Rotations

Casey White, MD, resident; Kelly Berchou, MD; Erin Conway, MD.

Faculty members Kelly Berchou, MD (center) and Erin Conway, MD (right) in simulation training facility with resident Casey White, MD.

Your core rotations give you a thorough grounding in the full spectrum of treating conditions germane to practicing internal medicine.

Rotations take place at a variety of sites, giving you opportunities to work in multiple settings with distinct patient bases and documentation systems.

Ambulatory Week

Also known as the +1 in our innovative and progressive 4+1 schedule.  This week you will be at your continuity ambulatory site for the whole week without call or other interruptions.  You will see your continuity patients, urgent ambulatory patients, and patients following up from recent hospitalizations.  You will also work on quality improvement and patient safety projects related to your site.  This week is an intensive education in ambulatory medicine and an easier schedule than the hospital weeks.  As a PGY2 and 3 you also learn how to take ambulatory call for your practice. 

Acute Leukemia and Lymphoma Service

Location: Roswell Park Comprehensive Cancer Center

Your rotation at Roswell Park gives you key experience with medical oncology, supervised by specialist faculty. You will learn to care for both inpatients and outpatients with a wide variety of diagnoses, including malignant hematologic diseases and solid tumors. You will conduct targeted physical examinations and take patient medical histories, order appropriate laboratory tests and interpret data, manage patients with chemotherapy, and address the complications of these treatments. In addition, you will get experience with ancillary methods of care, including radiation oncology and surgical oncology.

Cardiology

Location: Buffalo General Medical Center

In this rotation, you will gain experience managing a broad range of cardiac diseases under the supervision of a cardiology attending. To supplement your hands-on clinical experience, you may spend variable amounts of time on electrocardiogram (ECG) interpretation, echocardiography interpretation with emphasis on basic cardiac anatomy, physiology and pathophysiological correlation. Cardiology faculty will supervise your care of patients with primary cardiac problems, including STEMI, NSTEMI, heart failure and CAD. You will work with some patients in the Coronary Care Unit and others on a step-down unit.

Community Practice

Location: Medicore Associates of Chautauqua

During this rotation, you will participate in a wide range of procedures and gain experience managing complex patients in settings where consults with specialists are not readily available. The clinic where this rotation takes place is Medicore Associates in Fredonia, NY, a rural community.

Emergency Medicine

Location: Buffalo General Medical CenterErie County Medical Center

In this second-year rotation, you will work with a wide variety of undifferentiated patients at one of several fast-paced hospital emergency rooms. You will evaluate acute complaints, generate appropriate differential diagnoses, and initiate appropriate management for these patients under the supervision of emergency medicine faculty. You will participate in resuscitating patients from the field and become adept at performing quick, focused patient histories and physical examinations in order to ensure that each patient receives optimal immediate and follow-up care.

Geriatrics

Location: Buffalo VA Medical Center and Erie County Medical Center

This second-year rotation familiarizes you with the distinct challenges and resources relevant to caring for older populations. You will work with patients who have very heterogeneous levels of physiologic function, health statuses, belief systems, values and personal preferences. Diagnoses include those specific to geriatric patients, such as delirium and dementia, as well as conditions common across patient populations, many of which present distinct symptoms and unique concerns with elderly patients. You will learn how to balance observing patients carefully, making judicious diagnostic interventions and accepting limits your patients define, and how to help aging patients maintain functional independence. You will work closely with nutritionists, social workers, hospice staff and other professionals to coordinate interdisciplinary care, a key component of managing these patients’ health.

Inpatient Medicine

Location: Buffalo General Medical CenterErie County Medical CenterBuffalo VA Medical Center and Roswell Park Comprehensive Cancer Center

You will have opportunities to rotate on inpatient services in all our affiliated hospital systems over the course of your residency, gaining expertise in managing a variety of patient bases and working with multiple professional environments and electronic health records systems. Your inpatient rotations will give you responsibility for supervising the admission processes for new patients, maintaining progress notes and patient records, communicating patient care issues among members of your work team (including faculty attendings), presenting cases and mortality reviews, and teaching medical students and, in your later years, junior residents.

Internal Medicine Consultation

Location: Buffalo General Medical Center

In your third year, you will provide consultations to other specialties, including making preoperative evaluations and perioperative management recommendations. You will develop essential skills to provide effective and timely consultation, interact with other consultants, and document consultative interactions appropriately. You will learn to assess the level at which you should be involved in the care of patients and to communicate with referring physicians to educate and support them with patient care. These experiences draw and build on skills developed throughout your residency in your ambulatory and inpatient experiences.

Medical Intensive Care

Location: Buffalo General Medical Center and Buffalo VA Medical Center

Your MICU rotations give you experience treating patients with a full range of cardiac, pulmonary, renal, endocrine and neurological disorders, as well as infectious diseases and cases of poisoning and overdose. You will take comprehensive medical histories and physical examinations for patients with these conditions, and learn to counsel patients and their families effectively regarding pathophysiology, treatment options and prognosis. Many intensive care patients are at particular risk for iatrogenic complications such as decubitus ulcers and hospital-acquired infections, and you will gain skills to assess these risks and act proactively to reduce them.

Neurology

Location: Buffalo General Medical Center

Your required neurology rotation helps you develop core neurological evaluation skills, including taking histories, conducting physical examinations, and performing accurate and thorough neurologic exams. You will see patients with a variety of conditions, including acute ischemic stroke, acute hemorrhagic stroke, status epilepticus and brain tumors, for new admissions and follow-up care, including post-discharge follow-up planning where appropriate. When necessary, you will anticipate patients’ needs in a complex health system and guide them appropriately by collaborating with professionals in occupational therapy, physical therapy, speech therapy, acute rehabilitation, long-term care placement facilities, and so on.

Palliative Medicine

Location: Buffalo VA Medical Center and Roswell Park Comprehensive Cancer Center

In this rotation, you learn to propose and defend comfort care for patients when cure is no longer a rational goal in settings including hospital consultation services and hospice home care. You will evaluate and treat symptoms common in terminally ill patients, focusing on how physical, psychological, social and spiritual factors affect suffering. In addition, you will gain an understanding of the neuroanatomy and physiology of different pain mechanisms and how to honor medical decisions that are guided by patients’ philosophies and values.

Specialty Blocks

These blocks expand your education in the ambulatory experience of Rheumatology, Pain Medicine, Sports Medicine, Dermatology, Gynecology and Pre-operative evaluation.