Internal Medicine

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Areas of Rotation

The general medicine service at each hospital consists of two teams, each of which is made up of one attending, one senior resident, two interns, and 3rd and 4th year medical students. The teams alternate call every other day, with each intern on call every fourth day. The night float resident covers five nights per week.  The weekend coverage is split between the wards seniors and the day float resident.
 
Prisma Health Richland/Dorn VA Wards Services
Admissions are triaged by the hospitalist service and distributed to the different resident services.  The team accepts admissions primarily from the Emergency Department but does also have responsibility for direct admissions and transfers from outside hospitals at times.  The on-call wards team functions as the code team as well. For each call day, the intern is limited to five new patient evaluations. Typically, this is made up of three daytime admissions and two nighttime admissions by the night float resident.  In addition, the senior resident may take up to two consults per call shift.  A senior resident is limited to a maximum of twenty patients on his or her service.  The intern can be primarily responsible for up to ten patients at a time.
 
Night Float
The night float is a PGY 2 or PGY 3 resident. The night float takes new admissions from 9 p.m. to 6 a.m. (Monday through Friday) and then attends morning report. Prior to morning report, the night float meets with the night float attending to review admissions and have dedicated education time.  On Saturday mornings, night float is responsible for rounding on one of the off-interns patients.
 
MICU
The MICU rotation takes place at Prisma Health Richland Hospital. The MICU team for the month consists of three senior residents, four interns, and 3rd and 4th year medical students. The senior residents come from both the Internal Medicine department and the Emergency Medicine department. The interns come from Internal Medicine, Emergency Medicine, and Family Medicine. The team is responsible for patients in the 14 bed Medical Intensive Care Unit as well as any medical patients in the Surgical Intensive Care Unit. Admissions come primarily from the Emergency Department but can also consist of outside hospital transfers and rapid responses from the general medical wards as well. Each intern attends a two-day seminar on the Fundamentals of Critical Care in the Spring to prepare them to be a senior resident in the MICU.

Our critical care rotation is one of the greatest strengths of our program. Attending involvement, bedside ultrasound rounds, resident autonomy, opportunity to perform procedures, and a multidisciplinary approach set us apart! During the rotation, there is 24-hour critical care fellow support to assist with rounds, management plans and procedures. Department head, Dr. William Owens designed an educational website for our residents which highlights the rotation responsibilities and key learning objectives. Click here to browse the website:  http://www.medicalicu.com/
 
Electives
During elective blocks, residents have the opportunity to rotate through various medical subspecialties. These include: cardiology, geriatrics, infectious disease, rheumatology, nephrology, gastroenterology, hematology/oncology, ultrasound, endocrinology, pulmonology, dermatology, allergy/immunology, wilderness medicine, palliative care, neurology, sports medicine, and research. Below are brief descriptions of unique components of the core electives. 
 
Cardiology 
At Prisma Health–Midlands, you will receive excellent training in cardiology. Residents train in a free-standing heart hospital with experienced faculty and cardiology fellows. The cardiology block provides an excellent mix of didactics and hands on clinical experience in core cardiology, as well as exposure to cardiology subspecialties including interventional cardiology, advanced heart failure, and electrophysiology.
 
Infectious Disease 
Infectious disease is one of the most valuable rotations during our training. The Immunology Center’s Ryan White clinic is the largest HIV/AIDS clinic in the region with approximately 25 new HIV infected patients every month. At this site, more than 1400 HIV infected patients are currently enrolled in the Ryan White program. The clinic is staffed by the Ryan White administration with social services, compliance/adherence support, and mental health and substance abuse services on-site. It also has a dedicated HIV-in-pregnancy clinic and serves a diverse community of many ethnic and social backgrounds. In addition to Ryan White services, the Immunology Center also provides a location to see ambulatory infectious disease consults. We are the largest outpatient infectious disease practice in the region. We have a busy practice with a wealth of referrals from the community as well as follow-up patients from the inpatient consultation service. 
 
While on the infectious disease elective, residents will also have the opportunity to work with the Antimicrobial Stewardship Team. Residents will gain practical experience and understanding in the utility of hospital formularies and antimicrobial stewardship; understand the process in the appropriate selection, dosing, route and administration of antimicrobial agents; gain an appreciation for the financial impact of hospital formularies; and understand the practical aspects of the balance between limiting antimicrobial overuse and the need to provide prompt, adequate antimicrobial therapy.   
 
Geriatrics 
During your geriatric rotation, you will have the opportunity to enjoy one on one training with our amazing faculty and fellows. Inpatient time is spent in the region’s only acute care of the elderly (ACE) unit. Outpatient experiences include time in the mobility clinic, Senior Primary Care Clinic, and Palmetto Senior Care’s adult health day centers.  Palmetto Health’s geriatric fellowship is the only training program in the state.   
 
Since its inception in 1997, the Geriatrics Fellowship program at Prisma Health–Midlands /USC School of Medicine has graduated more than 30 physicians who now practice in a wide variety of settings. The program has been accredited “with commendation” by the RRC. With the aging of the population, the opportunities in the field of geriatrics will only expand over time. The fellowship program and the Division of Geriatrics are recognized as one of the top programs in the nation with recognition from the Donald W. Reynolds Foundation, the Hartford Foundation and the Geriatric Education Center funded by HRSA. 
 
Rheumatology
This is a favorite of every resident who rotates through.  It is primarily an outpatient-based rotation with some hospital consult work as well.  Comprehensive rheumatology lectures occur each morning with the teaching attending.  Our program has recently been expanded to include a focus on musculoskeletal ultrasound to augment clinical practice.

Ultrasound
Prisma Health–Midlands and USC School of Medicine Columbia are a leading institutions for training in point-of-care ultrasonography. Internal medicine residents have the option of completing a dedicated ultrasound elective, where they will be exposed numerous skills in image acquisition and interpretation. Additionally, residents can utilize the USC School of Medicine Ultrasound Institute ultrasound simulations and standardized patients. Finally, residents have the opportunity to improve their ultrasound skills by rounding alongside the internal medicine and emergency medicine ultrasound fellows.