.

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.

The cardiology subspecialty elective 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. Residents are welcome, when their schedule allows, to participate in seven hours of weekly cardiology fellow conferences.

Critical Care Medicine

The Lehigh Valley Health Network has extensive Critical Care facilities. These include the following critical Care Units: Burn, Cardiac, Trauma, Neuroscience, Surgical and Medical. In addition, there are several step-down units that provide intermediate intensive care nursing and monitoring.

Transitional and Internal Medicine residents and interns rotate through the Coronary Care and Medical Intensive Care Unit. These comprehensive rotations provide interns and residents first hand clinical and learning experiences in the diagnosis and management of shock states, acute coronary syndromes, arrhythmias, ventilator support, and numerous other disease states.

The Medical Intensive Care Unit is staffed by intensive care physicians. Residents work closely with the intensivists and subspecialty physicians to provide treatment for a broad array of illnesses. Residents will have the opportunity to perform invasive procedures including central venous catheter placement. 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 division consists of eight members, all of whom have academic appointments and one institutionally based division chief. 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.

Residents will spend afternoons in a private outpatient endocrine office to gain exposure to general endocrinology with a focus on diabetes and thyroid disease. 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 is well-equipped with state of the art equipment. Upper endoscopy, colonoscopy, flexible sigmoidoscopy, ERCP, endoscopic ultrasound and capsule endoscopy are common procedures. Physiologic studies to evaluate esophageal and analrectal motility disorders are available. Wireless pH monitoring with Bravo is performed in selected patients.

Medical residents are offered an elective rotation on the gastroenterology consult inpatient service with 2 or 4 wk rotations. The resident is an integral part of the consultation service under the supervision of the teaching attending. Evidence based medicine is emphasized.

16 board certified gastroenterologists are members of the GI division. Each gastroenterologist has an active clinical practice and many members have decades of clinical experience.

Ambulatory experience in GI is provided by half-day rotations in the GI Clinic at the hospital. If additional exposure is desired, rotations to gain experience can be arranged at the teaching attending's private office.

The clinical experience is supplemented by participation in the tumor board meetings, IBD conference held monthly in conjunction with the surgical service and daily didactic teaching on rounds. Histopathology review with our pathology colleagues is available. Additional selected conferences are offered during the month of April for all residents. Residents are encouraged to observe endoscopic procedures relevant to their patients.

Geriatrics

The Division of Geriatrics offers a clinical rotation for medical residents and students which include 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 an elective in medical oncology and hematology which emphasizes consultation services in the hospital and office, interdisciplinary patient care rounds, and participation in weekly tumor boards.

The resident sees new patient consultations in the hospital and office under the supervision of the attending physician and prepares a written consultation report. Inpatient rounds occur each morning with the rounding oncologist, physician assistant, and hem/onc fellow. Tumor boards are scheduled several times weekly and over the month will include conferences in colorectal, urology, skin/soft tissue, pulmonary, endocrine and breast as well as a weekly general conference at which time a variety of hematologic, head and neck, and neoplasms are presented.
 
Weekly resident education sessions include: 1) Participation in Radiation Oncology treatment planning rounds which provide the resident with a detailed exposure to both the clinical and technical approach to treatment planning for the patient receiving radiation. 2) Participation in Hershey Grand Rounds lectures and discussion via videoconference. 3) Participation in case presentation/journal club. At this presentation the resident will present a case, summarizing and prioritizing the pertinent oncologic, hematologic, and medical problems, and, based on their reading and current literature, their recommended approach to management of the patient’s oncologic and/or hematologic problems. In addition, the resident will select and present a journal article during this session with relevance to the case (to coordinate selection with the hem/onc fellow). 4) Presentation in hematopathology case conference. The resident will present a case(s) selected by Dr. Cornfield. In addition to the weekly educational sessions, the resident will complete one half-day session in the blood bank, one half-day session in pathology, and two half-day sessions per week in office practice with an attending.

Infectious Diseases

The Infectious Diseases Division of the Lehigh Valley Health Network (LVHN)and the Lehigh Valley Practice Group (LVPG) is known as Lehigh Valley Infectious Diseases Services (LVIDS) and is the exclusive Infectious Diseases group in the Network providing 100% Infectious Diseases consultative services. The group is lead by Luther Rhodes M.D., F.A.C.P, F.I.D.S.A., FSHEAwho has been in practice since the late 1970’s and spearheads the various service line activities of the group including Infection Control, Antimicrobial Stewardship, Wound Healing, Travel Medicine and Research. There is an excellent wealth of experience and teaching abilities amongst the 12 ID physicians, who all participate in the teaching activities of LVIDS.
 
The Educational activities of the Division are robust and enhanced by 12 Infectious Diseases Board Certified consultants and six dedicated physician assistants. We have active case management rounds, weekly journal club, and microbiology rounds in addition to the diverse patient care activities of the division. There is opportunity to run the teaching service which pulls both “bread and butter” ID from all parts of the hospital and more interesting or unusual “zebra” cases. Patients come from all areas of the hospital including the Intensive Care Units, Trauma Unit, Burn Center, Hematology Oncology and solid organ transplants. Sophisticated electronic access to educational materials enhances the learning opportunities. There are also three full time board certified members of the Aids Activities Office (AAO) at the 17th street site who provide care in one of the largest HIV clinics in the state of Pennsylvania.

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 various modalities of renal replacement therapy including peritoneal dialysis, intermittent hemodialysis, CVVHD and apheresis are performed.
The Division of Nephrology also plays a vital role in the hospital's kidney and pancreatic transplant program.

Neurology

During the neurology rotation, residents care for patients with a wide variety of neurological disorders under the supervision of the teaching attendings in primary, consultative and outpatient settings.

The Neurology Division staffs the following centers - The Headache Center, Multiple Sclerosis Center, Neuromuscular Center, Epilepsy Center, and Cerebrovascular Disease Center. In addition, there is an active general neurology practice with additional concentrations of patients with movement disorders such as Parkinson’s disease and other degenerative disorders such as Alzheimer’s Disease. This all affords the resident the opportunity to view a wide range of neurological conditions in depth. The resident will observe various neurodiagnostic procedures from neuroradiological imaging to electroencephalography, electromyography, and nerve conduction studies. Required conferences include a case based core curriculum comprised of 12 lectures, and also held from September through June, monthly neuropathology conference, and weekly Neurology Grand Rounds.

Residents can also participate in a variety of clinical research projects in the Neuroscience Research section, discussed bi-monthly at the Neuroscience Research Conference. Studies have involved stroke prevention and acute care, MS, epilepsy, Alzheimer disease, headache, and movement disorders.

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 seven 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.

Rheumatology

Under the guidance of this division's six board-certified rheumatologists, this experience provides broad exposure to the diagnosis and management of rheumatic diseases, including systematic lupus erythematosis, vasculitis, severe rheumatism, back pain and mechanical knee derangements. Consultations in the hospital, private offices, and the LVPP medical clinic are also offered, along with exposure to the clinical laboratory.