Year One

All four of our interns begin the year together in medicine or pediatrics for their first 3-month block of rotations. Starting together allows our interns to stay in close contact with each other and to help each other with advice about hospital systems and specific rotations. Pediatric rotations in the first year are designed to provide a strong foundation that will allow experience in subspecialty areas in the later years. Our interns will participate in a variety of pediatric month-long clinical rotations.

The normal newborn and neonatal ICU rotations occur early and allow the intern to initiate ongoing care of patients evaluated shortly after birth. Key issues in the normal newborn rotation include prenatal care and effects, breastfeeding knowledge and support, safety/accident prevention/SIDS, growth, and many other topics. Supervision is by members of the General Academic Pediatric faculty. In contrast, the neonatal intensive care rotation emphasizes the care and stabilization of sick premature babies; neonatal resuscitation; and some of the chronic problems of premature infants, such as bronchopulmonary dysplasia and sequelae of asphyxia. The third month is a general pediatric ward rotation at Children's Hospital of Pittsburgh. This inpatient month focuses on managing children under 12 years of age, with a variety of medical problems.

The other three-month block rotation concentrates on inpatient care beginning with the emergency room at Children's Hospital. This is a very well-staffed and busy location. It offers experiences ranging from trauma to common pediatric illnesses. Here the intern will come in contact with pediatric, emergency, and family practice residents as well as fully trained emergency room pediatricians and pediatric subspecialists. Patients requiring inpatient care will be admitted to an inpatient unit or kept on a rapid treatment unit for about 24 hours. These latter locations are the "other month" rotations on this block. On the limited stay unit, supervision will be by a pediatric staff generalist. On general pediatric inpatient wards, two residents and four interns form a team. Experience will range from acute, self-limited illness to more serious and chronic disease in Pediatrics. Teamwork, regular conferences, teaching -- both for the intern and for medical students -- will be key parts of the rotation. Intern time is spent on an adolescent floor and an inpatient subspecialty service. Interns at the Children's Hospital of Pittsburgh take overnight call every 4th night.

The first adult medicine block in the intern year provides residents with basic skills in inpatient and outpatient medicine, which build the foundation for subsequent training. The block begins with inpatient medicine. This rotation provides the backbone and structure to the majority of later clinical learning. It provides the opportunity to present and discuss the pathophysiology, diagnosis, and therapies of various diseases and to understand the reasoning and decision-making processes behind various diagnostic and therapeutic options.

At UPMC Shadyside, teams generally consist of one PGY 1 and one PGY 2. Two interns are matched with PGY 3 or 4 residents. Two teams are assigned to an attending physician who is responsible for teaching rounds each month. Attending rounds are five days a week and alternate between "walk rounds," where the service of one team is reviewed at the bedside, and "sit-down rounds," during which a case is presented formally, followed by bedside examination of the patient. This year UPMC Shadyside has implemented a "Firms" system in order to concentrate teaching cases and to facilitate interaction with teaching attendings. Overnight call is every sixth night, and short call (daytime admitting duty) is alternated every other day.

The Medicine block continues with the Intensive Care Unit. The ICU rotation exposes the resident to the diagnosis and management of a variety of critical medical conditions. Residents are paired with interns in a one-in-four call system. The Medicine block ends with a second month of inpatient medicine.

Of the four inpatient medicine rotations in the first year, two occur at UPMC Shadyside , one at UPMC Presbyterian and one at VA Pittsburgh Healthcare System. At these latter sites, two interns are assigned to one resident and a hospitalist attending. Activities include daily work rounds or attending rounds six days a week. A night float system is in place at these facilities. Throughout the locations of inpatient training, interns are responsible for five to 10 patients and average one day off per week. The second Medicine block consists of two months of inpatient medicine and a one-month subspecialty elective.

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